The World Health Organization has declared mpox an international public health emergency for the second time in two years, as case numbers and fatalities are rising in several East and Central African nations. This declaration follows the Africa Centres for Disease Control and Prevention’s recent announcement of a continent-wide health emergency related to mpox.
While many nations outside of Africa effectively managed the mpox outbreak that began in 2022, significant outbreaks have persisted in the Democratic Republic of the Congo (DRC). The variant circulating there is a more dangerous strain than those that previously reached the US and Europe, and it has spread from the DRC into four other countries in the region in recent months.
Mpox, formerly known as monkeypox, is a disease related to smallpox but generally less severe. It is believed to originate from African rodents and non-human primates, spreading through close contact with infected individuals, including sexual and skin-to-skin interactions. The disease can also be transmitted from a pregnant person to their child during pregnancy or after delivery. Symptoms typically include a rash resembling blisters, fever, fatigue, muscle aches, cough, and sore throat.
Historically, mpox has caused sporadic cases and outbreaks in Nigeria, the DRC, and various other African countries. There are two primary strains: clade I, which has been more commonly associated with central Africa and results in more severe illness, and clade II, which has traditionally affected West Africa.
In May 2022, cases of mpox, particularly of the clade II variant, emerged in countries outside Africa, prompting the World Health Organization to declare it a public health emergency of international concern by July. By May 2023, nearly 90,000 cases had been reported across over 100 countries, with more than 150 fatalities.
Public health organizations worldwide swiftly improved disease surveillance, raised awareness among high-risk groups, and promoted safe practices. In the US and Europe, authorities administered over a million vaccine doses, resulting in a significant decline in mpox transmission. The World Health Organization lifted the emergency status in May 2023, although reports of new cases persisted globally.
By June 2024, North, Central, and South America had reported 175 cases, Europe recorded 100, and Southeast Asia documented 11 cases. The DRC continued to struggle with its outbreak, reporting 7,851 cases and 384 deaths, predominantly related to the more severe clade I strain.
This situation raised alarms and prompted both the Africa CDC and the WHO to declare health emergencies due to new outbreaks in the DRC and neighboring countries like Burundi, Kenya, Rwanda, and Uganda.
The Africa CDC, serving the African Union’s 55 member states, made history with its first-ever continental emergency declaration. Other African nations also reported a resurgence of mpox cases from clade II. In May 2024, there were 465 documented cases, which increased to 567 by June.
Jean Kaseya, Director General of Africa CDC, announced during a press briefing, “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.”
Despite swift responses, efforts have been hindered by challenges similar to those faced during prior pandemics, like Covid-19, including a lack of global cooperation and resource sharing. While vaccines were quickly distributed in Western countries, the DRC has only recently begun to receive vaccines, with supplies still severely limited relative to its population of over 100 million.
Efforts continue among national governments and multinational organizations to bolster public health infrastructure in Africa and reduce reliance on foreign aid. While the declaration by the Africa CDC signifies a step towards improved response to the mpox outbreak, the immediate influx of necessary resources remains uncertain.
Mpox was first identified in 1958 among monkeys in Denmark, and the first human case was reported in 1970 in the DRC. While sporadic cases appeared over the years, the virus’s transmission methods and its sudden resurgence in 2022 are not fully understood. Researchers have noted considerable mutations in the mpox virus, with a new variant, clade IB, recently discovered in the DRC.
Rosamund Lewis, an expert at the WHO, suggests that the recent spread of mpox could be attributed more to changes in social behavior and population exposure than to mutations in the virus itself. In the DRC, a significant portion of cases this year have affected children exposed to infected animals or household members, highlighting that adult sexual transmission might not be the sole factor.
Severe mpox cases are more prevalent among individuals with preexisting HIV conditions, of which Africa has the highest prevalence globally. This dual threat played a role in the Africa CDC’s declaration of a continental emergency.
There is an ongoing shortage of mpox vaccines. Two vaccines — Jynneos and LC16 — are effective against the disease, but access has been limited in Africa. The Democratic Republic of the Congo lacks the means to produce or purchase sufficient quantities, relying instead on international donations. Following COVID-19, the Africa CDC has attempted to address these gaps, but progress has been slow.
Recently, the US Agency for International Development pledged $10 million to aid the mpox response in the DRC, yet it remains to be seen whether the new emergency designations will significantly impact vaccine distribution. In the meantime, the Africa CDC and WHO are increasing financial efforts to address the outbreak, including recent fund releases from the African Union and the WHO.
Kaseya emphasized the collective responsibility, stating, “This is a fight for all Africans and we will fight it together.”