The World Turned Its Back on Mpox: A Deadlier Outbreak Emerges in Africa
In May 2023, the World Health Organization (WHO) declared an end to the public health emergency surrounding mpox—formerly known as monkeypox—a move that seemed to signal a victory against the virus. However, just over a year later, the situation has taken a drastic turn for the worse. A far more serious epidemic is now brewing across much of sub-Saharan Africa, forcing the WHO to reassess its stance and acknowledge the severity of the evolving threat.
The Rise of a Deadlier Strain
Since January 2024, over 15,000 mpox cases and 461 deaths have been reported on the African continent. This outbreak extends beyond the Democratic Republic of Congo (DRC), where mpox has long been endemic, to 13 other African nations, including Rwanda, Kenya, Burundi, and Uganda, where the disease was previously unknown.
This resurgence is driven by a more virulent strain of the virus, known as clade 1, which experts believe is up to 10 times more deadly than the clade 2 strain that dominated the 2022 global outbreak. Clade 1 poses a significant threat to vulnerable populations, including children under the age of 5, pregnant women, and individuals with weakened immune systems.
A Global Response Gone Wrong
The 2022 outbreak, while alarming, primarily affected men who have sex with men, allowing for targeted vaccination and intervention strategies in many countries. However, this narrow focus led to a critical oversight: inadequate resources and attention were given to countries in sub-Saharan Africa, who were grappling with a long-standing mpox presence and were most susceptible to the emergence of a more dangerous variant.
Dr. Boghuma Titanji, an associate professor in infectious diseases at Emory University, states that the lack of sustained global surveillance and resource allocation in Africa played a crucial role in the rise of this deadlier outbreak. The world, she asserts, "failed to do enough last time around."
The Shifting Landscape of Transmission
While the 2022 outbreak primarily spread through sexual networks, the new strain displays a broader pattern of transmission. The virus is believed to have initially spread through sexual contact, but is now being passed on to family members as infected individuals return to their communities.
Dr. Jean Nachega, a Congolese infectious disease doctor, highlights the differences in mortality rates between the two strains: "The 2022 global outbreak was clade 2, and mortality was less than 1 percent. Now we’re talking about a strain which can have up to 10 percent mortality."
A recent study published in Nature Medicine sheds light on the transmission dynamics of the outbreak. Researchers tracked the spread of mpox from a small mining town in eastern DRC, where the virus was likely introduced through sex workers, to neighboring Rwanda, Uganda, and Burundi. This transmission occurred as infected individuals traveled home to visit their families, demonstrating the potential for rapid dissemination across borders.
The Urgent Need for Action
The current mpox situation in Africa demands an immediate and robust response. Countries must prioritize:
- Strengthening surveillance systems: The global health community needs to step up its commitment to monitoring mpox cases in Africa, ensuring early detection and response.
- Improving access to diagnostics and treatments: Rapid diagnosis and access to effective treatments are critical for managing the outbreak and preventing further spread.
- Increasing vaccination efforts: While focus on the clade 2 strain led to the development of vaccines, new approaches are needed to address the higher mortality rate of clade 1.
- Investing in research and development: Further research is crucial to understand the changing epidemiology of mpox, improve diagnostic tools, and develop more effective vaccines and treatments.
- Addressing health inequities: Strengthening health systems in sub-Saharan Africa, particularly access to healthcare services for vulnerable populations, is essential to tackling this outbreak and future public health threats.
A missed opportunity to prevent this deadly resurgence reminds us of the critical importance of global collaboration in infectious disease surveillance and resource allocation. Ignoring health disparities and neglecting the needs of vulnerable populations during outbreaks creates a breeding ground for the emergence of more dangerous and resistant pathogens. The world cannot afford to repeat this mistake. The fight against mpox and other emerging infectious diseases requires a coordinated, equitable, and sustained global response.
