WHO Declares MPOX a Public Health Emergency: A New Global Health Challenge Emerges

WHO’s Emergency Committee highlights the urgent need for vaccination, surveillance, and community engagement to curb the spread of MPOX, with the Democratic Republic of the Congo at the epicenter of the outbreak.

On August 14, 2024, the World Health Organization (WHO) declared the upsurge of mpox (formerly known as monkeypox) in the Democratic Republic of the Congo (DRC) and several other African nations a Public Health Emergency of International Concern (PHEIC). This decision followed the advice of the International Health Regulations (IHR) Emergency Committee, which convened on August 14, 2024, to assess the situation. The ongoing outbreak has been fueled by the resurgence of two sub-clades of the monkeypox virus, clade Ia and the newly identified clade Ib, posing significant challenges to public health in the region.

Epidemiological Overview:

 During the first half of 2024, 5,199 confirmed cases of mpox were reported globally, with the WHO African Region accounting for 36% of these cases. The DRC has been particularly affected, reporting 95% of Africa’s cases, including over 15,000 clinically compatible cases and more than 500 deaths, surpassing the numbers observed in 2023. The outbreak has been driven by two distinct sub-clades of the monkeypox virus:

1. Clade Ia: Endemic to the DRC, this strain primarily affects children and has an aggregated case fatality rate of 3.6%. The transmission is sustained through multiple modes, including person-to-person contact following zoonotic introduction.
2. Clade Ib: A newly emerged strain identified in 2024, believed to have originated in September 2023. Clade Ib is spreading rapidly in the eastern DRC, particularly through sexual contact, and is primarily affecting adults. This strain has now been detected in neighboring countries such as Burundi, Kenya, Rwanda, and Uganda.

The severity of mpox associated with clade Ia has historically been greater than that of clade II, which circulated during the 2022-2023 outbreak. However, data on clade Ib remains limited, with few deaths recorded so far.

WHO’s Strategic Response: 

The WHO Secretariat presented an overview of the global response to the mpox outbreak, highlighting the urgent need for international cooperation and resource mobilization. The assessed risk was deemed “high” for eastern DRC and neighboring countries, “high” for areas where mpox is endemic in the DRC, and “moderate” for other regions in Africa and worldwide.

The WHO has already taken several actions to support affected countries, including the release of USD 1.45 million from the WHO Contingency Fund for Emergencies and the initiation of processes to include Emergency Use Listing for two mpox vaccines. A regional response plan has also been developed, with an initial budget of USD 15 million.

Challenges and Concerns:

The WHO Secretariat outlined several challenges in controlling the mpox outbreak, including scientific uncertainties, gaps in understanding transmission dynamics, and inadequate diagnostic capacities in many countries. The lack of financial resources at both national and international levels to scale up interventions remains a significant concern. Additionally, access to vaccines and antiviral drugs such as tecovirimat is limited, posing further challenges in managing the outbreak.

Temporary Recommendations: 

In light of the PHEIC declaration, the WHO Director-General issued several temporary recommendations for States Parties experiencing the mpox upsurge:

1. Vaccination: Prepare for the introduction of mpox vaccines, especially in areas with recent cases, targeting high-risk groups such as contacts of confirmed cases, children, and healthcare workers.
2. Risk Communication and Community Engagement: Strengthen communication systems to effectively manage misinformation, address stigma, and engage with affected communities to support outbreak prevention and vaccination efforts.
3. Governance and Financing: Scale up national funding and explore external opportunities for targeted prevention and response activities. Integrate mpox prevention measures into existing programs for other endemic diseases.
4. Addressing Research Gaps: Invest in research to better understand mpox transmission, risk factors, and the effectiveness of public health interventions, with a focus on a One Health approach.

Conclusion: The WHO’s declaration of mpox as a PHEIC underscores the severity of the ongoing outbreak in Africa, particularly in the DRC and its neighboring countries. The international community must act swiftly to provide the necessary resources, including vaccines, therapeutics, and diagnostics, to support affected nations in controlling the spread of this disease. Coordinated efforts, both at the national and international levels, will be crucial in mitigating the impact of the mpox outbreak and preventing further international spread.