1. Vaccine Distribution Inequality: The distribution of mpox vaccines has been highly unequal. While countries like Japan, Europe, and the United States have ample supplies, African nations facing severe outbreaks have struggled to obtain vaccines.

2. Bureaucratic Hurdles: Bureaucratic processes have significantly slowed down vaccine delivery. The World Health Organization's delay in giving emergency use listing to the vaccine prevented organizations like UNICEF and Gavi from quickly distributing it to affected areas.

3. High Costs and Limited Donations: The vaccines, produced by a Danish company, are expensive and often unaffordable for African countries. Donations from wealthy nations have been limited, with the U.S. providing only a fraction of the doses needed in Africa.

4. Weak Health Infrastructure: Many affected African countries lack the necessary health infrastructure to effectively distribute and administer vaccines. This includes shortages of trained health workers, testing facilities, and proper surveillance systems.

5. Need for Self-Reliance: African nations are calling for self-reliance in vaccine production and distribution. The current system of waiting for charitable donations has led to delays and inequities, highlighting the need for Africa to develop its own manufacturing capabilities and strong health systems.