The World Health Organization (WHO) declared the mpox outbreak in the Democratic Republic of the Congo (DRC) and other affected African countries as a Public Health Emergency of International Concern (PHEIC) on August 14, 2024.
This marked the second time in two years that the WHO called for coordinated global efforts, highlighting the urgent need for accelerated vaccine access and increased resources for surveillance and response.
Mpox has two subtypes: Clade 1, which is endemic to the Congo Basin in central Africa, and Clade 2, which is endemic to West Africa.The rise in the DR Congo is being driven by two distinct Clade 1 strains.
The first is an epidemic of Clade 1a, formerly known as Clade 1, in northwest DRC.
The second, in northeastern DRC, is a new offshoot of Clade 1 called Clade 1b, which was discovered last September and is fast spreading. The spread of Clade 1b and its identification in surrounding countries were the primary grounds for the WHO's top emergency alert.
Since January 1, 2022, all six WHO regions have been reporting mpox cases, with 116 countries involved in the ongoing global outbreak.
The rise in cases and deaths, particularly among children, has been attributed to the discontinuation of the smallpox vaccine and high malnutrition rates in the affected regions.
In a related development, Sweden confirmed its first case of mpox clade I on August 15, 2024, according to the National Institute for Communicable Diseases (NICD).
The patient, who had recently travelled to a region in Africa experiencing a large outbreak, received appropriate care in line with health guidelines. This case marked the first confirmed instance of clade I mpox outside Africa.
Africa CDC declares continental health emergency
On August 13, 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared the ongoing mpox outbreak a Public Health Emergency of Continental Security (PHECS).
This was the first such declaration by the agency, empowering Africa CDC to lead and coordinate health emergency responses across the continent.
The agency's new role includes mobilising resources, enhancing surveillance, and strengthening health systems to combat the outbreak.
Global concern
The NICD reported that African health officials observed a significant surge in mpox cases throughout 2023, warning of a high risk of transmission to neighbouring countries and beyond.
The situation has been exacerbated by the continent's lack of treatments and vaccines, making it increasingly difficult to contain the virus.
The changing dynamics of transmission and a high mortality rate have intensified concerns about the social and economic impacts of the mpox virus.
Access to essential medical countermeasures, such as diagnostics for early detection and prevention, remains a significant challenge. The outbreak poses a common threat to health and economic security, underscoring the urgent need for all African Union member states to address this growing crisis.
“The outbreak has affected 13 African countries since 1 January 2024, reporting 18 737 cases (3 101 confirmed, 16 636 suspected) and 541 deaths [case fatality ratio (CFR): 18 737/541=2.89%], namely; Burundi, Cameroon, Central Africa Republic (CAR), Congo, Cote d’ Ivoire, DRC, Ghana, Kenya, Liberia, Nigeria, Rwanda, South Africa, and Uganda have declared an outbreak of mpox,” NICD reported
Meanwhile, South Africa is currently dealing with its own mpox outbreak, caused by mpox clade II. So far, the country has not detected any cases of the more deadly clade I virus.
However, much remains unknown about the newly mutated clade Ib strain that is spreading in Central Africa.
In response to the declarations of mpox as a Public Health Emergency of International Concern (PHEIC) by WHO and a Public Health Emergency of Continental Security (PHECS) by Africa CDC, South Africa has ramped up its efforts to enhance surveillance and raise awareness about the virus.
The country is particularly focused on preventing the spread of the virus within its borders and beyond.
Given the rise in mpox cases across the continent and considering the frequent travel and trade within Africa, there have been growing calls for African countries to strengthen their existing health frameworks.
Experts have emphasised the need for improved protocols, strategies, and agreements to foster cross-border solidarity, collaboration, and coordination in tackling infectious diseases like mpox.
With the situation evolving rapidly, it is clear that a united and coordinated response is crucial for containing the outbreak and protecting public health across Africa and beyond.