The World Health Organisation (WHO) yesterday declared the mpox outbreaks in Congo and elsewhere in Africa a global emergency as health authorities sound the alarm about the rapid spread of the disease and a dangerous strain moving across borders.
“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, according to an AP report.
The WHO's declaration yesterday follows the Africa Centres for Disease Control and Prevention (Africa CDC) officially declaring mpox a “public health emergency of continental security” earlier in the week.
The Africa CDC's decision, the first time it has acted on its own such a case, reflects scientists’ deep worry that the outbreak could evolve into an epidemic that spreads across the continent – and possibly beyond. They note that the virus is making an alarming appearance not just in rural regions, but also in densely populated areas.
Jean Kaseya, Africa CDC’s Director-General, said the centre’s historic move represents a pivotal moment in Africa’s fight against the long-simmering but now fast-spreading disease.
In just the past week, more than 2 500 new mpox cases and 56 deaths have been reported in five African Union member states: Burundi, the Central African Republic, Congo, the Democratic Republic of Congo (DRC) and South Africa. Between 8 May and 2 July, SA health authorities confirmed 20 cases, including three deaths.
However, the outbreak in South Africa is different from the current strain but similar to the one that grabbed global attention in 2022.
According to Africa CDC, mpox cases on the continent have escalated by 160% this year compared with last year, with Africa also having seen a higher fatality rate than anywhere else. At least 96% of cases have been recorded in the DRC, CIDRAP reports.
Since the beginning of the year, 17 541 cases have been reported across 13 AU states, reports Health Policy Watch.
In a major cause for concern, a new variant of the virus – clade 1b – is fuelling an outbreak in eastern DRC, and has now spread to neighbouring countries. In other areas of the DRC, clade 1a of the virus is also spreading: historically clade 1a variants have seen high mortality rates of up to 10%.
A mix of clade I and II cases also continues to be reported in multiple neighbouring countries, affecting children and adults and spreading through multiple modes of transmission.
Since the beginning of 2023, the outbreak in the Congo has already seen around 27 000 cases, and claimed more than 1 100 lives, most of them children. Another 50 cases had been confirmed and more were suspected in neighbouring regions where cases have previously not been reported, reports The East African.
The CDC declaration was the culmination of an extensive consultative process involving a diverse array of stakeholders at various levels, with at least 600 people being reached in various capacities to discuss data and evidence.
South African epidemiology expert Professor Salim Abdool Karim, the ECG chair, told Health Policy Watch that after reviewing epidemiological data, the Emergency Consultative Group (ECG), comprising African and international experts, had unanimously recommended declaring the public health emergency.
He expressed concerns, in particular, that the virus variants are now spreading almost entirely between humans – well beyond traditional animal reservoirs.
“The evidence does not seem to be that it’s zoonotic transmission. It seems to be almost all mostly from human to human transmission.”
He said new cases were being diagnosed in countries that had never seen mpox before, and the declaration should help “ensure that the disconnected attempts being made are brought together in a large plan … to improve the efficacy of our intervention measures”.
In the AP report Abdool-Karim said: “We are now in a situation where (mpox) poses a risk to many more neighbors in and around central Africa.” He said the new version of mpox spreading from Congo appears to have a death rate of about 3-4%.
Africa CDC wants the emergency announcement to co-ordinate a stronger international response, mobilise resources, enhance surveillance, accelerate research and development, and foster global solidarity, Kaseya said.
All of those have previously been sorely lacking.
Kaseya acknowledged the complexity of the situation, citing insecurity in certain regions, limited understanding of the epidemiological and transmission dynamics, inadequate global attention, and the unavailability of countermeasures as significant hurdles.
However, he said the announcement had garnered political support at the highest levels in Africa, especially the leadership of the African Union. Already, the AU has approved the emergency release of $10.4m to support response to the outbreak, and help in securing vaccines, strengthen surveillance systems, and bolster overall preparedness and response efforts.
Africa needs 10m doses – only 200 000 available
One of the challenges in response efforts is the limited availability of mpox vaccines, and multiple hurdles to their roll-out.
Existing vaccines have been produced by only two manufacturers, Bavarian Nordic (Jynneos), whose production has been constrained, and the Japanese LC16 KMB, produced by KM Biologics. The latter has the advantage of being just one, rather than two jabs, but it requires intradermal administration – a procedure requiring training for health workers unfamiliar with the technique.
Congo authorities had approved the use of both vaccines in June.
Currently, Africa requires at least 10m doses of mpox vaccines. But only 200 000 doses are right now available, said Kaseya, emphasising the urgency of more local manufacturing.
The Africa CDC is actively engaging with various partners, including the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) and the German-based BioNTech which partnered with Pfizer to produce the mRNA Covid vaccine, and others, to finalise contracts and scale up production for millions of doses in 2025.
Unlikely to see vaccines soon
However, although experts hope the Africa CDC announcement might galvanise action worldwide, vaccines to help curb the escalating outbreaks may still not reach the central African country for months, even if the WHO follows Africa’s top public health agency in declaring the outbreak an emergency.
Many obstacles remain, including limited vaccine supply, funding and competing disease outbreaks, reports Reuters.
“It is important to declare an emergency because the disease is spreading,” said Jean-Jacques Muyembe-Tamfum, head of Congo’s Institut National pour la Recherche Biomedicale (INRB), adding that he hoped any declaration would help provide more funding for surveillance as well as support access to vaccines in the region.
But he acknowledged that the road ahead was not easy in a huge country where health facilities and humanitarian funds are already stretched by conflict and outbreaks of diseases like measles and cholera.
“If the big declarations remain just words, it won’t make any material difference,” said Emmanuel Nakoune, an mpox expert at the Institut Pasteur de Bangui in Central African Republic.
While the Africa CDC said it had been granted $10.4m in emergency funding from the AU and Kaseya said there was a clear plan to secure 3m doses of vaccine this year, without elaborating further, sources involved in planning a vaccination roll-out said only 65 000 doses were likely to be available in the short-term, and campaigns were unlikely to begin before October at the earliest.
Threat intensified with HIV
The head of the US National Institute of Allergy and Infectious Diseases (NIAID) has called for wider access to mpox vaccines, warning that the virus poses a serious threat to countries hard-hit by HIV such as SA.
“This has the potential to be an explosive, damaging outbreak in SA, given the HIV epidemic. We need to do our best to get the preventive tools there,” said NIAID director Jeanne Marrazzo, who is currently visiting SA research sites supported by NIAID, the biggest funder of HIV/Aids research in SA for more than two decades.
The spread of clade 1b was “very worrisome” and SA officials needed to be prepared for its potential spread to SA, she told Business Day, “because pathogens don’t respect borders”.
South Africa has recorded 22 cases of mpox since 8 May, including three deaths, and although the health department has received donations of the mpox treatment Tecovirimat from the WHO, it has yet to secure any vaccines.
The country is still in talks with the WHO to secure donations, and is hoping to obtain 40 000 doses, said health department spokesperson Foster Mohale.
Business Day article – US research agency calls for wider access to mpox vaccines in SA (Restricted access)
AfricaCDC report (Open access)
CIDRAP article – Mpox cases spiking in 10 African nations (Open access)
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