Central Africa is facing a troubling surge in monkeypox cases, prompting urgent responses from health authorities. On August 13, the Africa Centres for Disease Control and Prevention (Africa CDC) declared its first-ever public health emergency due to the outbreak. Following this, the World Health Organization (WHO) will convene on August 14 to consider declaring a global emergency.
Spread of the Virus
Recent months have seen a rapid spread of monkeypox, or mpox, across Central Africa. Notable increases have been observed in densely populated areas like Bukavu in the Democratic Republic of the Congo (DRC), which has over 1 million residents. Additionally, four countries in the region have reported mpox cases for the first time. This surge is believed to be linked to an outbreak that began in South Kivu province in late 2023, a region plagued by conflict.
The current viral strain in Central Africa appears more severe than the one responsible for the 2022 global outbreak, which affected over 95,000 people and resulted in more than 180 deaths.
Concerns from Experts
Anne Rimoin, an epidemiologist from the University of California, Los Angeles, who has worked on mpox in the DRC since 2002, stresses that outbreaks can affect regions far from their origin. “An infection anywhere is potentially an infection everywhere,” she notes.
In 2024, Africa has reported 17,500 mpox cases, surpassing the 15,000 cases recorded in 2023. Children are particularly affected, with about two-thirds of cases in the DRC involving individuals under 15.
Emergence of New Strains
Some recent infections are linked to the clade II strain, which caused the 2022 outbreak. However, there is a growing number of cases attributed to clade I, a strain that has historically caused smaller outbreaks in Central Africa. Researchers recently identified a new variant of clade I, called clade Ib, which appears to spread more efficiently, including through sexual contact.
The spread of clade Ib has been exacerbated by the humanitarian crisis in South Kivu and other diseases like cholera. Recently, Burundi, Kenya, Rwanda, and Uganda reported their first mpox cases. In early August alone, the DRC reported nearly 2,400 suspected cases and 56 deaths, prompting the Africa CDC to declare a public health emergency.
Global and Local Responses
The WHO is considering whether the outbreak warrants a global emergency declaration, which would signal the need for international coordination.
Mpox symptoms include painful skin lesions and, in severe cases, death. It remains unclear if the symptoms of clade Ib differ from those of clade II or how transmissible it is. Espoir Bwenge Malembaka, an infectious disease expert at the Catholic University of Bukavu, notes that clade I has historically been reported in rural areas with limited healthcare, potentially contributing to its higher death rate.
Need for Vaccines and Treatments
Effective surveillance and regional cooperation are crucial to controlling the outbreak, according to Bwenge Malembaka. However, mpox vaccines and treatments remain scarce in African countries.
Negotiations are underway between the Africa CDC and Bavarian Nordic, a Danish biotechnology firm, to secure 200,000 doses of the mpox vaccine. This is far short of the 10 million doses estimated as necessary. Challenges include distributing vaccines to regions with poor healthcare infrastructure and reaching high-risk populations, such as sex workers and men who have sex with men.
Rimoin emphasizes the importance of not repeating past mistakes, where vaccines and treatments were stockpiled in high-income countries. “Providing tools to the countries at greatest risk is crucial for controlling outbreaks at their source,” she says.
