Topline
The World Health Organization is considering declaring an international health emergency over an escalating mpox outbreak in Africa after the continent’s top public health body called its spread a public health emergency yesterday, warning the disease could snowball without immediate steps to contain it and stoking fears a deadlier mpox pandemic could be on the horizon.
Mpox cases are surging in parts of Africa.
Key Facts
The Africa Centres for Disease Control and Prevention (Africa CDC), the African Union’s health watchdog and the top public health body on the continent, said a growing mpox outbreak in the Democratic Republic of Congo and neighboring countries constitutes a “public health emergency of continental security” on Tuesday.
The emergency designation is the agency’s first since launching in 2017 and comes amid growing concern among scientists over the rapid, unchecked spread of a concerning mpox strain that is more lethal than the version of the virus responsible for the global outbreak in 2022.
The variant, called mpox clade Ib (1B), is an offshoot of the clade I virus that has caused sporadic outbreaks in the DRC for decades and appears to spread more easily between people through routine close contact, especially among children.
Clade I infections have historically been confined to central Africa, predominantly the DRC, but the Africa CDC said the disease has now spread beyond Congo to at least 13 countries, with four—Burundi, Rwanda, Uganda and Kenya— reporting their very first clade I cases in recent months.
Africa CDC chief Jean Kaseya stressed the declaration is “not merely a formality” but a “clarion call to action” in recognition of a “crisis that demands our collective action.”
Kaseya said “there is no need for travel restrictions at this time,” adding the decision will unlock funding and other resources and mobilize institutions in affected countries to empower health officials to act “swiftly and decisively” in the face of outbreaks.
How Bad Is The Outbreak In Africa?
At least 13 African countries have reported clade I mpox infections and in 2024 so far there have been 2,863 cases and 517 deaths. Most of these have been in the DRC, the Africa CDC said. Given limited capacity for testing to confirm infections genetically, confirmed cases give only a limited picture. Suspected cases on the continent are in excess of 17,000 this year so far, up from just under 15,000 for all of 2023 and around 7,150 for 2022. Africa CDC said “this is just the tip of the iceberg” given the “many weaknesses in surveillance, laboratory testing and contact tracing.”
What Is Mpox And How Can It Be Stopped?
Mpox is a disease formerly known as monkeypox. Symptoms include a fever, swollen lymph nodes and characteristic rash and the disease follows infection with the monkeypox virus, typically through close contact with infected humans, animals or contaminated materials like bed linen. The disease is normally mild but can kill, with young children and people with compromised immune systems especially vulnerable. The virus is a close relative of smallpox, one of the deadliest human pathogens and the only infectious human disease to have been eradicated, though it is much less severe (smallpox killed around a third of people infected in the best cases). There are two broad groups of monkeypox virus that cause mpox infections: clade I and clade II. Data suggests infections with the former has a fatality rate of around 10% and the rate for clade II is less than 1%. Specific treatments for infection are limited and largely untested, especially in mpox clade I infections, and hospitals are mostly restricted to providing supportive care in the worst cases. Smallpox vaccines have been shown to provide at least some degree of protection against infection, though data is limited, particularly for clade I infections. As smallpox was eradicated globally in 1980, and eliminated in many countries much earlier, many people alive today have not received a vaccine for the virus or, if they have, will have done so a long time ago. Other preventative measures include avoiding bushmeat, potentially infected animals and avoiding unprotected close contact with those who appear infected or materials they’ve come into contact with.
Tangent
Many older smallpox vaccines are kept as a biosecurity measure in national stockpiles but are not considered appropriate to use in most circumstances given the strong risk of potentially severe side effects. A more modern vaccine, produced by Bavarian Nordic, is an improvement on these and was rolled out during the global outbreak in 2022, but supplies are limited and the shots can be costly for poorer nations dealing with mpox outbreaks like many of those in Africa. Complicating matters is that many of these countries also lack the basic health infrastructure to deliver the shots to those who need them in order to stamp out outbreaks effectively, particularly in rural areas. Supplies are likely to be an ongoing issue. Kaseya said the Africa CDC has signed a deal for 215,000 vaccines that are available now with Bavarian Nordic, with further plans to secure 3 million doses this year. Kaseya did not disclose details of plans to secure another 3 million doses this year and even if it materializes it falls far short of the more than 10 million doses Kaseya said will be needed on the continent.
Key Background
Scientists have been aware of mpox for decades, but the disease has garnered relatively little international attention as outbreaks have typically been small in scope and limited to regions in central and western Africa, for clade I and II, respectively. Most cases were linked to spillover infections from animals and though scientists still aren’t clear what animals are the natural reservoirs of the virus, rodents are the primary suspect. That all changed in 2022 when the virus began spreading globally, predominantly, though not exclusively, in networks of gay, bisexual and other men who have sex with men. The virus, an offshoot of clade II called clade IIb, appeared to be better able to spread among people and through sexual contact, a previously undocumented means of transmission.
What To Watch For
The World Health Organization’s emergency committee is set to convene on Wednesday to discuss whether the mpox outbreak in Africa should trigger a Public Health Emergency of International Concern (PHEIC). The designation is the highest level of alert the Geneva-headquartered global health agency can sound. The power to declare a PHEIC rests with WHO’s director general, Dr. Tedros Adhanom Ghebreyesus, on the advice of an expert committee. Experts told Forbes the committee will consider three criteria to see whether an outbreak merits a PHEIC designation: if it is serious, sudden, unusual or unexpected, if it has potential for international spread and if it requires a coordinated global response. The WHO declared the global mpox outbreak a PHEIC in July 2022 and lifted the designation roughly a year later in May 2023.
Crucial Quote
“This is not just another challenge; it is a crisis that demands our collective action, a moment that calls upon the very essence of our humanity, our unity, and our strength,” Kaseya said when announcing the emergency declaration. “Our continent has seen many struggles,” Kaseya said, pointing to pandemics, outbreaks, natural disasters and conflicts, adding that “through every adversity, we have risen, not as fragmented nations, but as one Africa.” He urged nations to “summon that same spirit of solidarity” to tackle the mpox outbreak. “But let me be clear: this is not just an African issue. Mpox is a global threat,” Kaseya stressed, calling on nations around the world to help the continent combat the disease.
Further Reading
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