The World Health Organization on Wednesday finally declared the spread of mpox in some African countries a public health emergency of international concern.
The declaration comes hot on the heels after the Africa CDC declared the disease a Public Health Emergency of Continental Security (PHECS).
The decision from WHO came following the advice the UN health arm’s Director General Dr Tedros Ghebreyesus got from a panel of experts on the disease.
“Today, the Emergency Committee on #mpox met and advised me that in its view, the situation constitutes a public health emergency of international concern. I have accepted that advice.
“@WHO is on the ground, working with the affected countries, and others at risk, through our country and regional offices, as well as with partners including the @AfricaCDC, NGOs, civil society and more,” he said on the microblogging site X (formerly Twitter.
Mpox is caused by a virus in the same family as smallpox, a virus that was declared eradicated in 1980. The virus, which is believed to be carried by small rodents in some countries in Africa, causes painful scarring rashes when contracted by people. People with mpox can also experience fever, muscle aches, headaches, and respiratory symptoms. The infection is especially dangerous in young children — most mpox deaths occur in young children — and people with compromised immune systems.
A public health emergency of international concern, or PHEIC, can be called in response to a disease event in which risk of cross-border spread is considered high and international cooperation will likely be needed to contain the threat. In this case, cross-border transmission has already occurred multiple times. The declaration of a PHEIC gives the WHO director-general the authority to issue what are known as temporary recommendations — guidance to countries on steps they should take to address the problem.
Some of the cases in Africa — notably in South Africa and in the Ivory Coast — are being caused by the version of the virus that sparked the earlier mpox PHEIC, which ran from late July 2022 through mid-May 2023. That strain of the virus became known as clade IIb. This earlier outbreak, which has involved extensive person-to-person transmission, is believed to have begun in Nigeria perhaps as early as 2015. It was the first time ongoing person-to-person spread of mpox was recorded. That transmission was primarily through sexual contact, which also had not been previously reported as a way the virus could be spread.
That outbreak, which was first detected in the United Kingdom in early May 2022, saw transmission primarily occur among gay, bisexual, and other men who have sex with men. It has not stopped, with nearly 100,000 cases reported by 116 countries since spread was first recognized. But in many places the rate of new infections has slowed considerably from the peak of the outbreak in the summer of 2022.
At least 13 African countries, including previously unaffected nations like Burundi, Kenya, Rwanda, and Uganda, have reported Mpox outbreaks. So far in 2024, these countries have confirmed 2,863 cases and 517 deaths, primarily in the Democratic Republic of the Congo (DRC). Suspected cases across the continent have surged past 17,000, a significant increase from 7,146 cases in 2022 and 14,957 cases in 2023. This is just the tip of the iceberg when we consider the many weaknesses in surveillance, laboratory testing and contact tracing.
The trigger for the new PHEIC is a situation that was first observed last September in the Democratic Republic of the Congo, one of the countries where mpox is endemic. The version of the virus that transmits in the DRC is known as clade I. It has been seen to cause more severe disease than clade II and clade IIb viruses.
Mpox transmission in the DRC has traditionally involved small children who become infected when they trap and handle the rodents believed to carry the virus. Infected children may also infect others within their households.
