The World Health Organisation (WHO) has declared mpox in Africa a public health emergency of international concern, a day after the Africa Centres for Diseases Control and Prevention made its own declaration. 

The heightened alerts follow the detection and rapid spread of a new clade or variant of the mpox virus in the eastern part of the  Democratic Republic of Congo (DRC). This new clade has now been detected in neighbouring Kenya, Rwanda and Uganda – countries where mpox had never been reported before. 

This development shows the worrying potential for further spread of this viral infectious disease within Africa and beyond. According to the WHO in the past month more than 100 cases of clade1b have been reported in four countries: Burundi, Kenya, Rwanda and Uganda which are neighbouring the DRC. This year alone,  the DRC has recorded 15,600 mpox cases and 537 deaths.

“On top of outbreaks of other mpox clades in DRC and other countries in Africa, it’s clear that a coordinated international response is needed to stop these outbreaks and save lives,” says WHO director general Dr Tedros Adhanom Ghebreyesus in a statement. 

What about South Africa?

South Africa is among the countries facing an outbreak of the disease with the first case reported in May. A total of 22 cases and three deaths have been reported so far. 

However, local  scientists believe that there is no need to worry at the moment as the risk still remains low in the country. Most of the reported cases have made full recoveries and the government has prioritised contact-tracing. 

Dr Jacqueline Weyer, head of the Centre for Emerging Zoonotic and Parasitic Diseases, National Institute of Communicable Diseases (NICD) tells Health-e News that a Public Health Emergency of International Concern (PHEIC) is a mechanism under the International Health Regulations which is used to improve coordinated responses for the containment of outbreaks. This same instrument was used in the COVID-19 response.

“When a PHEIC is declared there are increased requirements from countries to demonstrate their commitment to outbreak responses, and increased access to resources for the outbreak. The latter would include support for enhanced surveillance and access to vaccines and therapeutics,” she says. 

NICD executive director Professor Adrian Puren adds that, at the moment, there is no need for South Africans to panic as the country has access to treatment and vaccination. 

“There is a multi-country mpox epidemic which has also included South Africa. There has been an identification of mpox Clade 1b in DRC which appears to be spreading mainly through sexual workers and it is detected in neighbouring countries,” he says. 

A more deadly strain 

Speaking with Health-e News, Dr Chris van Straten, global health advisor clinical governance at International SOS, a company that protects global workforce from health and security threats, adds that the reason scientists and WHO are concerned is that the outbreak seen in the DRC is something different. 

“It’s not the mpox we’re seeing in South Africa, which is clade 2. It [clade 2] is less transmissible and less dangerous.  We need to keep an eye on the spread of clade 1b. In Africa we need more tests, we need to know where the cases are,” he says. 

He adds that, as seen with all viruses including COVID, the more people get infected there is a real risk that the virus can change, circulate, and become stronger. 

“It can become easier to spread and a more dangerous virus. What worries WHO, doctors and scientists is that the virus seems to be spreading faster and has killed a lot more people than the other types of mpox. 

I am worried that people want to sexualise this, yes it can be transmitted by sex. In the DRC  a lot of people were infected through sex workers. But a lot of children have also been infected. They got really sick and died. It was from family contacts, sharing utensils, towels and a close living environment,” he says.

Why is the WHO stepping up? 

Straten says it is about giving Africa the tools to fight the disease. 

“The disease is now spilling to countries that have never seen mpox before, people won’t have antibodies. There are a lot of potential patients with HIV or malnutrition and not a strong immune system. We are worried that it could spread even further,” he says. 

Puren adds that it is important for African countries to get support from other regions of the world.  

“The areas of complexity will be getting vaccines. However at the moment only those who are at high risk will be vaccinated. It will not be a straightforward roll-out like what happened during COVID-19 where everyone was eligible for vaccination,” he says. 

WHO announced that, to allow for an immediate scale up, it has released US$ 1.45 million from the WHO Contingency Fund for Emergencies and may need to release more in the coming days. 

What  the declaration means for South Africa 

Straten says as ministries of health are working hard to figure how far the disease has spread. 

“The reason South Africa is affected is that there are a lot of business people travelling back and forth from the affected countries.We have people coming to South Africa looking for employment. There is a lot of movement between Kenya, Uganda and South Africa. We need to remain aware of mpox, and if you have been travelling you  need to go see a doctor if you have blisters, a rash that looks like chicken pox, or shingles and a headache,” he says. 

He says he is concerned that the new variant is more infectious and seems to kill more people. 

“I am worried for me, I am concerned for young children and pregnant women. However, I am confident we have strong scientists who have been doing good work.This is not a call for alarm, it’s distressing but it is really a call to action,” he says. – Health-e News