WHO declares Mpox outbreaks in Africa a global health emergency

LONDON — The World Health Organization has declared smallpox outbreaks in Congo and other parts of Africa a global emergency, with confirmed cases among children and adults in more than a dozen countries and a new form of the virus spreading. Few vaccine doses are available on the mainland.

Earlier this week, the African Centers for Disease Control and Prevention announced that the mpox outbreak was a public health emergency, with more than 500 deaths, and called for international help to stop the spread of the virus.

“This is something that should concern us all… The potential for further spread beyond Africa and beyond is very concerning,” said WHO Director-General Tedros Adhanom Ghebreyesus.

The Africa CDC previously said mpox, also known as monkeypox, has been detected in 13 countries this year and that more than 96 percent of all cases and deaths are in Congo. Cases are up 160% and deaths are up 19% compared to the same period last year. So far, there have been more than 14,000 cases and 524 people have died.

“We are now in a situation where (pox) is a risk to several neighbors in and around central Africa,” said Salim Abdool Karim, an infectious disease expert in South Africa who heads the Africa Emergency Group CDC. He noted that the new version of mpox spreading from the Congo appears to have a fatality rate of about 3-4%.

During the 2022 global mpox outbreak, which affected more than 70 countries, less than 1% of people died.

Michael Marks, professor of medicine at the London School of Hygiene and Tropical Medicine, said declaring mpox outbreaks in Africa was a justified emergency if it could lead to more support to contain them.

“It is a failure of the global community that things had to get so bad to release the necessary resources,” he said.

Officials at the Africa CDC said nearly 70 percent of Congo’s cases are in children under 15, who also accounted for 85 percent of the deaths.

Jacques Alonda, an epidemiologist working in Congo with international charities, said he and other experts were particularly concerned about the spread of mpox in refugee camps in the country’s conflict-ridden east.

“The worst case we’ve seen is a six-week-old baby who was only two weeks old when he contracted mpox,” Alonda said, adding that the baby had been in their care for a month. “He became infected because overcrowding at the hospital meant he and his mother were forced to share a room with someone else who had the virus, who had not been diagnosed.”

Save the Children said Congo’s health system had already “collapsed” under the strain of malnutrition, measles and cholera.

WHO Director-General Tedros Adhanom Ghebreyesus said officials were dealing with multiple mpox outbreaks in different countries with “different modes of transmission and different levels of risk”.

The UN health agency said mpox was recently identified for the first time in four East African countries: Burundi, Kenya, Rwanda and Uganda. All these outbreaks are related to the one in Congo. In Ivory Coast and South Africa, health authorities reported outbreaks of a different and less dangerous version of mpox that spread worldwide in 2022.

Earlier this year, scientists reported the emergence of a new form of the deadly form of mpox, which can kill up to 10 percent of people, in a Congolese mining town that they feared could spread more easily. Mpox is mainly spread through close contact with infected people, including sex.

Unlike previous outbreaks of mpox, where lesions were seen mostly on the chest, hands and feet, the new form causes milder symptoms and lesions on the genitals. This makes it harder to identify, meaning people could also infect others without knowing they are infected.

In 2022, the WHO declared mpox a global emergency after it spread to more than 70 countries that had not previously reported mpox, mainly affecting gay and bisexual men. Before this outbreak, the disease was seen mostly in sporadic outbreaks in Central and West Africa, when people came into close contact with infected wild animals.

Western countries have largely stopped the spread of mpox with vaccines and treatments, but very few of these have been available in Africa.

Marks of the London School of Hygiene and Tropical Medicine said that in the absence of mpox vaccines licensed in the West, officials might consider inoculating people against smallpox, a related disease. “We need a large amount of vaccine so we can vaccinate the most at-risk populations,” he said, adding that would mean sex workers, children and adults living in outbreak regions.

Congolese authorities said they had requested 4 million doses of the smallpox vaccine, Cris Kacita Osako, coordinator of the Monkeypox Response Committee in Congo, told The Associated Press. Osako said these will be used mainly for children under 18.

“The United States and Japan are the two countries that have positioned themselves to provide vaccines to our country,” Osako said.

Although the WHO’s emergency declaration is intended to spur donor agencies and countries to action, the global response to previous emergency designations has been mixed.

Dr. Boghuma Titanji, an infectious disease expert at Emory University, said the latest WHO emergency declaration for mpox “did very little to move the needle” on getting things like diagnostic tests, drugs and vaccines to Africa.

“The world has a real opportunity here to act decisively and not repeat the mistakes of the past, (but) that will require more than an (emergency) declaration,” Titanji said.

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Associated Press writers Gerald Imray in Cape Town, South Africa, Christina Malkia in Kinshasa, Congo and Mark Banchereau in Dakar, Senegal contributed to this report.