Why mpox is a global health emergency – again

On August 13, the Africa Centers for Disease Control and Prevention said the ongoing outbreak of mpox is a continental security public health emergency, a first for the organization. On August 14, a WHO expert panel found overwhelming evidence that mpox is again a global emergency, said Dimie Ogoina, an infectious disease doctor at the Niger Delta University Teaching Hospital in Okolobiri, Nigeria and chairman of the emergency committee.

Following the committee’s advice, WHO director-general Tedros Adhanom Ghebreyesus said on August 14 that the outbreak is now a public health emergency of international concern. “It is clear that a coordinated international response is needed to stop these outbreaks and save lives,” he said.

Sweden reported a case of mpox linked to travel to Africa, the country’s Public Health Agency announced on 15 August. The person was infected with clade I mpox, the first time that version of the virus has been diagnosed outside the African continent.

Here are three things you need to know about the outbreak.

Why is mpox an emergency again?

The disease has spread rapidly in Africa, now affecting people in at least 13 countries, the Africa CDC says. Congo, which has seen a steady rise in cases over the past decade, saw large increases last year and this year. Across Africa this year alone, there have been more than 15,600 cases and 537 deaths from mpox, including deaths of young children and people whose immune systems have been weakened by HIV.

About 90 cases of the disease have appeared in countries such as Burundi, Kenya, Rwanda and Uganda that had never before recorded mpox cases.

To make matters worse, a new version of the virus, known as clade Ib, emerged in Congo and has now been confirmed in four neighboring countries. This variant appears to cause more severe cases and may be more transmissible than clade II, which caused the 2022 outbreak.

The 2022 outbreak mostly affected men who have sex with men, although the virus spread to others through contact with infected skin or clothing, bedding or other objects.

Clade Ib is spreading among adults through heterosexual sex, which can become a problem especially for pregnant women, Ogoina said during a press conference: An infection can put them and their babies at risk.

And this time, children have proven to be particularly vulnerable to the virus. As of May 26, two-thirds of the cases reported this year in Congo, or 5,254, have been in children aged 15 and older. And 87 percent of the deaths, or 321, were in that age group.

In Burundi and Congo there is evidence that the virus is spreading in the community, while other countries have so far reported isolated cases.

What is the significance of mpox being called a public health emergency?

Vaccines and treatments will be deployed to help protect vulnerable people in some countries. Supplies of both are limited and experts warn that the full extent of the outbreak is unknown. Increased surveillance will be important to understand how the disease is spreading and who would benefit most from vaccination, WHO epidemiologist Maria Van Kerkhove said during the press conference.

The WHO is seeking $15 million from the global health agency’s emergency fund to pay for increased surveillance and countermeasures. The WHO is also asking other countries to donate vaccines from their national stocks. Japan has already taken a step forward to offer its own version of the mpox vaccine.

Congo and Nigeria have promises they may be able to get enough vaccine this fall to deploy, but other African countries are still waiting.

The 2022 mpox outbreak showed that getting the word out to affected communities and talking to them about ways to stay safe is also effective in containing an outbreak, Van Kerkhove said. “There are many interventions that can be used locally, in communities, to prevent transmission.”

Can the explosion be stopped?

Maybe, but it will take effort.

Scientists do not fully understand many things about the virus, including which animals serve as reservoirs for it and whether there is a real difference in virulence and transmissibility between the two clades now circulating.

One thing is clear. The world can no longer afford to ignore the spread of the virus in Africa, Ogoina said. “Mpox, originating in Africa, was neglected there and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself.”