The World Health Organization (WHO) has declared the recent MPOX outbreak in Africa a “Public Health Emergency of International Concern,” a category previously used for the Ebola outbreak, COVID-19, and the expected MPOX surge in Europe in 2022.
As the deadly virus spreads across borders, cases of MPOX are on the rise in many African countries, threatening to spark a major global pandemic. Here's what we know so far:
What is mpox?
Mpox, formerly known as monkeypox, is an infectious disease caused by a virus. A rash usually appears after flu-like symptoms such as fever, chills, and muscle aches. The rash starts as raised spots that turn into fluid-filled blisters that eventually crust over.
There are two main distinct types, known as “clones”: clade I was formerly known as the Congo Basin clade, and clade II as the West African clade. Both can be fatal, but clade I has historically been associated with a higher mortality rate.
What does the WHO emergency declaration mean?
The WHO emergency declaration is intended to galvanize aid agencies and countries to act, and health experts said it should speed up access to testing, vaccines and treatments in affected areas and launch a campaign to reduce stigma around the virus.
However, global reactions to the declaration so far have been mixed.
Jean Kaseya, director of the Africa Centers for Disease Control and Prevention (CDC), said the CDC's public health emergency declaration was intended to “mobilize our organizations, collective will and resources to take swift and decisive action.” Kaseya called on Africa's international partners to help, saying the rapidly growing number of cases in the continent has been largely ignored.
“It's clear that current control strategies are not working and it's clear that more resources are needed,” said Michael Marks, professor of medicine at the London School of Hygiene and Tropical Medicine. “If (a global emergency declaration) is the mechanism by which we get out of these situations, then it is justified,” he said.
Where is the infection occurring?
The Africa CDC reports that 34 African countries have reported infections or are considered “high risk.”
The Democratic Republic of Congo (DRC) is experiencing a severe outbreak, with over 14,000 reported cases and 524 deaths since the beginning of 2024. Outbreaks are not uncommon in the DRC, but this year's figures are already in line with the total for all of 2023, and include cases in previously unaffected provinces.
Infections have also been reported in Burundi, Kenya, Rwanda and Uganda, neighbouring countries of the Democratic Republic of the Congo which had previously had no cases.
Why are cases increasing now?
A new branch of lineage I, lineage Ib, has been detected in eastern Democratic Republic of Congo and has also been identified in Kenya, Rwanda and Uganda, and scientists believe this variant is playing a role in the spread of the virus.
Lineage I has traditionally been spread by people who ate meat from infected bushmeat. Lineage Ib is transmitted from person to person primarily through sexual contact, but also through other physical or face-to-face contact, or through contaminated bedding or towels. “We don't know if it's more contagious, but it's being transmitted in an efficient way,” said Dr Rosamund Lewis, head of MPOX at the World Health Organization (WHO).
Other forms of the virus are still circulating. The Democratic Republic of the Congo has recorded cases of lineage Ia, as has the Central African Republic. Lineage II has been reported in Cameroon, Côte d'Ivoire, Liberia, Nigeria and South Africa, according to the WHO.
The increase comes amid growing insecurity in the region and increased contact between humans and nature due to the climate crisis, which Dr Jean Kaseya, director of the Africa CDC, said were also contributing factors.
How does it spread, and why do children suffer disproportionately?
The virus spreads across borders as infected people move around: Kenyan authorities have diagnosed MPOX in a long-distance truck driver who had also been in Rwanda, Tanzania and Uganda.
Mpox also spreads through sexual networks, with many infected people originally being sex workers.
During the 2022 global MPOX outbreak, the majority of cases were among gay and bisexual men, with the virus spreading primarily through close contact.
Similar trends have been observed in Africa, but in the Congo, children under the age of 15 now account for more than 70% of MPOX cases and 85% of deaths.
Experts say this could reflect differences in immune systems, with higher rates of malnutrition making children more susceptible to infections. Older people in the region may have been vaccinated against smallpox, giving them some protection, but younger generations have not.
Greg Lamb, director of Save the Children Congo, said the group was particularly concerned about a malaria outbreak in the crowded refugee camps in the east, where 345,000 children are “crammed into tents in unsanitary conditions”.
Is there a vaccine?
The vaccine is available but access is a problem — the Africa CDC says 10 million doses are needed but only 200,000 are available — and a shortage of treatments and diagnostics is hampering the response.
Plans for the vaccination program are still being developed but are likely to include tracing and vaccinating contacts of infected people, as well as targeting groups such as people with HIV who are considered at higher risk of severe illness.
The WHO has placed the two vaccines on its emergency use list, allowing organisations such as GAVI and UNICEF to procure and distribute them.
What happened during the last major outbreak?
In 2022, the disease spread globally from Europe, particularly affecting the gay male community.
The WHO declared a public health emergency in July of that year, and contact tracing programs and mass vaccination programs were implemented. The emergency was lifted in May 2023 after the number of infected people reached approximately 90,000.
