Mpox Outbreak in the DRC Declared a Public Health Emergency by WHO

The ongoing mpox outbreak in the Democratic Republic of the Congo (DRC) has prompted the World Health Organization (WHO) to once again declare it a public health emergency of international concern. This declaration mirrors a similar one made in 2022 when the virus began spreading to countries where it was not previously endemic. While wealthy Western nations managed to control the outbreak rapidly, African countries, including the DRC, received little assistance, leaving them at the heart of the epidemic.

Currently, infection rates in the DRC are on the rise, the virus is evolving, and the WHO has raised alarms again. Here’s what you need to know about the situation.

WHO’s Concern and Response

WHO Director-General Tedros Adhanom Ghebreyesus expressed serious concern about the outbreak, stating that everyone should be vigilant. The WHO intends to increase the distribution of diagnostics, treatments, and vaccines to the DRC. However, experts caution that it may take several months for these vaccines to reach the DRC and other affected African regions.

Understanding Mpox

Previously referred to as “monkeypox,” mpox is characterized by a rash of flat sores that develop into liquid-filled blisters, which can be itchy or painful. In addition to the rash, mpox can cause flu-like symptoms such as fever, headaches, body aches, swollen lymph nodes, chills, and overall fatigue. The majority of cases in the outbreak that began in 2022 have not been life-threatening. However, the disease can be fatal for individuals with compromised immune systems. Mpox spreads through close contact and has primarily affected men who have sex with men in the U.S. and Europe, where it has mainly spread within gay and bisexual communities.

Reasons for the Current Situation

There are several factors contributing to the current outbreak, according to Dr. Boghuma Titanji, an assistant professor in Emory University’s infectious disease department. More than 14,000 mpox cases have been reported in the DRC this year, surpassing the total number of cases for all of 2023. Tragically, over 524 people have died, including 240 children. According to the WHO and Save the Children, the infection is four times more deadly for children under the age of 15 than it is for adults.

Titanji notes that it remains unclear why the disease has become so lethal for children, but a variation or subclade of the virus, which has developed mutations making it more adept at human transmission, is suspected. This new subclade might also be responsible for the virus spreading across borders to other African countries, including Burundi, the Central African Republic, Kenya, and Rwanda. This situation led the Africa Centres for Disease Control and Prevention to declare a continent-wide public health emergency on August 13. However, Titanji points out that, so far, no cases of this new subclade have been detected outside of the African subregion.

Assessing the Risk of Mpox

For those outside Central Africa, the risk of contracting mpox has not increased. Although the Centers for Disease Control and Prevention (CDC) warned in May that the outbreak in the DRC poses a “global threat,” the agency still considers the overall risk to the general American public to be “very low.” For men who have sex with other men and have multiple partners, the risk is categorized as “low to moderate.” However, the CDC notes that this group could be at risk if the latest version of mpox reaches the U.S.

Even though the U.S. has an ample stockpile of vaccines and treatments for mpox, Dr. Titanji emphasizes the interconnectedness of the world today, stating, “We live in a very, very interconnected global village.” There are now outbreaks in 13 African countries. “These outbreaks are connected to the U.S. or Europe by just a couple of hours because it’s easy to get on a flight and travel,” Titanji explains. “If we don’t address problems when they’re still small and affecting a relatively confined geographic location, then we could potentially have to deal with it within our own shores.”

Implications of WHO’s Declaration for Africa

The practical implications of the WHO’s declaration remain uncertain, according to Titanji. “The global outbreak has been going on since 2022,” she points out, “and we still haven’t really seen containment of the outbreak in the African region.” She questions what will be different this time.

The WHO’s declaration is intended to act as a signal, emphasizing the gravity of the emergency in the hope that it will rally resources to the affected areas, thereby preventing the outbreak from spreading further. Ideally, this would mean that the international community would come together to provide funding, diagnostics, treatments, and vaccines to the DRC and other severely impacted African regions. However, Titanji recalls that in 2022, the declaration “did not necessarily translate to the tools needed to fight the outbreak in Africa.” She highlights that about 10% of mpox cases in the DRC remain unconfirmed due to a lack of diagnostic tools. Additionally, the vaccines and antiviral medications that were instrumental in controlling the outbreak in the U.S. are still in short supply in Africa.

During the press conference announcing the public health emergency declaration, the WHO estimated that an initial investment of $15 million would be required to fund surveillance, response, and preparedness measures. While the WHO has released $1.5 million toward this effort, they have called on donors to contribute additional funds to meet the necessary requirements.