WHO declares mpox outbreak a global health emergency

World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus announced that the upsurge of mpox in the Democratic Republic of the Congo (DRC) and a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC) under the International Health Regulations (2005) (IHR).

The WHO said that Dr Tedros’s declaration came on the advice of an IHR Emergency Committee of independent experts who met earlier in the day 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 WHO will share the report of the Committee’s meeting and, based on the advice of the Committee, issue temporary recommendations to countries.

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… pic.twitter.com/u2DSV6fitj

— Tedros Adhanom Ghebreyesus (@DrTedros) August 14, 2024

In declaring the PHEIC, Dr Tedros said, “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.”

There have been more than 15,000 suspected cases of mpox in Africa this year and 537 deaths, mainly among children in Congo, according to Africa CDC. The viral infection is usually mild but can kill, and causes flu-like symptoms and pus-filled lesions.

A new offshoot of the virus has caused outbreaks in refugee camps in the east of Congo this year, and spread to Uganda, Burundi, Rwanda and Kenya for the first time.

Ivory Coast and South Africa are also experiencing outbreaks linked to a different strain of the virus, which spread globally in 2022. This outbreak prompted WHO to declare a global emergency before ending it 10 months later.

WHO Regional Director for Africa Dr Matshidiso Moeti said, “Significant efforts are already underway in close collaboration with communities and governments, with our country teams working on the frontlines to help reinforce measures to curb mpox. With the growing spread of the virus, we’re scaling up further through coordinated international action to support countries bring the outbreaks to an end.”

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. Last year, reported cases increased significantly, and already the number of cases reported so far this year has exceeded last year’s total, with more than 15 600 cases and 537 deaths.

New strain of mpox

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 neighbouring the DRC is especially concerning, and one of the main reasons for the declaration of the PHEIC.

In the past month, over 100 laboratory-confirmed cases of clade 1b have been reported in four countries neighbouring 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.

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.

Last week, the Director-General triggered the process for Emergency Use Listing for mpox vaccines, which will accelerate vaccine access for lower-income countries which have not yet issued their own national regulatory approval. Emergency Use Listing also enables partners including Gavi and UNICEF to procure vaccines for distribution.

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

Experts hoped the meetings would galvanise action worldwide, many obstacles remain, including limited vaccine supply, funding and competing disease outbreaks.

“It is important to declare an emergency because the disease is spreading,” said Jean-Jacques Muyembe-Tamfum, head of Congo’s Institut National pour la Recherche Biomedicale (INRB). He said he hoped any declaration would help provide more funding for surveillance as well as supporting access to vaccines in Congo.

But he acknowledged the road ahead was not easy in a huge country where health facilities and humanitarian funds are already stretched by conflict and outbreaks of diseases like measles and cholera.

“If the big declarations remain just words, it won’t make any material difference,” said Emmanuel Nakoune, an mpox expert at the Institut Pasteur de Bangui in Central African Republic.

Africa CDC said last week it had been granted $10.4m in emergency funding from the Africa Union for its mpox response, and its director general Jean Kaseya said on Tuesday there was a clear plan to secure 3 million doses of vaccine this year, without elaborating further.

However, sources involved in planning a vaccination roll-out in Congo said only 65,000 doses were likely to be available in the short-term, and campaigns were unlikely to begin before October at the earliest.

Then, two vaccines were used – Bavarian Nordic’s Jynneos, and LC16, made by KM Biologics. Outside clinical trials, neither has ever been available in Congo or across Africa, where the disease has been endemic for decades. Only LC16 is approved for use in children.

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