Mpox outbreak: Why has the world reacted so slowly?

Aug. 20, 2024, 12:30 p.m.

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Despite the World Health Organization declaring mpox a global health emergency last week, the international response has been sluggish.

A new variant of mpox has been circulating in the Congo for several months.

The vast central African nation has recorded 96 percent of the world’s approximately 17,000 mpox cases this year.

It has also recorded 500 deaths.

Adding to the challenge, the country still lacks a single vaccine.

Advertisement Let’s examine the reasons behind the world's slow reaction to mpox:

Origins

According to Bloomberg, the current mpox crisis is rooted in the previous emergency.

In 2022, mpox outbreaks erupted in over 70 nations worldwide, including the United States, prompting the WHO to declare a global health emergency.

According to Wired, as of a certain point in time, there were 92,783 confirmed instances of mpox across 116 nations, resulting in 171 fatalities.

The 2022 global outbreak primarily impacted gay and bisexual men.

“Ninety-five percent of the cases during the 2022 outbreak were among men who have sex with men, reporting exposure through sexual or close contact with another infected individual,” Boghuma Titanji, an associate professor in infectious diseases at Emory University, stated to Wired.

“It was an outbreak that was highly concentrated, which enabled the prioritization of vaccinations within that network.”

There are two types of mpox – clade 1 and clade 2.

The 2022 outbreak was the latter.

“The 2022 global outbreak belonged to clade 2, and the mortality rate was less than 1 percent,” Jean Nachega, a Congolese infectious disease physician and an associate professor of medicine at the University of Pittsburgh, informed Wired.

The World Health Organization (WHO) declared the recent mpox outbreak a public health emergency of international concern following the identification of a new variant of the virus. Reuters It was largely contained within months in affluent countries through the use of vaccines and treatments, but limited doses were made available to Africa.

In May 2023, the World Health Organization (WHO) announced the end of mpox as a global health emergency.

At the time, Bloomberg cited the Africa Centers for Disease Control and Prevention, stating that the continent didn't receive adequate support.

Resurgence

Then, earlier this year, a new and potentially more contagious strain of mpox was first identified in a mining town in eastern Congo, roughly 450 kilometers south of Goma.

Mahoro Faustin, who manages the Bulengo camp in the region that's effectively the epicenter of a series of mpox outbreaks in Africa, said that about three months ago, officials first began noticing individuals in the camp exhibiting fever, body aches, and chills – symptoms that could point to malaria, measles, or mpox.

It’s uncertain how much the new variant is to blame, but Congo is experiencing its worst outbreak yet and at least 13 African countries have reported cases, four of them for the first time.

The outbreaks in these four nations — Burundi, Kenya, Rwanda, and Uganda — have been linked to Congo’s, and Doctors Without Borders declared Friday that Congo’s surge “poses a significant risk of widespread disease transmission” to other countries.

Salim Abdool Karim, an infectious disease specialist who chairs the Africa Centers for Disease Control and Prevention’s emergency committee, stated that the Congo outbreak exhibits a particularly alarming shift, as it disproportionately impacts young individuals.

Advertisement Individuals under 15 years of age represent 70 per cent of cases and 85 per cent of all fatalities in the nation, the Africa CDC reported.

Despite these advancements, Congo did not immediately seek vaccines, according to Bloomberg.

However, drug regulatory agencies only authorized the emergency use of these vaccinations in June.

While nations, organizations, and donors are striving to provide support, a unified response has only just commenced.

Advertisement “It seems the world hasn't grasped the folly of halting the World Health Organization emergency last year,” Tulio De Oliveira, director of Stellenbosch University’s Centre for Epidemic Response and Innovation, told Bloomberg. “If we had learned from that, we would have concentrated on containing the outbreak.”

The dire humanitarian situation in eastern Congo presents countless challenges to controlling an mpox outbreak, explained Dr. Chris Beyrer, the director of Duke University's Global Health Institute.

These challenges include ongoing conflict, illegal mining operations attracting sex workers, fluctuating populations near border areas, and widespread poverty.

