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16 August 2024
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Mpox outbreaks in Africa constitute a public health emergency of continental security
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On 13 August 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared mpox a public health emergency of continental security (PHECS) in Africa, acting under its mandate to address significant public health threats. This mandate was established in July 2022, by the Executive Council of the Africa Union (AU) Assembly through its decision EX.CL/Dec.1169(XLI), empowering Africa CDC to coordinate responses to epidemics by mobilising African leaders, governments and relevant agencies.
The decision was driven by the worsening mpox situation on the continent: since 2022, 40 874 cases and 1 512 deaths have been reported across 15 AU member states. In 2024 alone, 17 541 cases and 517 deaths have been reported from 13 AU member states. These figures represent a 160 percent and 19 percent increase in the number of cases and deaths, respectively, in 2024 compared with the same period in 2023. A 79 percent increase in the number of cases was observed in 2023 compared with 2022. The Democratic Republic of the Congo (DRC) accounts for 96 percent of all cases and 97 percent of all deaths reported in 2024.
Investigations in the DRC suggest that heterosexual transmission, especially among female sex workers (9 percent), is driving the outbreak, contrasting with the spread mainly among men who have sex with men in Europe in 2022. The high prevalence among women raises concerns about vertical transmission risks and adverse pregnancy outcomes.
The high risk of severe infection among people living with HIV, considerations for asymptomatic infections, poor vaccination strategies, limited access to medical countermeasures, and low detection rates were other concerns. The outbreak is further complicated by a high case fatality rate of over 3·9 percent, particularly among children younger than 15 years, who account for 60 percent of cases. Cross-border movements, low public awareness, high vulnerability due to factors such as HIV and malnutrition, limited understanding of mpox transmission and insufficient response capacities, including vaccine shortages, pose significant challenges to containment. The risk of mpox spreading to neighbouring countries and globally is high.
The day before the PHECS announcement, 15 of the 20-member Emergency Consultative Group (ECG) met to advise the Africa CDC Director General on whether the mpox outbreak constituted a PHECS. The group redefined PHECS as a significant event posing a risk to other countries, requiring immediate continental-level action to prevent and mitigate disease spread, expanding the original definition in the Africa CDC statute.
They also developed specific criteria to assess the situation objectively. These criteria, organised into nine areas, included: disease severity, transmission dynamics, impact on health systems, vaccine and treatment availability, public health risk, economic and social impact, public concern, global health security and political considerations (table). The framework was developed to guide a transparent and consistent decision-making process for declaring a PHECS in Africa.
World Health Organisation declares mpox global health emergency
The World Health Organisation (WHO) declared the ongoing mpox outbreak in Africa a global health emergency on Wednesday, 14 August 2024.
WHO convened its emergency committee amid concerns that a deadlier strain of the virus, clade Ib, had reached four previously unaffected countries in Africa. This strain had previously been contained to the Democratic Republic of Congo.
The independent experts met virtually Wednesday to advise WHO Director-General Tedros Adhanom Ghebreyesus on the severity of the outbreak. After that consultation, he announced that he had declared a public health emergency of international concern, the highest level of alarm under international health law. “The detection and rapid spread of a new clade of mpox in eastern DRC, its detection in neighbouring countries that had not previously reported mpox and the potential for further spread within Africa and beyond is very worrying,” he said.
“The emergency committee met and advised me that the situation constitutes a public health emergency of international concern. I have accepted that advice.”
Also known as a PHEIC, this is a status given by WHO to “extraordinary events” that pose a public health risk to other countries through the international spread of disease. These outbreaks may require a coordinated international response, according to the organisation.
“It was unanimous that the current outbreak of mpox, upsurge of mpox, is an extraordinary event,” committee Chair Dimie Ogoina said. “What we have in Africa is the tip of the iceberg. … We are not recognizing, or we don’t have the full picture of, this burden of mpox.”
The Africa Centres for Disease Control and Prevention declared the outbreak a public health emergency of continental security on Tuesday, the first such declaration by the agency since its inception in 2017.
Transmission and symptoms
Mpox, formerly known as monkeypox, is a viral disease that can spread easily between people and from infected animals. It can spread through close contact such as touching, kissing or sex, as well as through contaminated materials like sheets, clothing and needles, according to WHO. Symptoms include a fever, a painful rash, headache, muscle and back pain, low energy and enlarged lymph nodes.
For decades, the disease had largely been found in Central and West Africa, but it also began spreading in Europe and North America in 2022. WHO previously declared the spread of mpox a global health emergency in July 2022 and ended that declaration in May 2023.
Mpox is characterised by two genetic clades, I and II. A clade is a broad grouping of viruses that has evolved over decades and is a genetic and clinically distinct group. Clade II was responsible for the 2022 outbreak but clade Ib causes more severe disease.
“But we are not dealing with one outbreak of one clade; we are dealing with several outbreaks of different clades in different countries with different modes of transmission and different levels of risk,” Tedros clarified.
