The World Health Organization has once again declared mpox an international public health emergency, marking the second such declaration in two years. This announcement comes as cases and fatalities rise in various east and central African nations, following a similar declaration by the Africa Centres for Disease Control and Prevention (Africa CDC) for the continent.
While many countries outside Africa were able to quickly contain an mpox outbreak that began in 2022, large-scale infections have persisted in the Democratic Republic of the Congo (DRC). The strain prevalent in the DRC is more virulent than the variant seen in the US and Europe, leading to concerns as it spreads to neighboring countries.
Mpox, formerly known as monkeypox, is an infectious disease related to smallpox, believed to originate from African rodents and non-human primates. It spreads through close contact with an infected person, including sexual and skin-to-skin contact. Symptoms commonly include a blister-like rash, fever, fatigue, muscle aches, cough, and sore throat.
Historically, mpox has caused sporadic outbreaks in Nigeria, the DRC, and other African nations. There are two main strains: clade I, which results in more severe illness and is mainly found in central Africa, and clade II, generally associated with milder infections in west Africa.
An unexpected surge in mpox cases was noted outside Africa in May 2022, leading to the WHO’s declaration of a public health emergency later that July. By May 2023, over 100 countries reported nearly 90,000 cases and more than 150 deaths. Global public health efforts, particularly aimed at high-risk groups, eventually reduced transmission rates, prompting the WHO to lift the emergency status in May 2023.
Despite this, cases continued to be reported worldwide, including 175 in the Americas and over 100 in Europe by June 2024. In contrast, the outbreak in the DRC has remained dire, with clade I dominant, resulting in 7,851 cases and 384 deaths by May 2024. As this strain spread to Burundi, Kenya, Rwanda, and Uganda, health officials expressed concerns about a potential larger outbreak.
The Africa CDC’s classification of mpox as a continental emergency marked an unprecedented move, aimed at galvanizing resources to address the escalating threat. Despite efforts, challenges persist in outbreak responses, largely due to a lack of global cooperation and resource sharing, echoing difficulties faced during the COVID-19 pandemic. Vaccination efforts in the DRC have been notably delayed, with only a few hundred thousand doses allocated for a population exceeding 100 million.
There are ongoing efforts by national governments and organizations to enhance public health infrastructure in Africa, but it remains uncertain if the recent emergency designations will lead to a significant increase in resource allocation.
Mpox was initially discovered in 1958 in monkeys, with the first human case reported in 1970 in the DRC. The virus has since affected humans sporadically, particularly in the DRC and Nigeria. Though mpox is not new, questions linger about its transmission dynamics and the factors contributing to its recent global spread. Genetic analyses suggest a significant evolution in the virus since 2017, raising concerns over its mutation rate and the emergence of a new variant.
Currently, there are two vaccines effective against mpox: Jynneos and LC16. Despite the swift dissemination of millions of doses in western countries during the 2022 outbreak, the DRC had been without vaccines for the first two years. Recent shipments have begun to arrive, however, the limited quantities are significantly insufficient for the population’s needs.
International donors are providing support for outbreak response, including a recent $10 million from USAID for the DRC’s efforts. As the Africa CDC and WHO enhance their resource mobilization, the future availability of vaccines remains uncertain amidst the growing crisis.
Africa CDC Director General Jean Kaseya emphasized the urgency of collaborative efforts, stating, “This is a fight for all Africans and we will fight it together.”