Global alliance to control Mpox outbreak

Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox.’ The first human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo (DRC), which has subsequently spread to other central and western African countries. There are two known clades of the virus: clade I and clade II. The clade I, which is most frequently reported from countries in central Africa, tends to be more severe than clade II. Cameroon is the only country known to harbour both clades.

Accordingly, Monkeypox is a rare viral zoonotic disease caused by a double stranded DNA virus that belongs to the Orthopoxvirus genus of the Poxviridae family. The disease presents with symptoms similar to smallpox but with a lesser severity.

Recently, on Aug 13, 2024, the Africa Centers for Disease Control and Prevention (Africa CDC) declared mpox a public health emergency of continental security (PHECS) in Africa, acting under its mandate to address significant public health threats. This mandate was established in July, 2022, by the Executive Council of the Africa Union (AU) Assembly through its decision EX.CL/Dec.1169(XLI), empowering Africa CDC to coordinate responses to epidemics by mobilizing African leaders, governments, and relevant agencies.

The decision was driven by the worsening mpox situation on the continent since 2022, 40,874 cases and 1,512 deaths have been reported across 15 AU member states. In 2024 alone, 17,541 cases and 517 deaths have been reported from 13 AU member states. These figures represent a 160% and 19% increase in the number of cases and deaths, respectively, in 2024 compared with the same period in 2023. A 79% increase in the number of cases was observed in 2023 compared with 2022. The Democratic Republic of the Congo (DRC) accounts for 96% of all cases and 97% of all deaths reported in 2024.

Investigations in the DRC suggest that heterosexual transmission, especially among female sex workers (9%), is driving the outbreak, contrasting with the spread mainly among men who have sex with men in Europe in 2022. The high prevalence among women raises concerns about vertical transmission risks and adverse pregnancy outcomes.

The high risk of severe infection among people living with HIV, considerations for asymptomatic infections, poor vaccination strategies, limited access to medical countermeasures, and low detection rates were other concerns. The outbreak is further complicated by a high case fatality rate of over 3·9%, particularly among children younger than 15 years, who account for 60% of cases. Cross-border movements, low public awareness, high vulnerability due to factors such as HIV and malnutrition, limited understanding of mpox transmission, and insufficient response capacities, including vaccine shortages, pose significant challenges to containment. The risk of mpox spreading to neighboring countries and globally is high.

The day before the PHECS announcement, 15 of the 20-member Emergency Consultative Group (ECG) met to advise the Africa CDC Director General on whether the mpox outbreak constituted a PHECS. The group redefined PHECS as a significant event posing a risk to other countries, requiring immediate continental-level action to prevent and mitigate disease spread—expanding the original definition in the Africa CDC statute.

They also developed specific criteria to assess the situation objectively. These criteria, organized into nine areas, included: disease severity, transmission dynamics, impact on health systems, vaccine and treatment availability, public health risk, economic and social impact, public concern, global health security, and political considerations. The framework was developed to guide a transparent and consistent decision-making process for declaring a PHECS in Africa.

Currently, the Africa Centers for Disease Control and Prevention (Africa CDC) is working jointly with pertinent stakeholders in facilitating vaccinations supply to the current Mpox outbreak in some parts of Africa.

The current mpox outbreak “can be controlled and can be stopped”, the head of the World Health Organization (WHO) emphasized, announcing an action plan that calls for 135 million USD over the next six months.

“Responding to this complex outbreak requires a comprehensive and coordinated international response,” WHO Director- General Tedros Adhanom told Member States, as cases spread beyond Africa to Europe and Asia.

The briefing was held just over a week after he declared that mpox was a public health emergency of international concern.

Tedros said the global outbreak first emerged in 2022, with more than 100,000 confirmed cases reported since then. While the virus continues to circulate at low levels, Africa has seen an unprecedented increase and expansion.

Transmission is mainly centered in the Democratic Republic of the Congo (DRC), where there have been more than 16,000 suspected cases, including 575 deaths, this year alone.

The surge is being driven by two separate outbreaks of two strains of the mpox virus, or clades, and in different parts of the country.

The rapid spread of a new offshoot, clade 1b, was the main reason behind his decision to declare mpox a global public health emergency on 14 August.

“In the past month, cases of clade 1b have been reported in four countries neighboring DRC, which had not reported mpox before: Burundi, Kenya, Rwanda and Uganda. This week, cases have also been reported in Thailand and Sweden,” he said. In response, WHO and partners have developed a plan to stop outbreaks of human-to-human transmission of mpox through coordinated efforts at the global, regional, and national levels.

“Doing so requires concerted action between international agencies and national and local partners, civil society, researchers and manufacturers, and you, our Member States.”

He stressed that response must be anchored in equity, global solidarity, community empowerment, human rights, and coordination across sectors.

The Global Mpox Strategic Preparedness and Response Plan (SRSP) focuses on implementing comprehensive surveillance and response strategies, as well as advancing research and equitable access to medical countermeasures.

“Our initial estimates are that the SPRP requires approximately 135 million USD over the next six months for the acute phase of the outbreak. That amount will likely increase as we update the plan in light of growing needs,” Tedros said.

He added that, a dedicated WHO funding appeal will be released early next week.

Tedros noted that, WHO has so far released roughly 1.5 million USD from a contingency fund for emergencies, with more allocations expected in the coming days, “until funding from donors for the response comes in.”

The SPRP also calls for minimizing zoonotic transmission and empowering communities to actively participate in outbreak prevention and control.

At the global-level, emphasis is on strategic leadership, timely evidence-based guidance, and access to medical countermeasures for the most at-risk groups in affected countries.

In this regard, WHO is working with a range of international, regional, national and local partners and networks to enhance coordination across the key areas of preparedness, readiness and response.

WHO regional offices have also established Incident Management Support Teams (IMSTs) to lead preparedness and response activities, while staffing is being scaled up in affected countries.

Additionally, the Regional Office for Africa, in collaboration with the African Centers for Disease Control (CDC), will jointly spearhead the coordination of mpox response efforts, given that needs on the continents are greatest.

Meanwhile, health authorities at the national and sub-national level will adapt strategies to current epidemiological trends.

He said the agency “will coordinate the global response, working closely with each of the affected countries, to prevent transmission, treat those infected, and save lives.”

BY TEWODROS KASSA

THE ETHIOPIAN HERALD THURSDAY 29 AUGUST 2024

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