No cases of clade I mpox have been identified in the United States, the US Centres for Disease Control and Prevention says, but it is monitoring the situation and the US government has offered funding, assistance and vaccines to WHO and the DRC to support efforts in Africa.
Sources: Africa Centre for Disease Control (CDC), World Health Organisation (WHO)
The decision was driven by the worsening mpox situation on the continent: since 2022, 40 874 cases and 1 512 deaths have been reported across 15 AU member states. In 2024 alone, 17 541 cases and 517 deaths have been reported from 13 AU member states. These figures represent a 160 percent and 19 percent increase in the number of cases and deaths, respectively, in 2024 compared with the same period in 2023. A 79 percent increase in the number of cases was observed in 2023 compared with 2022. The Democratic Republic of the Congo (DRC) accounts for 96 percent of all cases and 97 percent of all deaths reported in 2024.
Investigations in the DRC suggest that heterosexual transmission, especially among female sex workers (9 percent), is driving the outbreak, contrasting with the spread mainly among men who have sex with men in Europe in 2022. The high prevalence among women raises concerns about vertical transmission risks and adverse pregnancy outcomes.
The high risk of severe infection among people living with HIV, considerations for asymptomatic infections, poor vaccination strategies, limited access to medical countermeasures, and low detection rates were other concerns. The outbreak is further complicated by a high case fatality rate of over 3·9 percent, particularly among children younger than 15 years, who account for 60 percent of cases. Cross-border movements, low public awareness, high vulnerability due to factors such as HIV and malnutrition, limited understanding of mpox transmission and insufficient response capacities, including vaccine shortages, pose significant challenges to containment. The risk of mpox spreading to neighbouring countries and globally is high.
The day before the PHECS announcement, 15 of the 20-member Emergency Consultative Group (ECG) met to advise the Africa CDC Director General on whether the mpox outbreak constituted a PHECS. The group redefined PHECS as a significant event posing a risk to other countries, requiring immediate continental-level action to prevent and mitigate disease spread, expanding the original definition in the Africa CDC statute.
They also developed specific criteria to assess the situation objectively. These criteria, organised into nine areas, included: disease severity, transmission dynamics, impact on health systems, vaccine and treatment availability, public health risk, economic and social impact, public concern, global health security and political considerations (table). The framework was developed to guide a transparent and consistent decision-making process for declaring a PHECS in Africa.
World Health Organisation declares mpox global health emergency
The World Health Organisation (WHO) declared the ongoing mpox outbreak in Africa a global health emergency on Wednesday, 14 August 2024.
WHO convened its emergency committee amid concerns that a deadlier strain of the virus, clade Ib, had reached four previously unaffected countries in Africa. This strain had previously been contained to the Democratic Republic of Congo.
The independent experts met virtually Wednesday to advise WHO Director-General Tedros Adhanom Ghebreyesus on the severity of the outbreak. After that consultation, he announced that he had declared a public health emergency of international concern, the highest level of alarm under international health law. “The detection and rapid spread of a new clade of mpox in eastern DRC, its detection in neighbouring countries that had not previously reported mpox and the potential for further spread within Africa and beyond is very worrying,” he said.
“The emergency committee met and advised me that the situation constitutes a public health emergency of international concern. I have accepted that advice.”
Also known as a PHEIC, this is a status given by WHO to “extraordinary events” that pose a public health risk to other countries through the international spread of disease. These outbreaks may require a coordinated international response, according to the organisation.
“It was unanimous that the current outbreak of mpox, upsurge of mpox, is an extraordinary event,” committee Chair Dimie Ogoina said. “What we have in Africa is the tip of the iceberg. … We are not recognizing, or we don’t have the full picture of, this burden of mpox.”
The Africa Centres for Disease Control and Prevention declared the outbreak a public health emergency of continental security on Tuesday, the first such declaration by the agency since its inception in 2017.
Transmission and symptoms
Mpox, formerly known as monkeypox, is a viral disease that can spread easily between people and from infected animals. It can spread through close contact such as touching, kissing or sex, as well as through contaminated materials like sheets, clothing and needles, according to WHO. Symptoms include a fever, a painful rash, headache, muscle and back pain, low energy and enlarged lymph nodes.
For decades, the disease had largely been found in Central and West Africa, but it also began spreading in Europe and North America in 2022. WHO previously declared the spread of mpox a global health emergency in July 2022 and ended that declaration in May 2023.
Mpox is characterised by two genetic clades, I and II. A clade is a broad grouping of viruses that has evolved over decades and is a genetic and clinically distinct group. Clade II was responsible for the 2022 outbreak but clade Ib causes more severe disease.
“But we are not dealing with one outbreak of one clade; we are dealing with several outbreaks of different clades in different countries with different modes of transmission and different levels of risk,” Tedros clarified.
No cases of clade I mpox have been identified in the United States, the US Centres for Disease Control and Prevention says, but it is monitoring the situation and the US government has offered funding, assistance and vaccines to WHO and the DRC to support efforts in Africa.
Sources: Africa Centre for Disease Control (CDC), World Health Organisation (WHO)