The World Health Organization has declared mpox a public health crisis of international concern. Cases of mpox – formerly called monkeypox – have increased in the Democratic Republic of Congo. In recent weeks, cases have appeared in neighboring African countries, including several that have never reported cases of mpox before.

“What we’re seeing is the tip of the iceberg” because of weaknesses in the surveillance system, says Dr Dimie Ogoinathe chairman of the emergency committee convened by the WHO and an infectious disease doctor at the Niger Delta University in Nigeria.

“This is something that should concern us all,” said WHO Director-General Tedros Adhanom Ghebreyesus.

The WHO has declared seven public health emergencies in the past, including one for mpox in 2022. The type of mpox circulating now is known to be more deadly than the one that swept the world two years ago.

“We have to be … aggressive”

On Tuesday, the Africa Centers for Disease Control and Prevention took a similar step, declaring mpox an emergency.

Africa CDC has never done anything like this before.

“We can no longer be reactive – we must be proactive and aggressive,” says Dr. Jean KaseyaDirector General of Africa CDC. “This is a fight for all Africans and we will fight it together.”

In it Democratic Republic of the Congo (DRC), children make up the majority of the 14,000 reported cases and 511 deaths so far in 2024. These numbers roughly match the number of cases reported throughout last year in the country – and exceed the number of mpox reported in 2022.

“(The declaration) is a wake-up call to the world that urgent action is needed,” said Dr. Nicole Lurieexecutive director of preparedness and response at the Coalition for Epidemic Preparedness Innovations, headquartered in Norway, in a statement.

Dr. Boghuma Titanjiassistant professor of medicine at Emory University, said in a statement that the declaration is “a crucial step toward improving coordination among African countries to address the ongoing mpox outbreak.”

Why Africa is so worried

In recent weeks, there has been a new and alarming development. Mpox has been detected in countries that have never previously identified cases. About 50 confirmed cases and more suspected cases have been reported in Burundi, Kenya, Rwanda and Uganda, according to World Health Organization officials.

It is with past health emergencies in mind that the Africa CDC is trying to move quickly and rally international support. “We were abandoned during the covid era, and today we don’t want to be abandoned again. We don’t want to be dependent. We are taking appropriate measures,” says Kaseya, noting that declaring a public health emergency is a new power the African Union gave the agency in 2023. Kaseya says the agency sought input from more than 600 experts and that the scientific committee convened to consider the mpox situation unanimously recommended the emergency declaration .

Kaseya says it is particularly worrying that around 70% of cases in the DRC are children under the age of 18. “This is a big alarm for the world,” he says. “We are losing the youth of Africa.”

Experts say the higher number of cases and deaths among children is likely because they are not protected by the smallpox vaccine – which was discontinued after the related virus was eliminated in 1980 – and because about 40% of children in the region are malnourished, making it harder for their bodies to fight the virus.

US response

There are concerns about mpox in the US as well. The US Centers for Disease Control and Prevention issued an mpox warning last week. While the risk to the general population in the US remains low, Christina Hutson, senior science advisor at the US CDC, says it’s important for doctors, health departments and travelers to be aware of the virus’ spread in Africa and be alert for symptoms.

Additionally, the United States last week pledged nearly $424 million to help with what the US Agency for International Development calls a “ongoing disaster” in the DRC, plus $10 million to respond to mpox and 50,000 mpox vaccine doses.

While Japan, the US, the EU and vaccine manufacturers are working on vaccine donations, the Africa CDC says the need far exceeds what is in the pipeline.

“We must have vaccines. Today we are only talking about almost 200,000 doses (being) available. We need at least 10 million doses,” says Kaseya. “The vaccine is so expensive – we can put it around $100 per dose. There are not many countries in Africa that can afford the cost of this vaccine.”

The type of mpox that is spreading in the DRC’s east – particularly among sex workers and other adults – and to some of the neighboring countries is a subtype called clade Ib. (Clade is the term used for mpox variants.) This is a new type of mpox that has kept researchers on their toes and discovered new information that is both good and bad.

It’s harder for diagnostic tests to pick it up because of a genetic change in the virus, says Hutson of the US CDC. It is also the first time that clade Ib has been spread through sexual transmission. However, it also appears to be less lethal than the original clade I circulating elsewhere in the DRC. The number of people who have died has fallen below 1%. That, she says, is at least a glimmer of good news.

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