Mpox Outbreak In Africa: A Stark Reminder Of Global Health Inequities

In an alarming development, the ongoing Mpox outbreak in Africa underscores a pressing issue within global health: diseases initially perceived as confined to specific regions, especially those affecting impoverished areas, can rapidly escalate into global crises. This reality is highlighted in a recent article by Wolfgang Preiser, Cheryl Baxter, and Jean Nachega in The Conversation.

Mpox, originally dubbed “monkeypox” due to its discovery in captive monkeys in 1958, was long considered a rare and inconsequential disease affecting only remote regions of tropical Africa. The first human case was identified in 1970, but the disease remained largely overlooked by both the scientific and public health communities for decades. This neglect persisted despite repeated warnings from African researchers about the need for global investment in diagnostics, therapeutics, and preventive measures.

The situation changed dramatically in 2022 when a significant Mpox outbreak emerged in developed countries. This global health crisis led to an unprecedented surge in research funding, with the volume of scientific studies on Mpox increasing more in the past year than in the previous six decades combined. By August 2022, over 6,000 new cases were reported weekly, highlighting the virus’s rapid spread beyond its endemic regions.

Increased transmissibility

The World Health Organisation (WHO) declared the outbreak a Public Health Emergency of International Concern on July 23, 2022. This high-level alert necessitated a coordinated international response, which included the deployment of vaccines and antiviral drugs that had been stockpiled in preparation for potential bioweapon attacks. Although the outbreak mainly involved the less virulent clade II of the virus, predominantly affecting men who have sex with men, the emergency declaration was a critical move to curb further spread.

The outbreak eventually subsided due to behavioural changes and vaccination efforts in at-risk groups, and the emergency status was lifted in May 2023. However, complacency could be dangerous. Recent reports indicate that Mpox cases are surging once again in Africa, particularly in the Democratic Republic of Congo (DRC), where a more virulent strain, clade I (formerly the Congo Basin strain), is causing increasing concern.

This new clade I strain is more deadly than its clade II counterpart and is showing a disturbing pattern of human-to-human transmission. It has already led to rising case numbers in several neighbouring countries, including Kenya, which had no prior record of Mpox. The strain’s increased transmissibility and higher case fatality rate further complicate efforts to control the outbreak.

Global health inequities

The current outbreak, which began in early 2023, is exacerbated by the DRC’s ongoing challenges, including natural disasters, violence, and other infectious diseases like measles and cholera. The DRC recently experienced the second-largest Ebola outbreak ever recorded, which, despite the availability of vaccines and treatments, posed significant control challenges.

Preiser, Baxter, and Nachega’s article emphasizes that the situation in Africa illustrates the broader issue of global health inequities. The availability of vaccines, diagnostics, and treatments in high-income countries played a crucial role in mitigating the global outbreak of 2022. However, similar resources remain scarce in much of Africa, hindering effective response efforts.