Top line
The World Health Organization is considering declaring an international health emergency over an escalating Mpox outbreak in Africa after the continent’s top health body declared the spread of the virus a public health emergency yesterday, warning that the disease could continue to spread without immediate action to contain it, fueling fears that an even deadlier Mpox pandemic could be on the way.
In parts of Africa, cases of Mpox are increasing rapidly.
Key data
The Africa Centers for Disease Control and Prevention (Africa CDC), the African Union’s health regulator and the continent’s main public health agency, said on Tuesday that a growing MPOX outbreak in the Democratic Republic of Congo and neighboring countries constitutes a “health emergency of continental security significance.”
The emergency declaration is the agency’s first since its creation in 2017 and comes amid growing concern among scientists about the rapid, uncontrolled spread of a worrying strain of Mpox that is more deadly 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 Democratic Republic of Congo for decades and appears to spread more easily between people, especially among children, through everyday close contact.
Clade I infections have so far been limited to Central Africa, primarily the Democratic Republic of Congo. However, the disease has now spread beyond Congo to at least 13 countries, with four of these countries – Burundi, Rwanda, Uganda and Kenya – reporting their very first cases of Clade I in recent months.
Jean Kaseya, head of the Africa CDC, stressed that the declaration was not just a formality but a “wake-up call to action” in the face of a “crisis that requires our collective action”.
Kaseya said that “there is no need for travel restrictions at this time.” The decision will result in funding and other resources being released and institutions being mobilized in affected countries to enable health authorities to act “quickly and decisively” in disease outbreaks.
How bad is the outbreak in Africa?
At least 13 African countries have reported infections with the I mpox clade, and so far in 2024 there have been 2,863 cases and 517 deaths. Most of these have occurred in the Democratic Republic of Congo, according to the Africa CDC. Given limited capacity for testing to genetically confirm infections, confirmed cases give only a limited picture. The number of suspected cases on the continent so far this year is over 17,000, up from just under 15,000 in all of 2023 and around 7,150 in 2022. The 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 to stop it?
Mpox is a disease formerly known as monkeypox. Symptoms include fever, swollen lymph nodes, and a characteristic rash. The disease follows infection with the monkeypox virus, typically through close contact with infected people, animals, or contaminated materials such as bedding. The disease is usually mild but can be fatal, with young children and people with weakened immune systems being particularly at risk. The virus is a close relative of smallpox, one of the deadliest human pathogens and the only human infectious disease to be eradicated, although it is much less severe (smallpox killed about a third of those infected at its best). There are two major groups of monkeypox viruses that cause Mpox infections: Clade I and Clade II. Data suggest that infections with the former have a mortality rate of about 10%, and the rate for Clade II is less than 1%. Specific treatments for the infection are limited and largely untested, particularly for clade I Mpox infections, and hospitals are mostly limited to providing supportive care in the most severe cases. Smallpox vaccination has been shown to provide at least some protection against infection, but data are limited, particularly for group I infections. Because smallpox was eradicated worldwide in 1980 and eliminated in many countries much earlier, many people alive today have not received vaccination against the virus, or if they have, it was long ago. Other preventive measures include avoiding bushmeat and potentially infected animals, and avoiding unprotected close contact with apparently infected people or materials with which they have come into contact.
tangent
Many older smallpox vaccines are kept in national stockpiles as a biosecurity measure, but are considered unsuitable in most cases due to the high risk of potentially serious side effects. A more modern vaccine manufactured by Bavarian Nordic is an improvement over these and was introduced during the global outbreak in 2022, but supplies are limited and vaccinations can be costly for poorer countries struggling with smallpox outbreaks, such as many in Africa. Making matters worse, many of these countries also lack the basic health infrastructure to deliver the shots to those who need them to effectively contain outbreaks, especially in rural areas. Supply is likely to be an ongoing problem. Kaseya said the Africa CDC has signed a contract for 215,000 vaccines now available with Bavarian Nordic, and plans are underway to procure an additional 3 million doses this year. Kaseya did not provide details of plans to procure an additional 3 million doses this year, and even if those plans materialize, they fall far short of the more than 10 million doses Kaseya says are needed on the continent.
Important background
Scientists have known about Mpox for decades, but the disease has attracted relatively little international attention because outbreaks have typically been small-scale and confined to regions in central and western Africa (Clade I and II, respectively). Most cases have been linked to animal vectors, and although scientists are still not clear on which animals are the natural carriers of the virus, rodents are considered prime suspects. That changed in 2022, when the virus began to spread worldwide, 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, seemed to be able to spread better among humans and through sexual contact, a previously undocumented mode of transmission.
What you should pay attention to
The World Health Organization’s emergency committee is scheduled to meet on Wednesday to consider whether the Mpox outbreak in Africa should trigger a public health emergency of international concern (PHEIC). That designation is the highest level of alert the Geneva-based global health agency can declare. The authority to declare a PHEIC rests with WHO Director-General Dr. Tedros Adhanom Ghebreyesus, on the advice of an expert committee. Experts told Forbes the committee will consider three criteria to decide whether an outbreak deserves a PHEIC designation: whether it is severe, sudden, unusual or unexpected, whether there is the potential for international spread and whether it requires a coordinated global response. The WHO declared the global Mpox outbreak a PHEIC in July 2022 and lifted the designation about a year later, in May 2023.
Key quote
“This is not just another challenge; it is a crisis that requires our collective action, a moment that captures the essence of our humanity, our unity and our strength,” Kaseya said in announcing the emergency declaration. “Our continent has seen many struggles,” Kaseya said, citing pandemics, outbreaks, natural disasters and conflict. He added, “From every adversity, we have risen, not as fragmented nations, but as one Africa.” He urged nations to “summon the same spirit of solidarity” to fight the Mpox outbreak. “But let me be clear: this is not just an African problem. Mpox is a global threat,” Kaseya stressed, calling on nations around the world to help the continent fight the disease.
More information
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