The World Health Organization (WHO) has declared the recent mpox (formerly known as monkeypox) outbreak in Africa a public health emergency of international concern as a new strain (clade) of the virus spreads.  

WHO’s Director-General Dr. Tedros Adhanom Ghebreyesus has determined that the upsurge of mpox in the Democratic Republic of the Congo (DRC) and a growing number of countries in Africa constitutes a PHEIC under international health regulations. 

“The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighboring countries are very worrying,” said Dr Tedros, in declaring the PHEIC, in an August 14, 2024, statement. “On top of outbreaks of other mpox clades in DRC and other countries in Africa, it’s clear that a coordinated international response is needed to stop these outbreaks and save lives.” 

Dr. Tedros’s declaration came on the advice of WHO’s  International Health Regulation Emergency Committee, composed of independent experts, who met earlier this week to review data presented by experts from WHO and affected countries. The Committee informed the Director-General that it considers the upsurge of mpox to be a PHEIC, with potential to spread further across countries in Africa and possibly outside the continent. The Director-General will share the report of the Committee’s meeting and, based on the advice of the Committee, issue temporary recommendations to countries. 

This PHEIC determination is the second in two years relating to mpox. Caused by an orthopoxvirus, mpox was first detected in humans in 1970, in the DRC. The disease is considered endemic to countries in central and west Africa. In July 2022, a multi-country outbreak of mpox was declared a PHEIC as it spread rapidly via sexual contact across a range of countries where the virus had not been seen before. That PHEIC was declared over in May 2023 after there had been a sustained decline in global cases. 

“The current upsurge of mpox in parts of Africa, along with the spread of a new sexually transmissible strain of the monkeypox virus, is an emergency, not only for Africa, but for the entire globe,” said IHR Committee Chair Professor Dimie Ogoina, in a August 14, 2024, statement. “Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself.” 

Mpox has been reported in the DRC for more than a decade, and the number of cases reported each year has increased steadily over that period, according to WHO. Last year (2023), WHO said that the reported cases increased “significantly” and already the number of cases reported so far this year (2024) has exceeded last year’s total, with more than 15,600 cases and 537 deaths. 

The emergence last year and rapid spread of a new virus strain in DRC, Clade 1b, which appears to be spreading mainly through sexual networks, and its detection in countries neighboring the DRC is especially concerning, according to WHO, and is one of the main reasons for the declaration of the PHEIC. 

Over the past month, over 100 laboratory-confirmed cases of Clade 1b have been reported in four countries neighboring the DRC that have not reported mpox before: Burundi, Kenya, Rwanda, and Uganda. Experts believe the true number of cases to be higher as a large proportion of clinically compatible cases have not been tested, according to WHO. Several outbreaks of different clades of mpox have occurred in different countries, with different modes of transmission and different levels of risk. 

The two vaccines currently in use for mpox are recommended by WHO’s Strategic Advisory Group of Experts on Immunization and are also approved by WHO-listed national regulatory authorities as well as by individual countries, including Nigeria and the DRC. 

Process for potential supply pacts put into motion 
Last week, WHO’s Director-General triggered the process for Emergency Use Listing for mpox vaccines, which will accelerate vaccine access for lower-income countries that have not yet issued their own national regulatory approval. Emergency Use Listing also enables partners, including Gavi, a public-private global health partnership, and the United Nations’ UNICEF to procure vaccines for distribution. 

WHO said it is working with countries and vaccine manufacturers on potential vaccine donations and is coordinating with partners through the interim Medical Countermeasures Network to facilitate equitable access to vaccines, therapeutics, diagnostics, and other tools. 

WHO anticipates an immediate funding requirement of an initial $15 million to support surveillance, preparedness, and response activities. A needs assessment is being undertaken across the three levels of WHO. 

Source: World Health Organization