The World Health Organization declared a global emergency after mpox outbreaks in Congo and elsewhere in Africa on Wednesday.
Earlier this week, the Africa Centers for Disease Control and Prevention declared the mpox outbreak a public health emergency, with more than 500 deaths, and called for international help to stop the spread of the virus.
“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.
The Africa CDC previously said mpox, also known as monkeypox, has been detected in 13 countries this year, and more than 96% of all cases and deaths are in Congo. Cases have increased by 160% and deaths by 19% compared to the same period last year. So far, there have been more than 14,000 cases and 524 people have died.
“We are now in a situation where (mpox) poses a risk to many more neighbors in and around central Africa,” said Salim Abdool Karim, a South African infectious disease expert who chairs the CDC’s Africa Emergency Task Force. He said the new version of mpox spreading from the Congo appears to have a fatality rate of about 3-4%.
In 2022, the WHO declared mpox a global emergency after it spread to more than 70 countries that had not previously reported mpox, mostly affecting gay and bisexual men. In that outbreak, less than 1% of people died.
Michael Marks, professor of medicine at the London School of Hygiene and Tropical Medicine, said declaring these recent mpox outbreaks in Africa an emergency is justified if it can lead to more support to contain them.
“It is a failure of the global community that things have to get this bad to free up the resources that are needed,” he said.
Officials at the Africa CDC said nearly 70% of cases in Congo are children younger than 15, who also accounted for 85% of deaths.
Jacques Alonda, an epidemiologist working in Congo with international charities, said he and other experts were particularly concerned about the spread of mpox in refugee camps in the country’s conflict-ridden east.
“The worst case I’ve seen is that of a six-week-old baby who was only two weeks old when he got mpox,” Alonda said, adding that the child has been in their care for a month. “He became infected because overcrowding at the hospital meant he and his mother had to share a room with someone else who had the virus, who was undiagnosed.”
Save the Children said Congo’s health system had already “collapsed” under the stresses of malnutrition, measles and cholera.
The UN health agency said mpox was recently identified for the first time in four East African countries: Burundi, Kenya, Rwanda and Uganda. All these outbreaks are linked to that in the Congo. In Ivory Coast and South Africa, health authorities have reported outbreaks of another and less dangerous version of mpox that spread worldwide in 2022.
Earlier this year, researchers reported the emergence of a new form of the more deadly form of mpox, which can kill up to 10% of people, in a Congolese mining town that they feared would spread more easily. Mpox is most often spread through close contact with infected people, including through sex.
Unlike previous outbreaks of mpox, where lesions were mostly seen on the chest, hands and feet, the new form causes milder symptoms and lesions on the genitals. This makes it harder to detect, meaning that people can also make others sick without knowing they are infected.
Prior to the 2022 outbreak, the disease had mostly been seen in sporadic outbreaks in central and western Africa when humans came into close contact with infected wild animals.
Western countries during the 2022 outbreak mostly stopped the spread of mpox using vaccines and treatments, but very few of them have been available in Africa.
Marks of the London School of Hygiene and Tropical Medicine said that in the absence of mpox vaccines licensed in the West, officials may consider inoculating people against smallpox, a related disease. “We need a large supply of vaccines so we can vaccinate populations most at risk,” he said, adding that would include sex workers, children and adults living in outbreak regions.
Congo has not received any of the mpox vaccines it has requested.
Congolese authorities said they have asked for 4 million doses, Cris Kacita Osako, coordinator of the Congolese Monkeypox Response Committee, told the Associated Press. Kacita Osako said they would mostly be used for children under 18.
“The United States and Japan are the two countries that have positioned themselves to provide vaccines to our country,” Kacita Osako said.
Dr. Dimie Ogoina, a Nigerian mpox expert who chaired the WHO’s crisis committee, said there are still significant gaps in understanding how mpox spreads in Africa. He called for stronger surveillance to track the outbreaks.
“We are working blindly when we cannot test all suspected cases,” Ogoina said.
Although the WHO’s emergency declaration is meant to spur donor agencies and countries into action, the global response to previous declarations has been mixed.
Dr. Boghuma Titanji, an infectious disease expert at Emory University, said the WHO’s recent mpox emergency declaration “did very little to move the needle” on getting things like diagnostic tests, medicines and vaccines to Africa.
“The world has a real opportunity here to act decisively and not repeat past mistakes, (but) it will require more than an (emergency) declaration,” Titanji said.
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