Mpox Outbreaks in Africa Declared Global Health Emergency by WHO

The World Health Organisation (WHO) has declared the mpox outbreaks in Congo and other African countries a global emergency. Cases have been confirmed in over a dozen nations, affecting both children and adults. The continent faces a shortage of vaccine doses.

Earlier this week, the Africa Centres for Disease Control and Prevention (CDC) labelled the mpox outbreaks a public health emergency. With more than 500 deaths reported, they called for international assistance to curb the virus's spread. "This is something that should concern us all...The potential for further spread within Africa and beyond is very worrying," said WHO director-general Tedros Adhanom Ghebreyesus.

Impact on Children and Healthcare System

Officials at the Africa CDC noted that nearly 70% of cases in Congo involve children under 15, who also account for 85% of deaths. Jacques Alonda, an epidemiologist working in Congo, expressed concern about mpox spreading in refugee camps in the conflict-ridden east. "The worst case I've seen is that of a six-week-old baby who was just two weeks old when he contracted mpox," Alonda said. The baby got infected due to hospital overcrowding, forcing him and his mother to share a room with an undiagnosed patient.

Save the Children highlighted that Congo's health system was already strained by malnutrition, measles, and cholera. The UN health agency recently identified mpox for the first time in four East African countries: Burundi, Kenya, Rwanda, and Uganda. These outbreaks are linked to the one in Congo. Ivory Coast and South Africa have reported outbreaks of a different, less dangerous version of mpox that spread globally in 2022.

New Form of Mpox

In 2022, WHO declared mpox a global emergency after it spread to over 70 countries, mostly affecting gay and bisexual men. In that outbreak, fewer than 1% of people died. Michael Marks from the London School of Hygiene and Tropical Medicine said declaring these latest outbreaks an emergency is justified if it leads to more support to contain them. "It's a failure of the global community that things had to get this bad to release the resources needed," he said.

A new form of mpox has emerged in a Congolese mining town, which scientists fear might spread more easily. This form can kill up to 10% of those infected. Unlike previous outbreaks where lesions appeared on the chest, hands, and feet, this new form causes milder symptoms with lesions on the genitals. This makes it harder to detect, increasing the risk of unknowingly spreading the virus.

Before the 2022 outbreak, mpox was mostly seen in sporadic outbreaks in central and West Africa when people came into close contact with infected wild animals. Western countries managed to control the spread during the 2022 outbreak using vaccines and treatments, but these resources are scarce in Africa.

Call for Vaccines

Marks suggested that in the absence of licensed mpox vaccines in Africa, officials could consider using smallpox vaccines due to their related nature. "We need a large supply of vaccine so that we can vaccinate populations most at risk," he said, including sex workers, children, and adults living in outbreak regions.

Congo has not received any of the mpox vaccines it requested. Congolese authorities have asked for 4 million doses primarily for children under 18. "The United States and Japan are the two countries that positioned themselves to give vaccines to our country," said Cris Kacita Osako, coordinator of Congo's Monkeypox Response Committee.

Dr Dimie Ogoina from Nigeria, who chaired WHO's emergency committee on mpox, mentioned significant gaps remain in understanding how mpox spreads in Africa. He stressed that identifying major transmission risk factors would help guide vaccination strategies.

Although WHO's emergency declaration aims to prompt donor agencies and countries into action, past responses have been mixed. Dr Boghuma Titanji from Emory University noted that the last WHO emergency declaration for mpox "did very little to move the needle" on providing diagnostic tests, medicines, and vaccines to Africa. "The world has a real opportunity here to act decisively and not repeat past mistakes," Titanji said.

The situation remains critical as efforts continue to control the spread of mpox across Africa amidst limited resources and growing concerns about its impact on vulnerable populations.