Mpox in Africa: WHO and Africa CDC consider declaring public health emergency as cases spike

The World Health Organisation will decide this week whether to declare mpox a public health emergency of international concern (PHEIC) as cases surge in the Democratic Republic of Congo (DRC) and spread rapidly to the rest of the continent, WHO director general, Tedros Adhanom Ghebreyesus, said on 10 August.

The head of the Africa Centres for Disease Control and Prevention (Africa CDC), Jean Kaseya, also said last week that Africa will “most likely” declare mpox a regional public health emergency in the hope of preventing the viral disease from becoming “another pandemic.”

Mpox cases are up 160% on this time last year and spiked in the week to 4 August, spreading to six new countries in 10 days, data presented by Kaseya at a media briefing in Addis Ababa showed.

Kesaya said mpox’s spread to new countries is “critical” and “demonstrates the need for a collective and collaborative approach in curbing the spread of the disease.”

In the week up to 4 August there were 887 new confirmed and suspected cases of monkeypox reported in Africa, bringing 2024’s total so far to 15 132 with 461 deaths reported, according to the Africa CDC presentation. The virus has reached 16 countries, with DRC recording more than 14 000 of the cases.

Mpox (formerly known as monkeypox), which commonly causes painful rashes and flu-like symptoms, comes from the same family as smallpox and can be prevented with the same vaccine. WHO declared mpox a PHEIC in July 2023 when it was detected in countries across Europe, but the emergency was declared over in May 2023 after outbreaks were contained through increased surveillance and the rollout of vaccines.

Kesaya said it was imperative for Africa to consider taking action alone rather than relying on WHO; otherwise, it would risk being left behind as it was during the covid-19 pandemic, when European nations were prioritised for vaccine supplies. None of the 10 million vaccine doses that are estimated to be needed to combat the outbreak have so far reached Africa, having been held up by delays with local authorisation for their use.

WHO is particularly worried about a series of recent developments that it outlined in an epidemiological update on 14 June.1 Sexual transmission has become a major driver of the disease for the first time, and a new strain of the virus was detected in the DRC in May “with genetic mutations suggestive of extended human-to-human transmission and geographic expansion,” it said. The disease has a high fatality rate (4.9%), and WHO is concerned the response in the conflict racked region is insufficient.

Among the hurdles to containing the outbreaks are “resource constraints to respond over such a wide geographical area, limited public awareness of mpox, insufficient treatment kits, a lack of vaccines to date, multiple competing public health priorities, and insecurity.”

Test positivity rates are high, suggesting both undertesting and under-reporting, WHO added. “Laboratory capacities are limited to two national laboratories, one in Kinshasa and one in Goma so only 18% of reported cases in 2024 have been tested by PCR,” it said in the update.

Mpox is spreading rapidly to vulnerable groups, including children, who make up 60% of the cases in the DRC. High transmission has been recorded in sex workers and men who have sex with men, both of whom are more likely to die from mpox because of high rates of immunosuppression. HIV rates in the DRC are estimated to be 7.5% among sex workers and 7.1% among men who have sex with men, WHO said.

“The additional public health impact of sustained human-to-human sexual transmission of mpox in [the DRC] indicates that a vigorous response is required,” WHO said and called for countries to increase surveillance, testing, contact tracing, and education.1

The African Union made an emergency approval of $10.4m (£8.2m) in funds for the Africa CDC earlier this month to support ongoing efforts to combat mpox across the continent.

On 9 August WHO called on vaccine manufacturers to apply for emergency use listing because of worrying trends in the disease’s spread. “There is a serious and growing outbreak in the DRC that has now expanded outside the country. A new viral strain, which first emerged in September 2023, has for the first time been detected outside DRC,” it said.2