On August 15, Sweden reported a case of the new MPOX strain, known as lineage 1b, marking the first time that the more deadly MPOX strain, formerly known as monkeypox, has been found outside of Europe and the African continent.
According to Swedish public health authorities, the person infected with the virus had recently returned from travel to an unnamed African country where a large outbreak of the new MPOX strain is occurring.
Just two days earlier, the African Union's public health agency had declared MPOX a “continental security public health emergency,” and the World Health Organization designated the virus outbreak in the Democratic Republic of Congo and several neighboring countries a “public health emergency of international concern” the following day.
This is the second time in just two years that the WHO has classified an MPOX outbreak with this designation, which allows the WHO to guide countries on the measures they should take to strategically tackle the surge in cases. So far in 2024, Africa has reported more than 20,000 MPOX cases and 582 deaths.
More serious tensions
The rapid spread of the new MPOX strain from Central African countries to other parts of the world has concerned public health experts because it appears to be more severely ill and better adapted to humans than the previously dominant lineage 2b, and is also more likely to cause higher mortality and severe illness.
Public health officials have warned that the new variant must be treated and addressed as an emergency not just for the African continent but for the whole world.
“Mpox was once thought of as an isolated African threat, but its changing nature, particularly in lineage 1b, requires a global response, with Europe having a key role to play,” David Heyman, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, told Parliament.
“The best thing to do in Europe and elsewhere is to offer vaccines for a variety of strategies and then determine which ones are important for blocking transmission based on the epidemiology,” Heymann says. Until the mid-1990s, experts thought MPOX could only be transmitted from animals to humans, but today it is known to spread by person-to-person contact, he notes.
According to the WHO, common symptoms of the new variant include skin rash, fever, headache, muscle and back pain, loss of energy and swollen lymph nodes. Children, pregnant women and people with weakened immune systems are at higher risk of severe illness and death from the virus.
Access to vaccines
Mpox vaccine is effective in protecting individuals against infection with viral diseases.
But as the COVID-19 pandemic has shown, ensuring equitable access to vaccines and treatments can be a major challenge. During the 2022 polio outbreak, wealthier countries, especially in Europe, were similarly able to secure vaccines and treatments more quickly than less-wealthy regions.
The WHO therefore stressed the importance of global equity in the fight against MPOX and called on EU countries to “support efforts to ensure that the vaccine is available to everyone who needs it, regardless of their geographic location.”
The WHO on Monday released its strategic preparedness and response plan, which will run from September this year to February next year. The six-month plan aims to support global efforts to significantly reduce the transmission of the new virus. We will thwart the more dangerous forms of MPOX by increasing WHO staff numbers in the most affected countries and strengthening surveillance, prevention and response strategies.
In response, EU Health Commissioner Stella Kyriakides last week called on European countries to support Africa's public health response, and the European Commission procured and donated 215,000 doses of the vaccine itself. Germany has since pledged to donate 100,000 doses of the MPOX vaccine to Africa, and France has pledged a further 100,000. Austria has said it will support the WHO effort but has not disclosed how many vaccines it plans to donate.
But some EU countries are taking a wait-and-see approach before pledging donations. “We will wait to see how the situation develops and ensure that the Dutch strategic stockpile is at a sufficient level before deciding on a donation,” Dutch Health Minister Fleur Agema (PVV) wrote to local lawmakers last week.
Heymann, from the London School of Hygiene and Tropical Medicine, stresses that any vaccine rollout must be accompanied by proper evaluation and local adaptation: “In Europe, when we use a vaccine, it's really important that we evaluate whether the vaccine was effective in preventing infection,” he says.
He also warns against a one-size-fits-all approach, especially when it comes to supporting African countries: “It's important to listen to what countries want and what they're saying, rather than just saying, 'We need this,'” he adds, advocating for a more coordinated, tailored approach to international health interventions.
Impact on the EU
The European Centre for Disease Prevention and Control While the number of lineage 1b infections in the European Union appears to be low, EU countries have begun taking precautions to help the region's health care workers cope with a sudden surge in cases. Researchers also stress the importance of continuing so-called genomic surveillance to monitor the evolution of the virus and track the emergence of more dangerous variants.
When the WHO first declared MPOX a public health emergency in 2022, the EU was able to reduce cases through its experience in disease control and coordinated public health actions on affected population groups.
“Two years ago, we were able to suppress MPOX in Europe thanks to our direct engagement with the male gay community,” Dr. Hans-Henri P. Kluge, WHO Regional Director for Europe, said in a statement last week. “Learning from our success, we have urged governments and health authorities to continue these measures to eliminate MPOX from Europe,” he added.
But Heyman also emphasizes the role of local scientists and experts, especially in Africa where the disease is deeply entrenched. “It's important that we continue to work with African countries,” he says. “That way, they can use their talented scientists to understand the epidemiology of MPOX and, if requested, get help from the northern hemisphere to develop optimal vaccination strategies.”
