The World Health Organization (WHO) has declared mpox to be a public health emergency of international concern (PHEIC) for the second time in two years following its outbreak in the Democratic Republic of the Congo (DRC) and its spread to over a dozen countries in Africa. The multi-country outbreak in Europe, in 2022, had led to a declaration of a PHEIC. WHO’s announcement comes a day after the Africa CDC declared the outbreak to be a public health emergency of continental security (PHECS), also marking the first time a regional and global health emergency has been declared for a disease outbreak. If this is first such declaration in Africa of a PHECS since 2017, it is also the first time that WHO has declared a PHEIC for a disease outbreak in Africa on the very first time the emergency committee met to decide on the matter. Though WHO claimed in August 2014 that the Ebola outbreak in West Africa was declared a public health emergency in the very first meeting of the emergency committee, an Associated Press investigation revealed how WHO resisted calling it a public health emergency for a few months. In the second Ebola outbreak in Africa in 2018-19, WHO declared it a public health emergency only when the emergency committee met for the fourth time.
If the 2022 mpox outbreak in the U.K, that spread to over 100 countries, was caused by the milder clade 2b virus — primarily affecting men who have sex with men, with limited cases among children and adolescents — the current outbreak is driven by a new and more lethal clade 1b, spread effectively through sexual and non-sexual contact. There have been 2,863 confirmed cases and 517 deaths this year, primarily in the DRC. The clade 1b emerged in the DRC in September 2023, with human-to-human transmission ongoing since then. In the DRC, around two-thirds of infections are in children under 15 years. Vaccines are again in acute short supply. As against 10 million doses needed to control the outbreak, just about 0.21 million doses may be supplied immediately. Even when vaccines were used to blunt transmission in Europe and the U.S. earlier, vaccines were not supplied to Africa despite mpox being endemic there for years. Currently, only the DRC and Nigeria have granted emergency use authorisation for the vaccine. The regulatory hurdle can be sidestepped if the company expresses interest for WHO’s emergency use listing, which will allow international agencies to supply the vaccine to all African countries. Even then, Africa will have to wait till the end of 2025 for the 10 million doses.
