Growing mpox 'crisis' prompts Africa CDC to declare first-ever public health emergency

As cases of mpox skyrocket in Africa, health officials there have declared the continent's first-ever public health emergency as a "call to action" for more global support.

The Africa Centres for Disease Control and Prevention (Africa CDC) made the declaration at a Tuesday media briefing, one day before a World Health Organization emergency committee is set to meet to discuss the possibility of reinstating another global public health emergency for mpox, the disease formerly known as monkeypox. 

The last WHO emergency declaration ran for 10 months following the unprecedented global spread of mpox in the summer of 2022. While worldwide numbers largely calmed down in the wake of that outbreak, case counts throughout Africa have been soaring for months, including infections in multiple new countries.

"The world cannot afford to turn a blind eye to this crisis," said Dr. Jean Kaseya, the Africa CDC's director-general, during his Tuesday remarks.

Mpox is known for spreading through sexual networks, but also transmits through other forms of close contact. It can cause a range of symptoms, from painful, pus-filled lesions to potentially deadly illness in vulnerable populations, including children and individuals co-infected with HIV.

While a milder clade of the virus sparked 2022's global outbreak, scientists and health officials began ringing alarms in recent months over another clade spreading rapidly throughout the Democratic Republic of the Congo (DRC), which may be causing more severe disease.

African health officials say in total, more than 15,000 mpox cases and 461 deaths were reported on the continent year-to-date, representing a 160 per cent increase from the same period in 2023. A total of 18 countries are impacted, with Burundi, Kenya, Rwanda and Uganda recently reporting infections for the first time.

Given limited surveillance, and the potential for mild infections, the number of cases and deaths is likely "just the tip of the iceberg," noted epidemiologist Salim Abdool Karim during the Africa CDC's briefing.

Africa aiming for 10 million vaccine doses

At a global level, the latest WHO figures show there have been nearly 100,000 lab-confirmed mpox infections across 116 countries since the start of 2022, and cases recently began ticking up again in some regions beyond Africa, as well — Canada included.

In Toronto, for instance, public health officials said on Tuesday that the city is experiencing another spike in cases, with close to 100 reported by the end of July, compared to 21 infections for the same period last year. One of those individuals was hospitalized, but has since recovered, officials told CBC News. Ottawa previously announced that cases were rising in that city, as well. 

Yet the epicentre remains in Africa, with families across the continent being torn apart by this disease, Kaseya told reporters. The emergency declaration is not a formality, he added, but a "call to action." 

The Africa CDC has signed an agreement for the procurement and rapid distribution of 200,000 vaccine doses manufactured by Bavarian Nordic, but Kaseya stressed that amount is not enough to quell case counts. Officials are working to secure more than 10 million doses in total, he said.

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Earlier this month, the U.S. pledged an additional $10 million US in health assistance to respond to the DRC and surrounding region's mpox outbreak, on top of a months-old promise to donate 50,000 vaccine doses.

As for Canada, federal officials here have not yet responded to CBC News's questions about what aid, if any, the country may offer, but did previously tell the Globe and Mail that there are no plans in place to share doses from Canada's stockpile.

Multiple scientists told CBC News the world is simply not responding fast enough to this ongoing crisis, with some questioning whether emergency declarations — from the Africa CDC or the WHO — will be enough to garner a global response.

"Globally, we dragged our feet on the situation in [DRC] with, obviously, predictable outcomes," said mpox researcher and University of Manitoba microbiologist Jason Kindrachuk during a recent call from Kinshasa, DRC.

Kindrachuk is among the scientists whose ongoing research is shining a light on the spread of a new clade throughout the central African country. 

"The concern continues to increase on a daily basis," he said.

'Matter of time' before virus jumps globally again

A major question now is what impact the Africa CDC's declaration will have on WHO discussions, set to start on Wednesday.

The organization's mpox emergency committee will provide its views on whether the situation in Africa constitutes a public health emergency of international concern (PHEIC) in a closed, virtual meeting. "WHO will provide updates as and when they are available," the organization said on Tuesday.

Dr. Boghuma Titanji, an infectious diseases specialist and assistant professor with the Emory School of Medicine in Atlanta, suggested the WHO's last declaration didn't move the needle enough in terms of providing support for vaccines, therapeutics, and resources to bolster testing and surveillance efforts throughout the African continent.

"What's going to be different this time, if we didn't really use the previous declaration to full emergency?" she said.

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What's likely now, Titanji added, is that the DRC's form of this virus could jump globally, echoing the sudden spread of mpox only two years ago.

"With the world being as interconnected as it is," she added, "it's just a matter of time before we get that first case in countries outside the African region."

During his remarks, Kaseya stressed that African nations will continue fighting the spread of the virus, regardless of the level of international help.

"We have faced Ebola, we have faced the devastation of HIV, we have faced the threat of COVID," he said. "In each of these battles we have emerged stronger … mpox will not be different."