In April 2024 Ministers of Health and partners in Africa met in Kinshasa, Democratic Republic of Congo, for a high-level emergency regional meeting about mpox in Africa. An outbreak in Democratic Republic of Congo (DRC) has been causing growing global concern, with a recent report identifying a novel Clade I MPXV lineage “associated with sustained human-to-human transmission”. The authors call for immediate action to contain any pandemic potential. However, while the smallpox vaccine was found to prevent about 85% of mpox cases, it was deployed almost exclusively in high-income countries, and DRC still has no access to vaccines or treatments.
A divergent strain
In October 2023 a “large” mpox outbreak emerged in the Kamituga region of DRC; this outbreak is the subject of a 2024 preprint. The authors state that 241 suspected cases were reported within 5 months of the first reported case; these “rapidly” increasing numbers were tested to reveal a “distinct MPXV Clade Ib lineage”, which is “divergent” from previously sequenced Clade I strains in the country. Of 108 confirmed cases, 29% were in sex workers, “highlighting sexual contact as a key mode of infection”.
Significant concerns
The authors of the preprint highlight “significant concerns” raised by the “sustained spread” of Clade I in a “densely populating, poor mining region”.
“Local healthcare infrastructure is ill-equipped to handle a large-scale epidemic, compounded by limited access to external aid.”
Not only are reported cases a concern, but they are “likely an underestimate of the true prevalence”. Conversations with local HCWs revealed that “many people” have mpox “signs and symptoms” but do not seek care. The “frequent travel” between Kamituga and neighbouring Bukavu is a worrying factor for the researchers, who anticipate “subsequent movement” to countries such as Rwanda and Burundi. Additionally, foreign sex workers returning to their home countries and the “highly mobile nature” of the mining population privude a “substantial risk of outbreak escalation”.
“Urgent measures must be implemented, including intensifying local surveillance, enhancing referral systems and case management, and implementing targeted mpox vaccination for individuals at high risk”.
African health ministers unite
At the high-level emergency meeting in DRC this month, the health ministers of Angola, Benin, Burundi, Cameroon, Central African Republic, Congo, Democratic Republic of Congo, Gabor, Ghana, Liberia, Nigeria, Uganda, and “partners” shared a communiqué:
Noting with concern – the prolonged and ongoing epidemic of mpox in several Central and West African countries and the potential risk of transmission to neighbouring countries and beyond
Seriously concerned – about the changing transmission dynamics, high mortality rate and transmissibility of the monkeypox virus, as well as the morbidity, mortality, and social and economic impacts
Aware – of the limitations on access to and acquisition of medical countermeasures, including diagnostics, treatments, vaccines, and other tools for early detection, verification, care, treatment, and prevention
Recognising – the common threat posed by the mpox outbreak to the health and economic security of the populations to the Central and West African regions and the urgent need to address this common threat by all member states of the African Union
Acknowledging – the existing frameworks, protocols, strategies, and agreements for cross-border solidarity, collaboration, and coordination on infectious disease issues
The communiqué outlines various commitments by African health ministers, including:
- Promoting a “One Health” approach
- Facilitating cooperation and collaboration between all Member States
- Facilitating technical support through Africa CDC and WHO mechanisms at various levels
- Exchanging information rapidly
- Establishing the Africa Taskforce for Mpox Coordination, to be facilitated by the African Union Commission, Africa CDC, and WHO
- Demanding partners harmonise support by interacting with the Taskforce
Despite the evident commitment of African health ministers, they are concerned by the “scale and severity” of the epidemic. Goats and Soda reports that DRC’s Health Minister, Dr Samuel-Roger Kamba, addressed the meeting in French to express urgency:
“This situation constitutes a public health emergency.”
However, Dr Nicaise Ndembi, virologist and senior advisor to Africa CDC’s Director-General, is quoted in the same article noting that “meetings are meetings” unless we “really take action”. Dr Ndembi is cautious about an official declaration, recalling the difficult experience of COVID-19 restrictions on local economies.
“It’s very sensitive.”
Despite this delicacy, Dr Ndembi encourages health officials: “Declare!”
“By declaring, you have access to the drugs, you have access to the vaccines…and that will open the door for international support to mobilise resources.”
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