Mpox Outbreak in Africa Sparks Global Health Emergency: W.H.O. and Experts Urge Swift Action

The rapid expansion of mpox, previously known as monkeypox, in African nations has led the World Health Organization (W.H.O.) to declare it a global health emergency on Wednesday.

This is the second time in three years that the W.H.O. has issued a global emergency due to an mpox outbreak; the first was in July 2022. That previous outbreak affected nearly 100,000 people, predominantly gay and bisexual men, across 116 countries, and resulted in about 200 deaths.

This new outbreak poses an even greater threat. Since the start of the year, the Democratic Republic of Congo has reported 15,600 cases of mpox and 537 deaths. Women and children under 15 are among the most vulnerable groups.

Dr. Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, expressed concern about the emergence and swift spread of a new strain of mpox in eastern D.R.C., its appearance in neighboring countries that had no prior cases, and the potential for further spread within Africa and globally.

The virus has now been reported in 13 African countries, including some that had never previously encountered mpox. On Tuesday, the Africa Centers for Disease Control and Prevention (Africa C.D.C.) declared a “public health emergency of continental security,” marking the first time the organization has exercised this authority since it was granted by the African Union last year.

“It is crucial for countries, the continent, and the international community to act quickly to stop the transmission of this virus,” said Dr. Nicole Lurie, executive director for preparedness and response at the Coalition for Epidemic Preparedness Innovations (CEPI), a nonprofit that supports vaccine development.

With the risk of global spread, the U.S. Centers for Disease Control and Prevention (C.D.C.) has urged healthcare providers and the public in the United States to remain vigilant for signs of the virus.

The W.H.O.’s declaration of a “public health emergency of international concern” is intended to encourage member countries to prepare for the virus’s potential spread and to share vaccines, treatments, and other vital resources with less wealthy nations.

“We need a unified international effort to address this new outbreak,” said Gregg Gonsalves, an epidemiologist at Yale University who was part of the W.H.O.’s mpox committee in 2022.

The 2022 outbreak was largely contained within specific sexual networks among gay and bisexual men. Behavioral changes and vaccination efforts helped to control the spread. In the United States, for example, cases decreased from over 30,000 in 2022 to around 1,700 last year.

However, the strain of mpox currently circulating in Congo is more severe, with a death rate of about 3%, compared to 0.2% in the 2022 outbreak. Symptoms of the infection include fever, respiratory issues, muscle aches, swollen lymph nodes, and a rash on various parts of the body, including the hands, feet, chest, mouth, or genitals.

Previously, mpox spread mainly through the consumption of contaminated meat or close contact with infected animals or people. Most of the deaths have occurred among children in this region of Africa, where malnutrition and other infectious diseases such as cholera, measles, and polio are already prevalent.

Experts believe that if the outbreak spreads globally, children in developed countries are less likely to suffer from severe illness.

Last year, for the first time, scientists discovered that this strain of mpox could be transmitted sexually, with cases being almost equally split between young men and women. Genetic analysis suggests that the virus acquired mutations around September that made it easier to spread among humans, partly through heterosexual prostitution.

This particular strain has not yet appeared outside Africa. So far, there have been more than 17,500 suspected and confirmed mpox cases in 13 countries, according to Africa C.D.C., with most of the cases and deaths occurring in Congo.

Given the virus’s rapid spread, the global health emergency declaration was warranted, said Anne Rimoin, an epidemiologist at the University of California, Los Angeles, who was part of the W.H.O.’s mpox panel in 2022.

“We’ve learned a lot about how quickly this virus can spread,” she said.

In response to the growing number of cases, Congo has approved two mpox vaccines: LC16, a Japanese product, and Jynneos, the vaccine developed by Bavarian Nordic that was used in the 2022 outbreak in the U.S. and Europe. However, Congo has not yet launched a vaccination campaign.

On August 9, the W.H.O. invited vaccine manufacturers to apply for an emergency use listing, a necessary step for international organizations like Gavi, a global vaccine alliance, to purchase and distribute vaccines in low-income countries.

Bavarian Nordic has donated 15,000 doses of Jynneos for distribution in African nations. But this is only a small portion of the 10 million doses needed to control the outbreak, according to Africa C.D.C.

“The challenge is that these vaccines are not sufficient,” said Dr. Dimie Ogoina, a Nigerian scientist and chair of the W.H.O.’s mpox emergency committee, adding that even with efforts to protect only those most at risk, more vaccines are needed.

LC16 was administered to Japanese children in the 1970s. Currently, clinical trials funded by CEPI are evaluating whether Jynneos can protect children and those already exposed to the virus, according to Dr. Lurie.

CEPI is also supporting the development of a new mRNA vaccine by BioNTech that would protect against mpox and related viruses, such as smallpox.

“This outbreak has been simmering for a long time, and we’ve repeatedly missed opportunities to stop it,” Dr. Lurie said. “I’m relieved that there is now a focused effort to address this issue.”