The World Health Organization (WHO) is preparing to declare the mpox outbreak in central Africa a Public Health Emergency of International Concern (PHEIC), the highest alarm the organization can raise for a health crisis. The committee responsible for making this decision is scheduled to meet on Wednesday, August 14, 2024. This would be only the eighth time the WHO has declared a PHEIC, underscoring the severity of the situation.
Mpox is an emerging zoonotic disease caused by Mpox virus infection, which affects both humans and animals and primarily spreads from animals to humans through direct contact with infected bodily fluids or lesions. The virus can also be transmitted between humans via respiratory droplets or sexual contact, particularly the more virulent clade 1b variant. After entry into the host, the virus attaches to cell receptors, fuses with the cell membrane, and releases its DNA into the host cell cytoplasm, where it replicates and assembles new viral particles. These particles are then released to infect other cells. The immune system responds by producing antibodies and T cells to target the infection, but the virus has evolved mechanisms to evade immune detection.
The current concern revolves around clade 1b, a deadlier variant of mpox that can be transmitted directly between humans through sexual contact. This strain has shown early signs of becoming a major epidemic, particularly in the Democratic Republic of Congo (DRC), where it is spreading at an alarmingly fast rate compared to other strains, such as clade 1a, which is not sexually transmitted and involves animal vectors. Unlike clade 1a, clade 1b has the potential to sustain human-to-human transmission indefinitely, increasing its potential to trigger a pandemic.
Simultaneously, the Africa Centres for Disease Control and Prevention (Africa CDC) is planning to declare a Public Health Emergency of Continental Security, marking the first time this type of emergency has been declared. This designation will enable African Union countries to coordinate their responses more effectively against the rapidly spreading virus. Both emergency declarations aim to curb the spread of mpox, which poses a serious threat of becoming the next global pandemic.
One of the immediate benefits of declaring a PHEIC is that it could expedite African countries’ ability to procure mpox vaccines. Without this emergency status, nations face prolonged national licensing processes, delaying access to necessary doses. Currently, bureaucratic obstacles have already delayed the delivery of 50,000 vaccine doses donated by the United States to the DRC by several months. Even when the vaccines finally arrive, logistical challenges such as transport, refrigeration, trained health workers, and necessary medical supplies will need to be addressed to ensure that the vaccines reach the population effectively.
Jean Kaseya, the head of Africa CDC, stated that the African emergency declaration will empower African nations to negotiate collectively for both existing and new mpox vaccines. This includes a forthcoming mRNA vaccine that is set to be manufactured in Rwanda next year by German pharmaceutical company BioNTech, which was instrumental in developing COVID-19 mRNA vaccines. WHO Director-General Tedros Adhanom Ghebreyesus emphasized the urgency of the situation, stating that the spread of mpox outside DRC, and the potential for further international spread within and outside Africa as reasons for convening the expert committee to consider the PHEIC declaration.
Currently, two mpox vaccines are commercially available: one produced by Bavarian Nordic in Denmark and another by KM Biologics in Japan. These vaccines are crucial for containing the virus by immunizing those at risk of catching and spreading it. In July, the Coalition for Epidemic Preparedness Innovations (CEPI) announced trials in the DRC to evaluate whether vaccinating people already exposed to mpox can prevent them from falling ill and transmitting the virus further.
However, large-scale vaccine procurement remains challenging for African countries without WHO emergency designation. Tedros initiated the process for the Emergency Use Listing (EUL) of both mpox vaccines. However, this process will take additional time. After a WHO technical committee evaluates and approves the vaccines, countries will need to negotiate prices and obtain import approvals.
The DRC estimates that it will need 10 million doses to contain the potential pandemic clade 1b and protect the country’s children from clade 1a. The production capacity for these vaccines, particularly the Bavarian Nordic vaccine, which is grown in hen’s eggs, remains uncertain, further complicating the response to this escalating crisis.
While there have been no reported cases of mpox in India, cases have appeared in Sweden and Pakistan. As a precautionary measure, the Indian Union Health Ministry has increased surveillance and instructed airports to remain vigilant. The Centre has directed officials at land ports along the borders with Bangladesh and Pakistan, as well as at all airports, to stay alert.
References
- WHO Director-General declares mpox outbreak a public health emergency of international concern [Internet]. [cited 2024 Aug 19]. Available from: https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern
- WHO poised to declare international mpox emergency [Internet]. SciDev.Net. [cited 2024 Aug 19]. Available from: https://www.scidev.net/global/news/who-poised-to-declare-international-mpox-emergency/
- Lu J, Xing H, Wang C, Tang M, Wu C, Ye F, et al. Mpox (formerly monkeypox): pathogenesis, prevention, and treatment. Sig Transduct Target Ther. 2023 Dec 27;8(1):1–15.
- Moore MJ, Rathish B, Zahra F. Mpox (Monkeypox). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK574519/
- Business Today [Internet]. 2024 [cited 2024 Aug 20]. Mpox Alert: Health Ministry instructs airports and officials to increase vigilance. Available from: https://www.businesstoday.in/india/story/mpox-alert-health-ministry-instructs-airports-and-officials-to-increase-vigilance-442129-2024-08-19