Mostly centred in the Democratic Republic of Congo DRC) and its African neighbours, the current outbreak of mpox has been declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO).
The declaration has sparked fears of a wider spread of the infectious disease, like the one seen in 2022, which saw cases reach 122 countries in total. Patients with mpox usually present with symptoms of a fever, along with a painful rash and enlarged lymph nodes.
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There are two clades of mpox: clade I and clade II. Endemic to Central Africa, clade 1 is the more deadly, causing a severe illness and – in past outbreaks – killing up to 10% of those who become unwell. clade II, on the other hand, has a survival rate of over 99.9% and is endemic to West Africa; it was clade II that spread in the major global outbreak in 2022.
The disease is spread through close, physical contact with an infected person or animal. Skin-to-skin contact with someone suffering from an mpox rash or scab will cause infection, as will contact with bodily fluids. The virus can also spread through contact with contaminated materials, including clothing or bedding, or through bites and scratches from an infected animal.
Where is mpox the biggest threat?
Mpox is primarily a threat to communities in West and Central Africa, but an outbreak of a new rapidly-spreading strain – clade 1b – has spread as far as Thailand and Sweden. It has also been detected in the the DRC, as well as in Burundi, Kenya, Rwanda and Uganda.
The current outbreak started in the DRC, where mpox is endemic. Since January 2023, the country has reported over 27,000 mpox cases, and 1,300 deaths. Not all cases of this outbreak are of the 1b strain, but a lack of vaccines and poor health infrastructure across impacted African countries is leaving impoverished communities particularly at risk.
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By GlobalDataBronwyn Nichol, senior officer of public health in emergencies at the International Federation of Red Cross and Red Crescent Societies (IFRC) tells Medical Device Network that, “Geographically, this outbreak is still at its worst in the Democratic Republic of Congo, where more than 90% of cases have been. But it is spreading to other countries in the region.
“The new clade 1b variant is affecting people of all ages and backgrounds, including those previously unexposed to zoonotic sources. But those for whom the consequences are most serious are the immunocompromised, those with limited access to healthcare, including marginalised grounds and those in communities where people live in very close proximity to one another or with poor sanitation. The worry at the moment is the spread to previously non-endemic countries in East Africa.”
How likely is an mpox pandemic?
The mpox outbreak is largely on the African continent, but cases have been reported in four additional countries: Thailand, Sweden, Pakistan and the Philippines. With Covid-19 fresh in minds across the world, the spread has sparked fear of another pandemic.
However, Dr Marc-Alain Widdowson, high-threat pathogens lead, at the Europe branch of the WHO tells Medical Device Network that, “Based on what we know right now, mpox should not become a global pandemic. Mpox is not the new Covid-19. It is not a respiratory virus and is much harder to contract than Covid-19.
“That said, the redeclaration of mpox as a global health emergency by the Director-General last week, is a wakeup call for European countries not to drop the ball and pretend like mpox has gone away – it hasn’t. Surveillance, testing, contact tracing and isolation of cases, must be ramped up, if we are to control and eventually eliminate mpox from the European Region, which isn’t new to mpox. We know what we need to do to find, isolate and treat mpox cases.”
The WHO Director-General Dr Tedros Adhanom Ghebreyesus declared the mpox outbreak to be a Public Health Emergency of International Concern (PHEIC) on 14 August, the day after the Africa Centres for Disease Control and Prevention (CDC) declared a Public Health Emergency of Continental Security (PHECS).
In declaring mpox to be a PHEIC, Dr Ghebreyesus said that “The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighbouring countries are very worrying. 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.”
What next for tackling the mpox threat?
Better provisions are urgently needed in the DRC, and other countries in which mpox is endemic. WHO’s Director-General has already triggered the process for Emergency Use Listing for mpox vaccines, enabling lower-income countries to access vaccines which are yet to receive national regulatory approval in their own countries. The listing also enables partners (such as UNICEF) to procure vaccines for distribution.
However, vaccines are expensive – around $200 per course – and there is urgent need for international collaboration if the spread is to be stopped at the source. Nichol tells Medical Device Network that “The international community must provide increased access to vaccines, testing, and treatment, along with supporting sustained community-based actions to reduce stigma, improve early detection, and contain the outbreak.”
To combat the current outbreak, an estimated 10 million vaccines are needed across Africa. As a result, Japan – where mpox vaccine manufacturer KM Biologics is based – has pledged 3 million vaccines. The European Union and the vaccine maker, Bavarian Nordic have promised 215,000, and US-based Emergent 50,000.
However, the vaccines are yet to arrive, and their absence is exacerbated by the broader health inequalities. Dorien Braam, assistant professor in social science at LSHTM and member of the UK-Public Health Rapid Support Team (UK-PHRST), has pointed out that “Health inequalities through a lack of access to health services, medication or endemic diseases also make people vulnerable, including children, who constitute a majority of community-transmitted cases in some parts of DRC and Burundi…
“Faced with a global shortage of mpox vaccines, international collaboration is also crucial, to address global health inequalities and promote the fair sharing of limited supplies.”
Will mpox become a threat in Europe?
Speaking to Medical Device Network, WHO’s Widdowson says that mpox “is a potential public health threat to Europe and the world, but at this stage the general public health risk remains low.
“This threat is not like Covid-19. Firstly – we have had over 27,000 cases of mpox already in our communities since 2022 and we have not seen widespread outbreaks but were able to reduce the number of new infections with effective community and public health measures.”
The mpox threat is small then, but emphasises the importance of preparedness and a swift response. During the 2022 outbreak, Europe experienced 10 deaths from the less-deadly clade II strain of the mpox virus. Of the 27,000 cases in the region, Spain, France and the UK were three of the hardest hit countries, with 8,084, 4,272 and 3,952 cases respectively, according to data provided by the US Centres for Disease Control and Prevention. Spain had the highest number of deaths of any European country, with three.
The advice in 2022 remains relevant now, and Widdowson explains how the outbreak will be managed: “there are simple behaviours which we already effective back in 2022, such as practicing safer sex including reducing the number of sexual partners, as well as isolating, notifying contacts and seeking for medical assistance in case of signs.”
Responsibilities lie with health authorities too, with lessons learnt from navigating the Covid-19 pandemic: “public health authorities throughout Europe must strengthen surveillance for mpox including testing for the new strain and ensuring access to care and diagnosis to anyone who thinks they may need it. This will allow for quick identification and then isolation, contact tracing and treatment if needed. There are also vaccines that are recommended for high-risk individuals which currently are largely in the MSM community.”
