The world has reacted too slowly to the new MPOX outbreak – here’s what to do now | Mona Taker
OOver the past year, cases of a new strain of mpox known as clade 1b began to rise significantly in Central Africa, leading the World Health Organization (WHO) to declare its highest alert and declare mpox a public health emergency of international importance. In the past month, this strain has been detected in Britain, the US, Germany, Sweden and India.
The first 100 days of an outbreak are critical to determine its course. In 2021, in response to the Covid-19 pandemic, the 100 Days Mission was agreed by global leaders – meaning they have committed to rolling out safe, effective and affordable tests, treatments and vaccines within 100 days of a pandemic threat being identified.
The International Pandemic Preparedness Secretariat is an independent, time-limited entity established to support the implementation of the mission. We have been monitor closely the status of tests, treatments and vaccines since the clock for mpox started ticking. This week marks 100 days since the WHO declaration – but has the world done enough to achieve the 100 Day Mission for the disease?
There have been some winning moments. The Africa Centers for Disease Control (Africa CDC) spoke up continental alarm for mpoxdemonstrating regional leadership. We have seen accelerated regulatory approvals for vaccines and commitments for vaccine donations from several countries. This has been possible thanks to the development of vaccines between outbreaks, which has allowed us to respond more flexibly to potential threats.
However, vaccines alone cannot end outbreaks. Despite ongoing vaccination campaigns, mpox continues to do so spread all over the world.
The true number of cases is likely masked by testing challenges. Effective and accessible tests are crucial for early detection and containment of diseases. On day zero, the only approved testing for MPox had to be done in a laboratory, conditions likely inaccessible in remote areas. Africa CDC aims to test 80% of suspected cases. However, as of this week only 36% of suspected cases had been tested in the DRC. It may take two to three days for laboratory results to be available. By then, an infected person can infect close contacts.
The WHO has done this to increase accessibility authorized a test that can be performed without a laboratory, near where doctors see cases, for emergency use in affected countries, and also provides faster results. Africa CDC has purchased 42,000 test kits to increase local testing capacity and support decentralization. The Innovative New Diagnostics Foundation (Find), the diagnostics alliance, has done this analyzed more than 200 types of tests, and more than 70 from developers evaluated to identify promising point-of-care, antigen-based rapid diagnostic tests (RDTs), which could be used in a similar way to the rapid Covid tests we use familiar with. However, currently few of these tests have the sensitivity levels to meet WHO standards.
To summarize: at day 100 we still don’t have a WHO-approved antigen-based RDT, or true point-of-care tests that can distinguish between mpox clades (i.e. which type it is) and which can be used easily. in rural communities. Without testing at the community level, efforts to monitor and contain the spread will be hampered. Until then, we need to decentralize laboratory testing to districts and strengthen human and infrastructural testing capacity.
There is some hope that treatments used for other diseases could be repurposed for MPOX as clinical trials are conducted and monoclonal antibody drugs are explored. But the reality is that after 100 days there is no longer a cure available for the new variant. For people who cannot use or access vaccines, treatments are crucial, but due to lack of funding and political attention, very few drugs are being developed for pandemic-prone diseases. Efforts are being made to address this through the branch of a coalition for the development of therapeutic agents – although this will be a long road, as most candidate treatments are still in the preclinical phase.
The mission may not be complete yet, but we won’t give up. The longer MPox is in circulation, the greater the risk that new variants will threaten the efficacy of existing vaccines and tests and treatments in development. Leaders must actively commit to the equitable rollout of promised vaccines and implementing community-based public health measures. They should accelerate access to promising point-of-care tests that identify different MPox strains and accelerate evaluation of repurposed treatments, while also investing in the development of new treatments and committing to expanding and accelerating of clinical trials for promising drugs that emerge.
Mpox tests our resolve and our preparedness. Despite the progress, the sad reality is that if we had learned and enshrined the lessons of previous emergencies, We could have responded faster. This is the second MPOX emergency in two years. If we had accelerated research and development in 2022, we might now have many more tools at our disposal.
Pandemic risk yes changeand outbreaks are no longer rare events. This becomes even more apparent with the recent one overflow of H5N1, a subtype of influenza, from animals to humans; the largest recorded outbreak from dengue; and the spread of Marburg virus disease.
The 100 Day Mission provides a framework to protect people and countries in this interconnected world. But the work must start well before day zero. It is the marathon before the sprint, and all sectors and levels of government must participate in this global effort.
Together we can make pandemics history, but are we prepared to do so?
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