Mpox vaccines roll out

Sex workers have been twice victimised, first by the virus and then by the stigma, but advocates hope the government will prioritise their safety

Kampala, Uganda | ESTHER NAKKAZI | When Brian Lubega, a 30-year old resident of Kawempe in Kampala, heard a radio announcement about mpox vaccine distribution in his area, he didn’t hesitate.

Lubega manages house rentals and works as a money lender, regularly interacting with many people in his part of the Ugandan capital. Concerned about his exposure, he made the decision to protect himself.

“I see people I know, especially boda-boda (motorcycle taxi) riders, infected. I use bodas all the time for travel, and I was afraid I’d catch the disease. So, when the chance came, I got vaccinated,” says Lubega.

Densely populated areas like Kawempe are hubs of activity, filled with informal settlements, small businesses and thriving markets. Amid all that daily bustle, the risk of disease transmission – which can occur via lesions in the skin, contaminated objects, respiratory particles, or through internal mucosal surfaces – is elevated. But Lubega, who received his first mpox shot in the first week of February, breathes easy.

In fact, Lubega was a couple of degrees removed from the epicentre of risk even before he received his shot. Dr Henry Kyobe, the National Incident Manager for mpox said viral transmission remains disproportionately concentrated among sex workers, who are very mobile, and their close contacts, who often include commuter taxi drivers, boda boda riders, and vendors. However, he pointed out that mpox transmission has not been restricted to any one portion of the social spectrum, and that cases have been recorded among individuals of “high socio-economic status”.

The Ministry of Health reported that, by 4 March 2025, 3,833 cases of mpox had been confirmed in Uganda, with 596 new cases in the past 14 days, and 34 cases in the prior 24 hours. Thirty-one people have died with the disease.

Epicentre of vulnerability

“Sex workers’ business is being spoiled,” said sex worker Chantel Mbabazi (not her real name). The absence of food support for mpox survivors and those infected is another major challenge, especially for those advised not to engage in sexual activity for at least three months after discharge, she reports.

Mbabazi is one of over 33,000 sex workers and marginalised individuals who make up the Alliance of Women Advocating for Change (AWAC). AWAC is a feminist umbrella network of 57 community-led organisations that advocate for a diverse range of socially at-risk women, including women in the sex trade, women who use drugs and others.

Macklean Kyomya, AWAC’s Executive Director, says mpox vaccines are badly needed in the population she represents – and for more than one reason. “The public points fingers at us: that we are the vectors carry on the mpox virus. There is a lot of stigma and cases are rising within our community,” she says.

The risk is real, in other words, even while blame is unjust. “The numbers (of mpox cases) are increasing,” says Dr Charles Okoth, a clinician with AWAC in an AWAC-produced educational and documentary video shared with VaccinesWork, “because of the different clients these female sex workers serve. You find that one may serve that specific client today, and the following day another female sex worker will serve that client. So if this client had mpox, he is going to spread to the different female sex workers in that hotspot.”

Recent research from an mpox outbreak in the Democratic Republic of the Congo found that heterosexual close contact was likely the major form of virus, transmission and that sex work was the dominant occupation among infected individuals.

Heightening the risk further is the tendency of female sex workers and other vulnerable women to share small spaces – as much a social protection measure as an economic need, Kyomya explains in the AWAC video. “Mpox does not know all those dynamics,” she adds, pleading that the government prioritise “the most, most at risk” during the vaccine roll-out.

The vaccines roll out

On 21 January 2025, Uganda received a consignment of 10,000 doses of the MVA-BN® mpox vaccine from the European Union’s Health Emergency Preparedness and Response Authority (HERA). Those doses rolled out in the first two weeks of February – with the majority administered to female sex workers.

“It was more of a ring vaccination strategy and mobilisation was more of peer-to-peer and focused on vaccinating sex workers. This Round One was very targeted and we only covered two locations in Kampala city – Kawempe and Makindye,” said Tabley Bakyaita Basajjatebadiba, Risk Communication Technical Officer under the Health Promotion, Education & Communication (HPE&C) Department of Uganda’s Ministry of Health.

AWAC members have complained that limited awareness of arrival of the first mpox vaccines arrival meant most of their members did not receive them. But Bakyayita Basajjatebadiba explained that with limited doses, it was ‘intentional’ to not call too much attention to their arrival. “That sort of awareness with a big launch can only be created if you have (enough) product to serve the community,” he reasoned.

“We are waiting for more vaccines to give the ones already vaccinated a second dose, and then we shall we shall include a larger target audience which will be more diverse and larger than what we handled,” he said.

“Uganda has been allocated another 100,000 doses of vaccines. I think the first shipment of 59,000 is coming, and then the remaining 41,000 will follow,” said Dr Ngashi Ngongo, Africa CDC’s Incident Manager for the mpox outbreak.

Kyobe, meanwhile, said the priority population will be health workers and commercial sex workers. He says within Kampala Metropolitan, the highest concentration of infections remains among sex workers operating in low-income areas.

While the next batch of vaccines is awaited, districts have implemented several disease control strategies including community sensitisation through audio towers and radio talk shows, mobilisation of village health teams (VHTs) for grassroots engagement, all promoting preventive measures.

The district task forces are also urging the public to avoid casual sexual encounters, congested places, and to prioritise hygiene practices such as frequent handwashing and regular cleaning of clothing.

“My prayer is that they prioritise our community and work with AWAC community leadership to take the lead in hard to reach areas,” says Kyomya.

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Source: VaccinesWork