An outbreak of mpox, the disease formerly known as monkeypox, in Africa resembles the early days of HIV, scientists say. The World Health Organization has declared the outbreak a public health emergency.
Medical experts urge the declaration to accelerate access to tests, vaccines and therapeutic drugs in affected areas and launch campaigns to reduce stigma surrounding the virus.
More research resources were also vital, they said, with “huge unknowns” about a new variant spreading between people in the Democratic Republic of 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 this year alone.
These include clades I and II of the virus, as well as a new type, clade Ib – an offshoot of clade I, which appears to be driving the outbreak in the DRC and neighbouring countries, and to which children appear to be 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 outbreaks of Ebola, Covid-19 and a 2022 MPOX surge in Europe.
Tedros Adhanom Ghebreyesus, the WHO director-general, said the situation was “deeply worrying” and warranted the “highest level of alarm under international health law.” He highlighted the emergence of clade Ib in eastern DRC and its detection in neighboring countries.
WHO has released $1.5 million from its emergency fund and plans to release more, he said. He called on donors to finance the remaining $15 million needed for WHO’s efforts in the region.
Trudie Lang, professor of global health at the University of Oxford, said: “I’ve heard so many people say this is very much like the early days of HIV.”
She said this was particularly the case because the virus appeared to be spreading through sexual networks, with “vulnerable, young, exploited sex workers” at high risk. A “high stigma” would require public health campaigns to ensure people understood and sought treatment.
While the data has yet to be analyzed and published, Lang said frontline teams she spoke to were reporting high rates of pregnancy loss due to the virus, and babies were being born with MPOX lesions due to in utero transmission. There were “huge unknowns,” she said, including the number of cases occurring outside of hospitals.
Lang said: “What I’m really concerned about is the number of cases that are not severe. If people have a milder infection that may be hidden, particularly if it’s a sexually transmitted genital infection, they may be walking around with it.
“The big question 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 could likely be easily contained with vaccination, as was the case with the MPOX outbreak in 2022. “What worries me is that that will happen very quickly in Europe, but not (…) in these really impoverished areas of Africa.”
Dr Ayoade Alakija, chair of the Africa Vaccine Delivery Alliance and the diagnostics non-profit Find, said that if the outbreak had been in Europe, mpox would already have been declared a major international health emergency. The declaration, she said, “should focus attention and open the money tap so that the response can recover from a slow start”.
“There is an urgent need for more in-depth research to better understand the dynamics of mpox transmission to guide control 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 exists so far,” Alakija said.
“Without equitable access to testing, it is also unclear how viruses like HIV might influence the severity and transmission of mpox. Failure to focus on tackling the virus in the DRC has almost inevitably led to spillover into neighbouring countries, and the longer action is delayed, the more likely it is to spread across Africa and beyond.”
The public health agency Africa Centres for Disease Control and Prevention (Africa CDC) had already declared on Tuesday that mpox was a public health emergency. Dr Jean Kaseya, the agency’s director-general, said the declaration was “not just a formality” but “a clear call to action” and warranted proactive and aggressive efforts to contain and eliminate the virus.
Dr Boghuma Titanji, assistant professor of medicine at Emory University in Atlanta, USA, responded to the announcement by saying she hopes the statement will prompt African governments to release funds to combat the outbreak.
The African Union approved $10.4 million (£8 million) for Africa CDC’s response in early August, but Kaseya has suggested The continent needs about $4 billion.