An outbreak in Africa of mpox, the disease formerly known as monkeypox, resembles the early days of HIV, scientists said, as the World Health Organization declared it a public health emergency.
The declaration should accelerate access to testing, vaccines and therapeutics in the affected areas, medical experts urged, and launch campaigns to reduce stigma surrounding the virus.
More resources for research were also essential, they said, with “massive unknowns” remaining a new variant spread among people in the Democratic Republic of the Congo. As of August 4, there have been 38,465 cases of mpox and 1,456 deaths in Africa since January 2022, including more than 14,000 cases and 524 deaths in the DRC alone this year.
It included clades I and II of the virus, as well as a new typeclade Ib – an offshoot of clade I, which appears to be driving the outbreak in the DRC and neighboring countries, and to which children appear particularly vulnerable.
The World Health Organization said the outbreak was serious enough to declare a “public health emergency of international concern”, the category used in the past for Ebola outbreaks, Covid-19 and a 2022 mpox surge in Europe.
Tedros Adhanom Ghebreyesus, the director-general of the WHO, said the situation was “very worrying” and warranted the “highest level of alarm under international health law”. He emphasized the emergence of clade Ib in eastern DRC and its detection in neighboring countries.
The WHO has released $1.5 million from its contingency fund and plans to release more, he said, calling on donors to step up to meet the remaining $15 million needed for its efforts in the region finance.
Trudie Lang, a professor of global health research at the University of Oxford, said: “I’ve heard so many people refer to this as very similar to the early days of HIV.”
She said this was particularly the case because the virus appeared to be spread via sexual networks, with “vulnerable, young, exploited sex workers” at high risk. A “high level of stigma” will require public health campaigns to ensure people understand and seek treatment.
While data has yet to be analyzed and published, Lang said the frontline teams she spoke to reported a high number of pregnancy losses due to the virus, and babies being born with mpox lesions due to transmission in the uterus. There were “massive unknowns”, she said, including the number of cases outside hospitals.
Lang said: “What I’m really concerned about is the number of cases that are not serious. If people have a milder infection that may be hidden, especially if it’s a sexually transmitted genital infection, they can walk around with it.
“The big question we have is when is it most contagious, and when is it transmitted?”
Lang added that if the virus were to arrive in Europe or the US, it would likely be easily contained with vaccination, as in the 2022 mpox outbreak. “What worries me is that it will happen very quickly in Europe, but it won’t […] into these truly impoverished areas Africa.”
Dr Ayoade Alakija, the chairman of Africa Vaccine Delivery Alliance and of the diagnostics non-profit organization Find, said that if the outbreak had been in Europe, mpox would already be considered a major international health emergency. The statement, she said, “must focus minds and loosen wallets so that the response begins to recover from a sluggish”.
“There is an urgent need for more in-depth investigation to better understand mpox transmission dynamics to guide control measures and response plans, as well as improved surveillance and equitable access to vaccines, diagnostics and treatments for all affected populations. Most vaccines and treatments have been pre-ordered by rich countries and only one diagnostic test still exists,” Alakija said.
“Without equitable access to testing, it is also unclear how viruses such as HIV can affect the severity and transmission of mpox. Not focusing on tackling the virus in the DRC has almost inevitably led to spillover into neighboring countries and the longer action is delayed, the more likely it will spread in Africa and beyond.”
The public health agency Africa Centers for Disease Control and Prevention (Africa CDC) already has announced Tuesday that mpox was a public health emergency. Dr Jean Kaseya, the organization’s director-general, said the declaration was “not merely a formality” but “a clarion call to action” and justified proactive and aggressive efforts to contain and eliminate the virus.
In response to that announcement, Dr Boghuma Titanji, an assistant professor of medicine at Emory University in Atlanta in the US, said she hoped the statement would prompt African governments to allocate funds to fight the outbreak.
The African Union approved $10.4 million (£8 million) for Africa CDC’s response at the beginning of August, but Kaseya proposed the continent will need about $4 billion.
