Scientists have warned that the outbreak of mpox, previously known as monkeypox, in Africa resembles the initial stages of the HIV epidemic. This announcement comes as the World Health Organization (WHO) declared the outbreak a public health emergency. Medical experts urge this declaration should accelerate access to testing, vaccines, and treatments in the affected areas and initiate campaigns to reduce the stigma surrounding the virus.
Additionally, experts emphasize the critical need for more research resources, citing significant unknowns about a new variant spreading among people in the Democratic Republic of the Congo (DRC). As of August 4, there have been 38,465 mpox cases and 1,456 deaths in Africa since January 2022, with the DRC alone accounting for over 14,000 cases and 524 deaths this year. The outbreak includes virus clades I and II and a new type, clade Ib, a sub-branch of clade I, which seems to be driving the outbreak in the DRC and neighboring regions, and to which children appear particularly susceptible.
The WHO has classified the outbreak as a “public health emergency of international concern,” a status previously applied to outbreaks like Ebola, Covid-19, and the mpox surge in Europe in 2022. WHO Director-General Tedros Adhanom Ghebreyesus expressed grave concern, calling the situation “very worrying” and demanding the “highest level of alarm under international health law.” He noted the emergence of clade Ib in eastern DRC and its detection in neighboring countries. The WHO has released $1.5 million from its contingency fund and plans to release more, urging donors to contribute to the $15 million needed for its regional efforts.
Trudie Lang, a global health research professor at Oxford University, remarked, “I have heard so many people refer to this as being very similar to the early days of HIV.” Lang noted the virus appears to be spreading through sexual networks, putting “vulnerable, young, exploited sex workers” at high risk. She stressed the need for public health campaigns to combat the “high level of stigma” and ensure people seek treatment.
While the data has yet to be thoroughly analyzed and published, Lang reported that frontline teams have observed a high number of pregnancy losses due to the virus and babies born with mpox lesions because of in-womb transmission. There are many unknowns, including the number of cases outside of hospitals. Lang expressed concern about the potential for milder infections to go undetected, particularly if the virus is transmitted sexually, which could allow individuals to spread the infection without realizing it.
“The big question that we’ve got is when is it most infectious, and when is it being transmitted?” Lang said. She added that if the virus reached Europe or the US, it could likely be easily contained with vaccination, as seen in the 2022 mpox outbreak. However, she worries that while this could happen quickly in Europe, impoverished regions in Africa might not receive the same swift response.
Dr. Ayoade Alakija, chair of the Africa Vaccine Delivery Alliance and of the diagnostics non-profit organization Find, stated that if the outbreak were in Europe, mpox would have been deemed a major international health emergency sooner. She hopes the declaration will “focus minds and loosen purse strings so that the response recovers from a sluggish start.”
Dr. Alakija emphasized the need for a deeper investigation into mpox transmission dynamics to guide control and response plans, along with enhanced surveillance and equitable access to vaccines, diagnostics, and treatments for all affected populations. She noted that most vaccines and treatments have been pre-ordered by wealthy countries, and currently, only one diagnostic test exists. Without fair access to testing, it’s unclear how viruses like HIV may affect the severity and transmission of mpox. The lack of focus on addressing the virus in the DRC has likely led to its spread to neighboring countries, and delayed action increases the likelihood of it spreading further in Africa and beyond.
The Africa Centres for Disease Control and Prevention (Africa CDC) had previously declared mpox a public health emergency. Dr. Jean Kaseya, the director general of Africa CDC, stated that the declaration is “not merely a formality” but “a clarion call to action,” necessitating proactive and aggressive efforts to contain and eliminate the virus. Responding to the announcement, Dr. Boghuma Titanji, an assistant professor of medicine at Emory University in Atlanta, expressed hope that the declaration would prompt African governments to allocate funds to combat the outbreak.
In early August, the African Union approved $10.4 million (£8 million) for the Africa CDC’s response. However, Dr. Kaseya estimates that the continent will require approximately $4 billion to address the outbreak effectively.
