Alarmed by mpox surge, Africa CDC is poised to declare a 'continental emergency'

Caption

Nurse Christian Musema takes a sample from a child declared a suspected case mpox at the treatment center in Munigi in the Democratic Republic of Congo, where the virus has been surging. Cases have also been identified in four other countries in East Africa.

The Africa Centers for Disease Control and Prevention has never done anything like this before. The agency is poised to declare a “public health emergency of continental security” as early as next week.

Since the beginning of last year, mpox cases have been surging in the Democratic Republic of Congo, with children making up the majority of the 14,000 reported cases and 511 deaths so far in 2024. Those numbers roughly match the number of cases reported in all of last year in the country.

Why Africa is so worried

In the last couple weeks, there’s 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 Africa CDC is trying to move quickly and garner international support. “Everything we are doing today [is because] we were abandoned during COVID time and, today, we don't want to be again abandoned. We don't want to be dependent. We are taking appropriate action,” says Dr. Jean Kaseya, director general of Africa CDC, noting that declaring a public health emergency is a new power given to the agency in 2023 by the African Union. 

Kaseya says that it’s particularly concerning that about 70% of cases in the DRC are in children under 18. “This one is a major alarm for the world,” he says. “We are losing the youth in Africa.”

Experts say the higher number of cases and deaths among kids is likely because they don’t have protection from the smallpox vaccine — which was discontinued after that related virus was eliminated in 1980 — and because about 40% of kids in the region are malnourished, making it harder for their bodies to fight off the virus.

The World Health Organization has also taken note of the evolving mpox situation. This week it announced that the group is convening an emergency committee to determine whether it will make a similar declaration to that of Africa CDC, designating the situation a public health emergency of international concern. “The committee will meet as soon as possible,” says WHO head Tedros Adhanom Ghebreyesus.

The U.S. response

There’s concern about mpox in the U.S. as well. The U.S. Centers for Disease Control and Prevention issued an mpox health alert this week. While the risk to the general population in the U.S. remains low, Christina Hutson — senior science adviser at the U.S. CDC — says it’s important for clinicians, health departments and travelers to be aware of the spread of the virus in Africa and vigilant about symptoms.

She says the spillover from DRC to neighboring countries is not surprising given how porous borders are. But “it is disappointing – because we've been working with DRC to try to help prevent spread.” She says the U.S. has been providing test kits and technical support to neighboring countries “so we were able to actually detect some of these cases pretty quickly.”

In addition, this Wednesday, the U.S. pledged nearly $424 million dollars to help with what USAID calls an “ongoing catastrophe” in the DRC plus $10 million to respond to mpox and 50,000 mpox vaccine doses.

While Japan, the U.S., the European Union and the manufacturers are working on vaccine donations. Africa CDC says the need far outstrips what’s in the pipeline.

“We need to have vaccines. Today, we are just talking about almost 200,000 doses [becoming] available. We need at least 10 million doses.” says Kaseya. “The vaccine is so expensive – 85 euros per dose – If we consider some fees, we can put it around $100 per dose. There are not so many countries in Africa that can afford the cost of this vaccine.”

The type of mpox spreading in the east of the DRC – particularly among sex workers and other adults – and into some of the neighboring countries is a subtype called Clade Ib. This is a new type of mpox that has kept scientists on their toes – discovering 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 U.S. CDC. It’s also the first time Clade I has been spread through sexual transmission. However, it also seems less fatal than the original Clade I circulating elsewhere in the DRC. The number of people who have died has dropped below 1%. At least that, she says, is a glimmer of good news.