Sarah Bagheni, residing in the Bulengo refugee camp in Goma, Congo, suspects she may have contracted Mpox. This comes after the World Health Organization declared Thursday, August 15, 2024, the increasing spread of mpox in Africa a global health emergency, cautioning that the virus could potentially spread across international borders. AP “This region is rich in minerals and mining sites,” Nachega stated to Wired. “A substantial number of workers originate from these nations. They receive their wages at the end of the month, engage in commercial sex, and subsequently return to their home countries to visit their families, thereby facilitating regional transmission of the disease.”

Millions are believed to be without access to medical care or guidance in the conflict-ridden east, where numerous rebel groups have been engaging in armed conflicts against Congolese army forces for years over mineral-rich territories, resulting in a massive displacement crisis.

Congo has the largest displacement camp population in Africa, and one of the largest globally.

Seven million individuals are internally displaced within Congo, with over 5.5 million residing in the eastern region, according to the United Nations refugee agency.

Hundreds of thousands of people have been displaced into densely populated refugee camps surrounding Goma, while others have sought shelter within the city.

Beyrer stated that unlike COVID-19 or HIV, there is a good vaccine and effective treatments and diagnostics for mpox, but "access issues are worse than ever" in places like eastern Congo.

All 26 of Congo's provinces have recorded mpox cases, according to the state-run news agency. However, Health Minister Samuel-Roger Kamba stated on Thursday that the country lacks a single vaccine dose and urged for "vigilance in all directions from all Congolese."

Dr. Rachel Maguru, who leads the multi-epidemic center at Goma's North Kivu provincial hospital, said that they also lack medications or established treatments for mpox and are relying on other experts like dermatologists to provide assistance wherever possible. A larger outbreak surrounding the city and its numerous displacement camps already burdened with an influx of people would be "terrible," she said.

She also pointed out a critical issue: impoverished and displaced people have other priorities, like making enough money to eat and survive. Aid organizations and stretched local authorities are already struggling to provide food, shelter and essential health care to the millions displaced, while also addressing outbreaks of other diseases like cholera.

Unlike the 2022 global outbreak, mpox is now spreading among heterosexual populations.

What happens next?

The WHO said the new variant might spread beyond the five African countries where it had already been detected — a timely warning that came a day before Sweden reported its first case of the new strain.

Beyrer said the global community missed multiple warning signs.

“We’re taking notice now, but mpox has been spreading since 2017 in Congo and Nigeria,” Beyrer said, adding that experts have been urging for vaccines to be distributed to Africa, but with minimal success.

He said the WHO’s emergency declaration was “long overdue,” as more than a dozen countries had already been affected.

Experts are warning that this strain of mpox could be deadly.

“We’re dealing with a strain that could have a fatality rate of up to 10 percent,” Nachego told Wired.

“It’s starting to resemble the HIV epidemic,” Nachega told Bloomberg. “When I graduated medical school, the HIV pandemic was gaining momentum. We must prevent this from becoming another sexually transmitted infection pandemic. That’s why we need to contain this clade 1 outbreak regionally before it reaches the scale of the 2022 outbreak, which spread globally.”

Bloomberg reported that although the vaccination group Gavi has been holding daily meetings regarding the outbreak since May, the Congolese government has yet to seek vaccines from them.

Samuel Boland, mpox incident manager for the WHO in Africa, informed Bloomberg that the Congolese government has requested vaccines from the US and Japan.

“We are all engaging with the same donors — which is excellent news — but we need to coordinate our efforts. Hopefully, in the coming days, we will establish a collaborative mechanism,” Gavi’s chief executive officer Sania Nishtar told the outlet.

“It is disheartening that vaccines are readily available, but certain obstacles prevent these countries from accessing them,” remarked Javier Guzman, director of global health policy at the Center for Global Development.

He cautioned that without swift action, the disease could spread to other nations.

Science.org reported that Africa CDC Director-General Jean Kaseya attributed the current situation to a lack of "appropriate assistance" provided to Africa.

“If we don’t deal with mpox as we need to do, we can be surprised.”

With inputs from agencies