The World Health Organization (WHO) has once again declared mpox an international public health emergency as cases and fatalities escalate across multiple countries in East and Central Africa. This latest announcement comes just a day after the Africa Centres for Disease Control and Prevention (Africa CDC) proclaimed mpox a continent-wide health emergency.
While many nations outside of Africa successfully contained an mpox outbreak that began in 2022, severe outbreaks continue in the Democratic Republic of the Congo (DRC). The prevalent strain there is a more lethal version than that which previously spread to the U.S. and Europe. In recent months, this strain has also spread from the DRC to four other East and Central African nations.
Mpox, formerly known as monkeypox, is related to smallpox but is generally less severe. It is believed to originate from African rodents and non-human primates, spreading through close contact with infected individuals, including during sexual and skin-to-skin contact. Pregnant persons can also transmit the virus to their babies during or after childbirth. Symptoms typically include a blister-like rash, fever, fatigue, muscle aches, cough, and sore throat.
Historically, mpox has caused sporadic outbreaks in the DRC, Nigeria, and some other African countries. There are two main strains: clade I, known for its severe illness and primarily found in Central Africa, and clade II, which typically causes infections in West Africa. The pandemic began in 2022 with clade II, prompting WHO to declare an international health emergency for the first time that July. By May 2023, the global count reached nearly 90,000 cases and over 150 deaths across 100 countries.
Thanks to rapid action, public health agencies worldwide improved surveillance, heightened awareness among at-risk groups, particularly men who have sex with men, and promoted safe sexual practices. The U.S. and Europe also administered over a million mpox vaccine doses, significantly reducing transmission rates. In May 2023, WHO lifted the emergency status.
Despite this, cases continued to be reported, with 175 cases in America and 100 in Europe noted in June 2024, while Southeast Asia reported 11 cases. The outbreak in the DRC remains dire, with 7,851 cases and 384 deaths reported as of May 2024.
The spread of clade I mpox from the DRC to Burundi, Kenya, Rwanda, and Uganda has raised fears of a potential new pandemic, leading both the Africa CDC and WHO to declare emergencies. This marks the first time the Africa CDC has categorized an outbreak as a continental emergency. Other African nations are also experiencing resurgent outbreaks from the clade II strain.
During a press briefing, Africa CDC Director General Jean Kaseya emphasized, “We declare today this public health emergency of continental security to mobilize our institutions, our collective will, and our resources to act swiftly and decisively.”
However, outbreak response efforts in the DRC and other African nations continue to face challenges similar to those seen during previous health crises, like COVID-19—namely, a lack of global solidarity and inadequate sharing of resources. While vaccines were promptly distributed in the U.S. and Europe, supplies to the DRC are only now beginning to arrive, and even then, only a few hundred thousand doses are available for a population exceeding 100 million.
Efforts are underway to enhance public health infrastructure and reduce reliance on external aid, but there is uncertainty about whether recent emergency designations will lead to a much-needed influx of resources.
Mpox was first identified in 1958 in monkeys, with the first human case reported in a nine-month-old infant in the DRC in 1970. Despite the long history of the virus, much remains unknown regarding its spread and the sudden global surge observed in 2022. Genetic research indicates significant mutations may have occurred, but consensus on their impact is still lacking.
In September 2023, a new variant named clade IB was detected in the DRC, although its effects are yet to be confirmed by WHO. Some experts suggest that the virus’s spread among new populations, especially among sex workers and men who have sex with men, has driven wider transmission.
Children account for a considerable percentage of mpox cases, especially in the DRC, where pre-existing HIV infections elevate the risk of severe sickness and death. With Africa having the highest HIV prevalence globally, the combined threat of mpox and HIV raises alarms for health officials, prompting declarations of emergencies.
Currently, there is a shortage of mpox vaccines, with Jynneos and LC16 being the main options available. The rapid distribution of vaccines in the U.S. and Europe sharply contrasts with the months of delays faced by the DRC, which lacks the capacity to produce vaccines locally or afford large quantities.
As the Africa CDC and other entities work to address these gaps, initial shipments of vaccines have begun trickling into the DRC. However, only 200,000 doses are currently available, creating challenges in resource allocation.
As global donor support continues to provide technical and financial assistance for mpox responses in Africa, recent emergency declarations by Africa CDC could potentially enhance funding avenues. The African Union has allocated $10.4 million for the response, with additional support from WHO.
“This is a fight for all Africans and we will fight it together,” reiterated Kaseya.