The World Health Organization (WHO) has named mpox a public health emergency of international concern for the second time, on the heels of a continental emergency declaration from African health officials as the region remains gripped by outbreaks of the virus.
Known for causing painful, pus-filled lesions, and in some cases severe illness or death, mpox first exploded globally in the summer of 2022, prompting the WHO’s first international emergency declaration which lasted 10 months until mid-2023.
The virus spread rapidly around the world through sexual networks, though case counts eventually cooled down at a global level following widespread vaccination programs.
The situation this year is, in many ways, more grim.
Thousands of infections are being reported throughout 18 African nations, a highly-transmissible form of the virus has spilled beyond the borders of Democratic Republic of Congo (DRC), and aid organizations say even vulnerable newborns are falling ill in that country’s overcrowded hospitals — all while health officials warn those hot spots lack the necessary vaccines and therapeutics to stamp out outbreaks.
More than 15,000 mpox cases and nearly 500 deaths have been identified on the continent year-to-date, representing a 160 per cent increase from the same period in 2023.
“It’s clear that a coordinated international response is essential to stop these outbreaks and save lives,” said WHO director general Dr. Tedros Adhanom Ghebreyesus in a Wednesday briefing following a meeting of the organization’s mpox emergency committee.
Africa has declared a mpox a continent-wide emergency after seeing a 160 per cent increase in cases and deaths compared to 2023. And with cases surging again in Toronto, officials are urging at-risk residents to get vaccinated now.
10 million vaccine doses needed: Africa CDC
On Tuesday, Africa Centers for Disease Control and Prevention (Africa CDC) officials said 10 million mpox vaccines are needed to meet demand, but to date, the continent has only procured 200,000 doses through manufacturer Bavarian Nordic.
A day later, in his opening remarks to the WHO’s mpox emergency committee, Tedros noted two vaccines are approved by WHO-listed national regulators, as well as by individual countries including Nigeria and the DRC.
“Last week I triggered the process for emergency use listing for mpox vaccines, which will accelerate vaccine access for lower-income countries which have not yet issued their own national regulatory approval,” Tedros continued.
“Emergency use listing also enables partners including Gavi [the global vaccine alliance] and UNICEF to procure vaccines for distribution.”
Plans are already in place in multiple countries to distribute shots, but there are gaps in access across many parts of Africa, said WHO committee chair Dr. Dimie Ogoina, a physician-scientist and professor of medicine at the Niger Delta University.
On Wednesday morning, prior to the WHO’s announcement, Canadian officials told CBC News that, to date, the country has enough mpox vaccine doses to meet domestic needs and has not received a request for vaccine donations from Gavi, the WHO, or any other countries.
However, Global Affairs Canada is “actively working with Gavi to look at all options for Canadian engagement, including potential donation, to ensure vaccines reach those who need them the most,” a spokesperson for Health Canada and the Public Health Agency of Canada said in an emailed statement.
Dr. Darrell Tan, an infectious diseases physician and clinician-scientist at St. Michael’s Hospital, part of Unity Health in Toronto, stressed that Canadians are fortunate to have access to these vaccines, which have proven effective in curbing case counts and protecting patients from serious disease.
“I think it is a grave concern that we are treating other parts of the world as though they are less important,” he added.
The U.S. pledged to donate 50,000 vaccine doses earlier this year, while the European Commission said on Wednesday that it has coordinated the procurement and donation of 215,000 vaccine doses from Bavarian Nordic to support the Africa CDC.
Without those kinds of broader efforts to squash the virus’ spread in Africa, there is a chance it could again jump “beyond Africa to other regions of the world,” Ogoina warned.
Children among those getting infected
Most concerning, health officials say, is a newer strain of the virus circulating in DRC, known as clade Ib, which appears to cause more severe disease and is now showing up in additional African countries for the first time, including Rwanda, Uganda, Kenya, and Burundi.
The 2022 outbreak, in contrast, was caused by the global spread of clade II, which is still circulating throughout much of the world, including Canada, the U.S., and various countries in Africa. That form spread rapidly through sexual networks, largely impacting men who have sex with men.
With clade II mpox cases now rising again in parts of Canada, including Toronto where Tan practices, he said men who have sex with men — and in particular people with new or increased numbers of sexual partners — still have a lot to gain from getting vaccinated.
Some medical experts worry broader groups could be at risk as well, should clade Ib spread globally.
Early research from a joint Canadian-DRC team suggests that form of the mpox virus also began spreading through sexual contact, but may be more virulent and capable of transmitting through close contact within households to vulnerable populations, including infants and children.
World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus is calling for a coordinated international response, as several countries in Africa report cases of a new strain of mpox, which was initially reported in Congo but has since spread to neighbouring countries.
WHO data suggests seven in 10 cases in DRC are among children under 15, with higher death rates than adults.
“Children are the worst impacted,” Ogoina stressed in the WHO’s briefing.
But WHO officials also cautioned that more studies are needed to understand the epidemiology of this newer form of the virus, including its transmission patterns, given the uncertainty around exact case counts.
“We need standardized data collection on the patients that are infected with mpox to understand the disease course, the severity of this,” said Dr. Maria Van Kerkhove, who leads the WHO’s department of epidemic and pandemic preparedness and prevention.
Since many regions of Africa and the DRC in particular are rural and remote, conducting such studies may be challenging.
The latest Africa CDC estimate puts the overall death rate for mpox at somewhere between three to four per cent, though officials stressed it’s a murky figure since official case counts are merely “the tip of the iceberg.”