Mpox Outbreak in Africa: A Global Health Wake-Up Call
As infectious disease researchers who have worked on HIV, SARS-CoV-2, and other viral infections, we are witnessing a stark reminder that an infectious disease in one corner of the world can suddenly become a global health threat. The current mpox outbreak in Africa is a case in point.
Mpox, previously known as monkeypox, was discovered in 1958 and was largely neglected by the scientific and public health communities, regarded as an uncommon infection in remote rural areas in tropical Africa without relevance for the rest of the world. However, the massive outbreak in developed countries in 2022 led to a surge in scientific studies and increased research funding.
Despite repeated calls from African researchers for increased global investment in diagnostic, therapeutic, and infection prevention tools for mpox, the 2022-23 global outbreak happened, and the World Health Organization (WHO) declared the current upsurge of mpox in central Africa a public health emergency of international concern.
The African region is now experiencing an upsurge in mpox cases, with cases arising from the endemic, largely zoonotic, pattern that used to be predominant in the past, as well as cases linked to the 2022 global outbreak and new, more dangerous strains. The current clade I MPXV (formerly called Congo Basin strain) is more virulent than the clade II (west African) strain, resulting in a higher case fatality rate.
The ongoing outbreak has its epicentre in South Kivu province, eastern DRC, and has the potential to fuel a large pandemic. It has a distinct epidemiological pattern with sustained chains of human-to-human transmission, often via the sexual route. The virus which causes it is the newly defined clade Ib lineage, which displays mutations that are the hallmark of human-to-human spread.
Case numbers are rising rapidly, even though many suspected cases are likely not tested and thus not counted as confirmed. Complicating matters, a commonly used test was found to miss infections with this lineage of the virus. The challenge is enormous, with the eastern DRC being an area beset by multiple problems, including natural disasters, violence, and infectious diseases.
To contain this outbreak and prevent it from turning into an epidemic, possibly even a pandemic, we propose the establishment of an African-led, multidisciplinary, multi-country Mpox Research Consortium (MpoxReC) in Africa. This consortium should conduct research towards the elimination of mpox as a public health problem.
Equitable access to diagnostic tests, vaccines, and antiviral treatments requires political commitment and financial investments. Scientific investigations are needed to learn more about exposure settings, transmission routes, and clinical presentations. It’s important to find the best ways to make these interventions.
The global health system must wake up to the reality that a disease in one corner of the world can suddenly become a global health threat. We urge policymakers and health authorities to take immediate action to address the mpox outbreak in Africa and prevent it from spreading further.
Authors:
Wolfgang Preiser, Head: Division of Medical Virology, Stellenbosch University
Cheryl Baxter, Head Scientific Research Support, Stellenbosch University
Jean Nachega, Professor of epidemiology, Stellenbosch University
