Scientists say an outbreak of monkeypox (previously called monkeypox) in Africa resembles early HIV epidemics, and the World Health Organization has declared it a public health emergency.
Medical experts said the declaration should speed up access to testing, vaccines and treatments in affected areas and launch a campaign to reduce stigma around the virus.
More resources for research are also essential, they said, because there are “many unknowns” about the new variant spreading among people in the Democratic Republic of Congo. As of August 4, 38,465 MPOX cases and 1,456 deaths have been reported in Africa since January 2022, with more than 14,000 cases and 524 deaths reported in the Democratic Republic of Congo alone this year.
These include virus lineages I and II, as well as a new type derived from lineage I, lineage Ib, which appears to be causing outbreaks in the Democratic Republic of the Congo and neighbouring countries, with children being particularly susceptible.
The World Health Organization said the outbreak was severe enough to declare a “public health emergency of international concern,” a category used in the past for Ebola outbreaks, COVID-19 and a surge in poliovirus infections in Europe in 2022.
WHO Director-General Tedros Adhanom Ghebreyesus said the situation was “deeply alarming” and called for “the highest level of vigilance under international health law.” He highlighted the emergence of lineage Ib in eastern Democratic Republic of the Congo and its detection in neighbouring countries.
The WHO says it has spent $1.5 million from its contingency funds with more on the way, and is calling on donor countries to help cover the remaining $15 million needed for operations in the region.
“I’ve heard a lot of people say this is very similar to the early days of HIV,” said Trudy Lang, professor of global health studies at the University of Oxford.
She said the virus appears to spread through sexual networks, particularly among “vulnerable, young and exploited sex workers” because they are at high risk. “High levels of stigma” will require public health campaigns to ensure people understand and seek treatment.
While the data has yet to be analyzed and published, Lang said the frontline teams she has spoken to have reported high numbers of pregnancy losses due to the virus and babies being born with MPOX lesions due to infection in the womb. “There are so many unknowns,” she said, including how many people are infected outside of hospitals.
“What really worries me is the number of cases that are not severe. Mild infections that may be hidden, especially genital infections, that people may be walking around with that infection,” Lang said.
“The big question we have is when is it most contagious and when does it become more widespread?”
Lang added that if the virus were to reach Europe or the US, it would be easily contained by vaccination, as was the case with the MPOX epidemic in 2022. “The worry is that in Europe it would happen very quickly, but […] In really poor parts of Africa.”
Dr Ayoade Alakija, president of Find, a nonprofit organization working with African vaccine suppliers and diagnostics, said MPOX would already have been considered a major international health emergency if the outbreak had occurred in Europe. He said the declaration “should refocus people’s minds and loosen purse strings to recover from a sluggish start.”
“More in-depth research is urgently needed to better understand MPOX transmission dynamics and guide control and response plans, as well as enhanced surveillance and equitable access to vaccines, diagnostics and treatments for all affected people. Most vaccines and treatments have been pre-ordered by wealthy countries and there is currently only one diagnostic test,” Alakija said.
“Without equitable access to testing, it is unknown how viruses such as HIV will affect the severity and transmission of MPOX. The lack of focus on tackling the virus in the DRC makes its spillover to neighboring countries almost inevitable, and the longer action is delayed, the greater the chance of it spreading across Africa and beyond.”
The public health agency Africa Centers for Disease Control and Prevention (Africa CDC) had already declared MPOX a public health emergency on Tuesday. Jean Kaseya, the organization’s director, said the declaration was “not just a formality” but rather a “clarion call to action” that justified aggressive and proactive efforts to contain and eliminate the virus.
Responding to the announcement, Dr Bogma Titanji, assistant professor at the Emory University School of Medicine in Atlanta, US, said he hoped the declaration would encourage African governments to allocate resources to combat the spread of the disease.
The African Union approved $10.4 million (£8 million) for the Africa CDC response in early August, but Kaseya suggests the continent needs around $4 billion.
