The Africa Centers for Disease Control and Prevention has never done anything like this before. On Tuesday, the agency declared a “public health emergency of continental security.” Their concern is mpox.
“We can no longer be reactive, we need to be proactive and aggressive,” says Dr. Jean Kaseya, director general of Africa CDC. “This is a fight for all Africans and we will fight it together.”
Since the beginning of last year, mpox cases have been surging in the Democratic Republic of Congo, with children making up the majority of the 14,000 reported cases and 511 deaths so far in 2024. Those numbers roughly match the number of cases reported in all of last year in the country – and dwarf the mpox numbers reported in 2022.
“[The declaration] is a wake-up call for the world that urgent action is needed,” said Dr. Nicole Lurie, executive director of emergency preparedness and response at the Coalition for Epidemic Preparedness Innovations, headquartered in Norway, in a statement.
Dr. Boghuma Titanji, assistant professor of medicine at Emory University, called the declaration “a crucial step toward enhancing coordination among African countries to address the ongoing mpox outbreak” in a statement.
Why Africa is so worried
In the last couple weeks, there’s been a new and alarming development. Mpox has been detected in countries that have never previously identified cases. About 50 confirmed cases and more suspected cases have been reported in Burundi, Kenya, Rwanda and Uganda, according to World Health Organization officials.
It is with past health emergencies in mind that Africa CDC is trying to move quickly and garner international support. “We were abandoned during COVID time and, today, we don't want to be again abandoned. We don't want to be dependent. We are taking appropriate action,” says Kaseya, noting that declaring a public health emergency is a new power given to the agency in 2023 by the African Union. Kaseya says the agency sought input from more than 600 experts and the scientific committee convened to consider the mpox situation unanimous recommended the emergency declaration.
Kaseya says that it’s particularly concerning that about 70% of cases in the DRC are in children under 18. “This one is a major alarm for the world,” he says. “We are losing the youth in Africa.”
Experts say the higher number of cases and deaths among kids is likely because they don’t have protection from the smallpox vaccine — which was discontinued after that related virus was eliminated in 1980 — and because about 40% of kids in the region are malnourished, making it harder for their bodies to fight off the virus.
The World Health Organization has also taken note of the evolving mpox situation. On Wednesday it is convening an emergency committee to determine whether it will make a similar declaration, designating the situation a public health emergency of international concern. A decision could come as soon as Wednesday afternoon.
The WHO declared mpox an emergency once before, between July 2022 and May 2023, although the type of mpox that spread globally then – Clade II –is different from the type of mpox spreading in the DRC, called Clade I. Clade I is typically more deadly than Clade II. Clade is the term used for mpox variants.
The U.S. response
There’s concern about mpox in the U.S. as well. The U.S. Centers for Disease Control and Prevention issued an mpox health alert last week. While the risk to the general population in the U.S. remains low, Christina Hutson — senior science adviser at the U.S. CDC — says it’s important for clinicians, health departments and travelers to be aware of the spread of the virus in Africa and vigilant about symptoms.
In addition, last week, the U.S. pledged nearly $424 million dollars to help with what USAID calls an “ongoing catastrophe” in the DRC plus $10 million to respond to mpox and 50,000 mpox vaccine doses.
While Japan, the U.S., the European Union and the manufacturers are working on vaccine donations. Africa CDC says the need far outstrips what’s in the pipeline.
“We need to have vaccines. Today, we are just talking about almost 200,000 doses [becoming] available. We need at least 10 million doses.” says Kaseya. “The vaccine is so expensive – 85 euros per dose – If we consider some fees, we can put it around $100 per dose. There are not so many countries in Africa that can afford the cost of this vaccine.”
The type of mpox spreading in the east of the DRC – particularly among sex workers and other adults – and into some of the neighboring countries is a subtype called Clade Ib. This is a new type of mpox that has kept scientists on their toes – discovering new information that is both good and bad. It’s harder for diagnostic tests to pick it up because of a genetic change in the virus, says Hutson of the U.S. CDC. It’s also the first time Clade I has been spread through sexual transmission. However, it also seems less fatal than the original Clade I circulating elsewhere in the DRC. The number of people who have died has dropped below 1%. At least that, she says, is a glimmer of good news.
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