LENIAS HWENDA: Mpox already a public health emergency in Africa

The African continent has experienced an unprecedented increase in mpox cases since the beginning of the year. A number of countries that were previously not affected by the disease are reporting cases as the virus spreads.

According to the World Health Organisation (WHO), 15 countries are now reporting mpox cases, including Burundi, Cameroon, Congo, Ghana, Liberia, Nigeria, Rwanda, the Democratic Republic of Congo (DRC) and SA. East African countries such as Kenya, Rwanda, Burundi and Uganda are non-endemic for mpox and are experiencing it for the first time.

Just in 2024 the number of mpox cases in some parts of Africa has cumulatively increased by more than 160% compared with 2023, according to WHO estimates. This is clearly an evolving public health emergency that requires a strong regional response.

At the global level, the response of WHO director-general Tedros Adhanom Ghebreyesus has been to trigger the process of emergency use authorisation for vaccines to expedite the availability of unlicensed medical products such as the vaccines that are needed to respond to mpox as a public health emergency.

According to the Africa Centres for Disease Control & Prevention (Africa CDC), the continent needs 10-million doses of mpox vaccines to combat the spread effectively, but only 200,000 doses of vaccine are available. The mpox virus, part of the same family as smallpox, is capable of spreading between people through contact. It is now spreading across the African continent at an alarming rate, and vaccines are required to reduce the rate of transmission.

Three things are alarming about the spreading mpox strain. First, a new virulent strain that first emerged in the DRC in 2023 has been detected outside the DRC in Rwanda, Kenya and Uganda for the first time. The WHO has confirmed its spread, noting that the strain — the deadliest seen so far — has spread to multiple African countries.

According to available information, the mpox variant reported in Kenya was caused by the same virulent strain previously seen only in the DRC. Its spread in non-endemic countries such as Burundi, Kenya, Rwanda and Uganda is a worrying development for public health.

Second, the manner of its transmission also appears to have changed. It no longer requires only intimate sexual contact to be transmitted, as did previous variants. It appears that the new variant can now be transmitted through normal touch. Women and children have an increased vulnerability. The virus is showing high case fatality rates of up to 10% in children, making them particularly vulnerable. 

Responding effectively to this evolving public health emergency requires a regional response, not a national one. A regional strategy should aim to strengthen Africa’s ability to detect and respond swiftly to the emerging variants of mpox that may evolve to become more virulent and more transmissible. The highest priority should be to interrupt transmission in a collaborative approach that strengthens outbreak control measures of countries.

Focusing response efforts by providing tools and information to communities at the epicentre of the outbreak will equip them to respond optimally and offers the best opportunity to minimise further spread. Regional organisations such as WHO Africa and the Africa CDC should be coalescing their support with that of countries to strengthen national responses — surveillance, detection, the provision of clinical care, and putting in place infection prevention and control measures.

Most importantly, they should have a plan to make vaccines, diagnostics and therapeutics available. A regional plan must do more than simply call for solidarity to provide the answer, or ask other countries to give up their vaccines for African countries. This has never worked as a strategy. It will not work now. The region must work together to secure vaccines, using all possible avenues beyond calls for solidarity to make them available and plan and roll out vaccination campaigns.

While doing that, the region must lean heavily on public health control measures as the primary means of protecting populations and preventing community and intercountry spread. At the same time, African scientists led by the Africa CDC should be working overtime to better understand the dynamics of transmission to help the region refine its response based on real world data.

This emergency outbreak comes straight after the Covid-19 pandemic, which should have provided many lessons and a guide to how we can mount a rapid and robust regional response to bring the spread of mpox under control quickly with a unified regional response. Africa is stronger when it acts together. 

• Dr Hwenda is founder and CEO of Medicines for Africa.