Africa declares monkeypox a continental emergency. Will this change anything?

In response to new and resurgent outbreaks in several African countries, the Africa Centers for Disease Control and Prevention Declared MOX became a public health emergency across the continent on Tuesday. While many countries outside Africa were able to quickly contain the MOX pandemic that began in the 1990s, 2022Large outbreaks remain prevalent in West and Central Africa, and more deadly strains are now spreading across borders into Africa.

Mpox, formerly known as monkeypox, is an infectious disease closely related to smallpox but less severe. African rodents and non-human primates.Mupox Spread It is transmitted through close contact, including sexual contact or skin contact, with an infected person. Pregnant women can also transmit the virus to their children during pregnancy and after birth. The most common ways of transmission are: Symptoms Mpox is a blister-like rash that usually lasts for 2-4 weeks. Other symptoms include fever, fatigue, muscle aches, cough, and sore throat.

For decadesIn 2000, MPOX caused sporadic cases and epidemics in Nigeria, the Democratic Republic of the Congo, and other African countries. Main lineage mpox: Clade Ilineage 1, which causes more severe disease and has historically been restricted to Central Africa, and lineage II, which has historically caused infections in West Africa.

in May 2022In 2020, countries outside of Africa suddenly began recording cases of MPOX caused by clade II. In July of that year, the World Health Organization declared the pandemic a Public Health Emergency of International Concern. By May 2023, 100 Countries Approximately 90,000 MPOX cases have been recorded; 150 deaths.

Fortunately, public health agencies around the world have acted quickly to improve disease surveillance and to raise awareness, especially among high-risk populations such as men who have sex with men. Encouraging Practice safe sex practices. In the United States and Europe, there are more than 30,000 and 25,000 cases of MPOX between May 2022 and May 2023, respectively, and authorities million Vaccination has led to a rapid decline in MPOX infections in most countries. May 2023The World Health Organization has lifted the state of emergency.

Although the MPOX epidemic is not currently considered an international health emergency, it remains ongoing and cases continue to be reported in countries around the world. As of June 2024, 175 cases were reported in North, Central, and South America, 100 in Europe, and 11 in Southeast Asian countries. Status Report Issued by the World Health Organization.

However, as the global MPOX burden eases, Outbreak The infection is worsening in the Democratic Republic of the Congo in Central Africa. Unlike other parts of the world, the MPOX strain causing infections there is a more severe strain of the virus. Clade IAs of May 2024, 7,851 MPOX cases and 384 deaths have been reported in the country.

In the past two months, Four East African countries Four countries – Burundi, Kenya, Rwanda and Uganda – have reported their first MPOX lineage I cases, raising concerns that a more deadly MPOX pandemic may be on the way. Other African countries are also facing resurgences of MPOX outbreaks caused by lineage II viruses. In May, 465 Cases of MPOX were recorded across African countries, with 567 cases in June, a 22 percent increase.

Due to the rise in mpox cases, Africa CDC has designated mpox a public health emergency for the continent. Africa CDC is a public health Distributor The African Union (AU), which represents 55 African countries, is the first time it has declared any outbreak a continental emergency.

“We are today declaring this a public health emergency for the security of the continent and will mobilize our institutions, collective will and resources to take swift and decisive action,” Africa CDC Director-General Jean Kaseya said at a press conference on Tuesday.

But efforts to respond to the outbreak in the Democratic Republic of the Congo and other African countries are again being hampered by the same challenges health authorities have faced during past outbreaks and pandemics. Including CoronaLack of global solidarity and willingness to share life-saving resources: While vaccination has been rapidly rolled out in the United States and Europe in 2022, vaccines are only just beginning to trickle in the Democratic Republic of Congo. But still, there are only a few hundred thousand vaccines available for a population of more than one million. 100 million people.

Slowly, national governments and multinational organizations such as the African Union Improve It aims to strengthen domestic public health infrastructure and technical capacity and reduce dependency on donor countries. The unprecedented move by Africa CDC to designate the MPOX outbreak as a regional health emergency signals the continuation of these efforts, although it is unclear whether this designation will spur the rapid influx of resources needed to respond to the MPOX outbreak.

