The World Health Organization (WHO) has declared the latest MPOX outbreak in Africa a “public health emergency of international concern,” the category previously used for Ebola outbreaks, Covid-19 and a 2022 MPOX surge in Europe.
Many countries in Africa are seeing rising cases of mpox as the deadly virus crosses national borders, amid fears it could spark a significant global outbreak. Here’s what we know so far.
What is mpox?
Mpox, formerly known as monkeypox, is an infectious disease caused by a virus. Flu-like symptoms, including fever, chills, and muscle aches, are usually followed by a skin rash that begins as raised spots, which turn into blisters filled with fluid. These eventually crust over.
There are roughly two different types, known as “clades.” Clade I was once known as the Congo Basin clade, and clade II as the West African clade. Both can be fatal, although clade I was historically a higher mortality rates.
What does the WHO emergency declaration mean?
The WHO’s emergency declaration is intended to galvanize donors and countries into action. It should accelerate access to testing, vaccines and therapeutic drugs in affected areas, medical experts urged, and launch campaigns to reduce stigma around the virus.
But global reaction to earlier statements was mixed.
Gen. Dr. Jean Kaseya, director of the Africa Centers for Disease Control and Prevention (CDC), said the agency’s declaration of a public health emergency was intended to “mobilize our institutions, our collective will and our resources to act quickly and decisively.” He appealed to Africa’s international partners for help, saying the rising number of cases in Africa had been largely ignored.
“It’s clear that the current control strategies are not working and there’s a clear need for more resources,” said Michael Marks, a professor of medicine at the London School of Hygiene & Tropical Medicine. “If (a global emergency) is the mechanism to unlock these things, then it’s justified,” he said.
Where do infections occur?
A briefing from the Africa CDC reported that 34 countries in Africa are either reporting infections or are considered “high risk.”
The Democratic Republic of Congo (DRC) is facing a serious outbreak, with more than 14,000 reported cases and 524 deaths since the beginning of 2024. Outbreaks in the DRC are not unusual, but this year’s figure already matches the total for all of 2023 and includes cases in previously unaffected provinces.
Infections are also being reported in Burundi, Kenya, Rwanda and Uganda, countries neighboring the Democratic Republic of Congo where no cases have previously been reported.
Why is the number of cases increasing now?
A new offshoot of clade I, clade Ib, has been discovered in eastern DRC and confirmed in Kenya, Rwanda and Uganda. Scientists believe this variant plays a role in the spread.
Clade I was historically spread mostly by people eating contaminated bushmeat. Clade Ib spreads from person to person, often through sexual contact, but also through other physical and face-to-face contact, or via contaminated bedding or towels. Dr Rosamund Lewis, the World Health Organization (WHO) lead for mpox, said: “We don’t know if it’s more infectious, but it’s being transmitted efficiently.”
Other forms of the virus continue to circulate. The DRC is also recording cases of clade Ia, as is the Central African Republic. Clade II has been reported in Cameroon, Côte d’Ivoire, Liberia, Nigeria and South Africa, the WHO said.
The rise comes amid high levels of insecurity in the region and the climate crisis is bringing humans closer to nature. These are also factors, according to Dr. Jean Kaseya, head of Africa CDC.
How does it spread and why are children disproportionately affected?
The virus is crossing borders and infected people are on the move. Kenyan Authorities diagnosed mpox in a long-distance truck driver who had also traveled to Rwanda, Tanzania and Uganda.
Mpox also spreads through sexual networks. Sex workers originally formed a large part of those infected.
During the global outbreak of mpox in 2022, gay and bisexual men made up the vast majority of cases and the virus spread primarily through close contact.
Although similar patterns have been observed in Africa, children under 15 years of age now account for over 70% of MPOX cases and 85% of deaths in Congo.
Experts say this could reflect differences in their immune systems, with high rates of malnutrition making children vulnerable to infection. While older people in the region may have had a smallpox vaccination, which offers some protection, this is not the case for younger generations.
Greg Ramm, executive director of Save the Children’s Congo, said the organization was particularly concerned about the spread of mpox in overcrowded refugee camps in the east, noting that 345,000 children were “crowded in tents in unsanitary conditions.”
Do we have vaccines?
Vaccines exist, but access is a problem. Africa CDC says 10 million doses are needed, but only 200,000 are available. A lack of treatments and diagnostics is hampering the response.
Plans for vaccination programs are still being reviewed, but will likely include tracing and vaccinating contacts of cases, and targeting groups such as people living with HIV who appear to be at higher risk of severe disease.
The WHO has issued emergency status for two vaccines, allowing organizations such as Gavi and Unicef to procure them for distribution.
What happened during the last major outbreak?
In 2022, the outbreak spread from Europe to the world, mainly affecting men who have sex with men.
The WHO declared a public health emergency in July of that year, and contact tracing programs and mass vaccination were initiated. The emergency was lifted in May 2023 after about 90,000 infections.