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As Africa’s mpox epidemic gathers pace, the world has another opportunity to demonstrate collective commitment to tackling an international health crisis. The challenge is to provide effective diagnostics, vaccines and treatments to regions with poor medical infrastructure — and to do so more promptly and efficiently than during the Covid-19 pandemic and previous outbreaks of viral infection.
The signs so far are not encouraging. The World Health Organization first declared mpox, previously known as monkeypox, to be a public health emergency of international concern in 2022. That outbreak, transmitted mainly by sexual contact, ebbed sufficiently for the WHO to let its emergency call lapse last year, before significant steps had been taken to develop tools to tackle the disease.
This year mpox has surged back, driven by a new viral variant called clade 1b, which seems to cause more severe symptoms and to be more transmissible, particularly to children. Almost 4,000 cases and about 80 deaths have been reported in the past week, according to the Africa Centres for Disease Control and Prevention, bringing the total recorded in the current outbreak above 22,000 cases and 600 deaths.
With the world little better prepared than in 2022, the WHO has revived its emergency declaration and this week launched a strategic response plan, which it said would cost $135mn over the next six months, plus $100mn to $150mn to buy 2mn doses of vaccine. Donors — public, private and philanthropic — should not hesitate to provide the funds required to implement this well-prepared programme.
Although the virus was first discovered in 1958 in captive monkeys and detected in a human patient in 1970, remarkably little is known about mpox. “In Africa we are working blindly,” Dimie Ogoina of Nigeria, who chairs the WHO mpox emergency committee, said this week.
Besides physical assistance in the form of diagnostics, medicines and vaccines, a global scientific effort is needed to investigate the epidemiology, routes of transmission, symptoms and genetic evolution of mpox. Robust surveillance systems must be set up, especially in sub-Saharan Africa where the virus is endemic in wild animals. Symptoms are sometimes confused with other infections that cause fever and skin lesions such as chickenpox, so health workers need access to diagnostic facilities where samples can be tested quickly.
No antiviral medicine works well to treat mpox but vaccines originally developed for smallpox, a closely related virus, can prevent infection. The supply of these mpox vaccines — made by Denmark’s Bavarian Nordic and Japan’s KM Biologics — to Africa has so far been lamentably slow, held up by regulatory and administrative hitches as well as funding shortages, though wealthy countries are at last beginning to pledge doses from their stockpiles.
The pledges should be turned into firm donations and the required vaccination infrastructure set up without delay. It would make sense to give scarce supplies first to essential health workers, then there could be “ring vaccination” with jabs offered to contacts of confirmed mpox patients. After the vaccines’ safety and efficacy have been confirmed, there could then be a campaign to inoculate infants and children.
Mpox is very unlikely to mutate into a form that could cause a global pandemic on the scale of Covid or Aids, though this is not completely out of the question. But high-income countries must rise to the task of helping those with fewer health resources prevent what threatens to become a regional disaster. Their failure to share vaccines and other countermeasures against Covid caused understandable resentment. Both equity and self-interest demand a much better response to mpox.
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