For the second time since 2022, mpox has been declared a global health emergency as the virus spreads rapidly across the African continent and threatens to spread to other regions. The World Health Organization (WHO) issued its highest level of alert on Wednesday, citing more than 14,000 cases and 524 deaths in Africa this year, surpassing last year’s figures.
WHO Director-General Dr. Tedros Adhanom Ghebreyesus has classified the surge of mpox in the Democratic Republic of the Congo (DRC) and the increasing number of cases in other African countries as a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations (2005). “The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighboring countries are very worrying,” Dr. Tedros stated. “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.”
This new form of the virus, known as clade 1b, has spread into eastern parts of the central African nation and has been reported for the first time in countries such as Kenya, Rwanda, and Uganda. Clade 1 viruses tend to result in more deaths compared to other strains that spread globally in 2022 and 2023. “The detection and rapid spread of a new clade of mpox in eastern DRC, its detection in neighboring countries that had not previously reported mpox, and the potential for further spread within Africa and beyond is very worrying,” Dr. Tedros reiterated.
Dr. Tedros’s declaration came following the recommendation of an IHR Emergency Committee, composed of independent experts who reviewed data presented by WHO and the affected countries. The committee informed the Director-General that the mpox surge qualifies as a PHEIC with potential to spread further across Africa and possibly to other continents. “Today, the emergency committee met and advised me that in its view, the situation constitutes a public health emergency of international concern. I have accepted that advice,” Dr. Tedros told a news conference. “This is something that should concern us all.”
In response to the escalating crisis, WHO has pledged to coordinate the global response, working closely with affected countries to prevent transmission, treat those infected, and save lives. “WHO is committed in the days and weeks ahead to coordinate the global response, working closely with each of the affected countries, and leveraging our on-the-ground presence, to prevent transmission, treat those infected, and save lives,” Dr. Tedros added.
WHO Regional Director for Africa Dr. Matshidiso Moeti emphasized the efforts already underway to curb the spread of mpox. “Significant efforts are already underway in close collaboration with communities and governments, with our country teams working on the frontlines to help reinforce measures to curb mpox,” Dr. Moeti stated. “With the growing spread of the virus, we’re scaling up further through coordinated international action to support countries bring the outbreaks to an end.”
Committee Chair Professor Dimie Ogoina also expressed concern about the situation, emphasizing the global implications of the outbreak. “The current upsurge of mpox in parts of Africa, along with the spread of a new sexually transmissible strain of the monkeypox virus, is an emergency, not only for Africa but for the entire globe,” Professor Ogoina said. “Mpox, originating in Africa, was neglected there and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself.”
Jean-Jacques Mbungani Mbanda, a former health minister in Congo, highlighted the seriousness of the situation. “It has really exploded,” Mbungani said, expressing relief that WHO has now intervened, though he noted the response could have come earlier. “We are happy that today, even if it could have been done earlier, the World Health Organization has weighed in.”
This PHEIC declaration marks the second in two years related to mpox. The virus, caused by an Orthopoxvirus, was first detected in humans in 1970 in the DRC and is considered endemic in central and west African countries. In July 2022, a multi-country outbreak of mpox was declared a PHEIC as it spread rapidly via sexual contact in regions where the virus had not previously been seen. That emergency was declared over in May 2023 after a sustained decline in global cases.
Mpox has been reported in the DRC for over a decade, with a steady increase in the number of cases reported each year. Last year, reported cases rose significantly, and the number of cases reported this year has already exceeded last year’s total, with more than 15,600 cases and 537 deaths.
Mpox, also known as monkeypox, is a viral disease that spreads easily between people and from infected animals. It can be transmitted through close contact such as touching, kissing, or sexual activity, as well as through contaminated materials like sheets, clothing, and needles. Symptoms include fever, a painful rash, headache, muscle and back pain, low energy, and enlarged lymph nodes.
The outbreak in 2022, largely driven by clade II of the virus, caused some 140 deaths out of approximately 90,000 cases. The disease manifests with fever, muscle aches, and large boil-like skin lesions.
The new clade 1b strain, which has been spreading rapidly in the DRC, appears to be primarily transmitted through sexual networks and has now been detected in neighboring countries. In the past month alone, over 100 laboratory-confirmed cases of clade 1b have been reported in four neighboring countries that had not previously reported mpox: Burundi, Kenya, Rwanda, and Uganda. Experts believe the actual number of cases is higher as many clinically compatible cases have not been tested. “What we have in Africa is the tip of the iceberg. … We are not recognizing, or we don’t have the full picture of, this burden of mpox,” committee Chair Dimie Ogoina emphasized.
The Africa Centres for Disease Control and Prevention declared the outbreak a public health emergency of continental security on Tuesday, marking the first such declaration by the agency since its inception in 2017. Since the beginning of the year, more than 17,000 mpox cases and over 500 deaths have been reported in 13 African countries, with the DRC reporting the highest number of cases—more than 14,000.
In response to the crisis, WHO has released $1.45 million from the WHO Contingency Fund for Emergencies to support immediate scale-up efforts. The organization anticipates an initial funding requirement of $15 million to support surveillance, preparedness, and response activities and has called on donors to fund the full extent of the mpox response. “WHO anticipates an immediate funding requirement of an initial $15 million to support surveillance, preparedness and response activities,” WHO stated, appealing to donors for assistance.
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The US government has also offered funding, assistance, and vaccines to WHO and the DRC to support efforts in Africa. The CDC has recommended that people in the US who are exposed to or at high risk of catching mpox should get vaccinated. Last week, WHO’s Director-General initiated the process for Emergency Use Listing for mpox vaccines, which will accelerate vaccine access for lower-income countries that have not yet issued their own national regulatory approval.
Two vaccines for mpox are currently recommended by WHO’s Strategic Advisory Group of Experts on Immunization and are approved by WHO-listed national regulatory authorities, including in Nigeria and the DRC. WHO is working with countries and vaccine manufacturers to facilitate equitable access to vaccines, therapeutics, diagnostics, and other tools through the interim Medical Countermeasures Network.