Mpox was first discovered 1958 The first case of MPOX in humans (a 9-month-old infant) was reported in a group of monkeys at a Danish research facility. 1970 In the Democratic Republic of Congo, researchers and doctors Not decided It is unclear how the infant became infected, but close contact with an infected monkey may have been the source of the infection. Small rodents, monkeys, mammals Can pass The virus cannot infect humans, but it usually spreads through human-to-human infection.

Further human MPOX cases were documented in the Democratic Republic of Congo in 2005, and since then thousands of suspected cases have been reported every year. Since 2017, MPOX infections have also become frequent in Nigeria.

Although mpox has been around for a long time, there are still many unknowns about how the virus spreads and why it suddenly spread across the world in 2022. What researchers do know is that the virus has been mutating rapidly in recent years.

Interestingly, and perhaps worryingly, most genetic mutations have no effect at all, but some may make the virus more lethal or more effective at spreading. When geneticists compared the 2022 mpox genome to samples collected in 2017, Found Some 40 Genetic mutation Among the researchers, Suggested It is known that these mutations make the virus more susceptible to human-to-human transmission, but the evidence does not seem to be solid. consensus still.

In September 2023, an entirely new mpox clade I variant, tentatively designated clade IB, was identified. Found It originated in the Democratic Republic of Congo. The World Health Organization has not confirmed whether the new variant causes more severe illness or spreads more easily.

Rosamund Lewis, MPOX technical lead at the World Health Organization, is adamant that genetic mutations are not the cause of the global surge in MPOX. Rather, she suggests that the virus accidentally started infecting new populations — sex workers and men who have sex with men — which then spread more widely. MPOX is reminiscent of the origins of HIV. Chimpanzee Before the confirmed cases in southwestern Cameroon root Kinshasa, the capital of the Democratic Republic of Congo, is a bustling urban centre and home to a large number of sex workers.

Sexual transmission among adults may be only one of the major causes of MPOX infection. 70 percent 100% of MPOX cases recorded this year were children who may have been infected through close contact with infected animals or infected household members.

One of the biggest risk factors for severe MPOX infection is death Existing HIV infectionunfortunately, 25.6 million People in Africa are infected with HIV more With higher infection rates than any other region in the world, many African countries are likely to experience more deadly epidemics than other parts of the world. Kaseya explained that the dual burden of MPOX and HIV was also a major factor in the Africa CDC declaring the MPOX epidemic a continental emergency.

There is at least one vaccine — GineosAlso called Imvanex In Europe, MPOX is considered effective. Approved In 2019, it was used as a vaccine against smallpox and measles.

As MPOX cases began to be recorded in the United States and Europe in 2022, health authorities quickly distributed millions of doses of existing vaccines. But for the first two years of the pandemic, no vaccine was available in the Democratic Republic of Congo.

The Democratic Republic of the Congo, like most of Africa, I don't have one China does not have the infrastructure to manufacture the vaccine domestically, nor can it afford to buy millions of doses (the MPOX vaccine costs just under $100 per dose, according to Kaseya). DRC is only $649As a result, these countries have had to rely on donations from the United States, Europe and other countries. In response to the COVID-19 pandemic, the Africa CDC stepped up to lead the effort. effort Efforts are being made to close this critical gap, but progress is slow.

In this vacuum, authorities in the Democratic Republic of Congo and other African countries continue to respond to the outbreak without a vaccine. Only last month did the first Gyneos doses begin to arrive in the Democratic Republic of Congo. But Lewis said the country received only 200,000 doses, forcing officials to scramble to put together a plan for how to use limited resources. Kaseya did not elaborate on how Africa CDC would assist in the process.

Donor governments have been providing technical and financial support to the response to the MPOX epidemic in Africa. Last week, the United States Agency for International Development (USAID) said: $10 million Funding to support MPOX response in the Democratic Republic of Congo.

It is unclear whether Africa CDC's decision to designate MPOX as a continental emergency will affect the availability of the MPOX vaccine. Nevertheless, Africa CDC appears to be leading the way in directing domestic resources to the MPOX response. Earlier this month, the African Union $10.4 million To fund measures against MPOX.

“This is a fight for all Africans and we will fight it together,” Kaseya said.