August 8, 2024



WHO to convene panel of experts to determine whether expanding mpox outbreaks in Africa constitute global health emergency; US agencies respond with health alert, additional funding

WHO Director-General Dr. Tedros Adhanom Ghebreyesus will convene an emergency meeting of experts as soon as possible to advise him on whether the recent surge in mpox cases—particularly the spread of a novel and more deadly mpox clade outside the Democratic Republic of the Congo (DRC)—constitutes a public health emergency of international concern (PHEIC). The decision to gather experts comes after several neighboring nations, including Burundi, Kenya, Rwanda, and Uganda, reported their first-ever cases of the virus. Those countries have reported at least 50 confirmed cases. Many of those cases were caused by the new clade Ib mpox virus, which could be more transmissible and severe, that was first identified earlier this year in DRC. Mpox clade Ia, which is endemic in some African countries, is also causing outbreaks in DRC, as well as in Central African Republic and Republic of Congo.

The decision to recommend a PHEIC depends on meeting some of several factors, including whether the threat is serious, unusual, or unexpected or if there is significant risk of international spread. WHO is particularly concerned about the potential for mpox to spread further due to limited access to vaccines and treatments in affected regions. Even if the committee recommends declaring a PHEIC, the final decision rests with Dr. Tedros, who said this week that stopping transmission of the virus “will require a comprehensive response, with communities at the center.” In 2022, WHO declared mpox to be a global emergency after it spread to more than 70 countries, mostly affecting men who have sex with men. That outbreak involved clade II, which is endemic in West Africa and causes less severe disease than clade I viruses. South Africa is experiencing a clade II mpox outbreak that has resulted in 24 cases and 3 deaths.

Last week, the Africa CDC reported that mpox has been detected in 10 countries on the continent this year; DRC has more than 96% of all cases and deaths. The virus is transmitted through household and sexual contact, fomites, and respiratory spread. While most affected patients are adults, children younger than 15 are more vulnerable to severe disease and death. Compared with the same period last year, Africa CDC said cases are up 160% and deaths have jumped by 19%. The agency last week announced the approval of US$10.4 million from existing COVID funds to support ongoing efforts to combat mpox outbreaks across the continent.

US agencies respond

In response to the evolving situation, the US CDC issued a health alert to healthcare providers, advising them to consider mpox as a possible diagnosis for patients presenting with symptoms such as fever, rash, and swollen lymph nodes, especially if they have a travel history to regions experiencing outbreaks. The alert notes the risk of clade I mpox importation to the US is very low at this time. The alert also provides information for clinicians on evaluation, testing and diagnosis, treatment, isolation of suspected and confirmed cases, and vaccination.

As part of US$424 million in humanitarian assistance to DRC, USAID announced US$10 million in health assistance for a range of vital public health interventions in response to the current mpox outbreak in DRC and other countries in the region. Additionally, the agency is donating 50,000 mpox vaccines to DRC. In related news, BARDA announced nearly US$157 million for Bavarian Nordic to “partly replenish” US government stocks of the company’s smallpox/mpox vaccine Jynneos. The vaccine became available on the US commercial market earlier this year.

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Editor: Alyson Browett, MPH

Contributing Editor: Prarthana Vasudevan, MS, MSPH, DrPH (c)