After a meeting of an International Health Regulations (IHR) Emergency Committee on 14th August 2024, WHO Director-General Dr Tedros Adhanom Ghebreyesus announced that the mpox outbreak in the Democratic Republic of the Congo (DRC) and a “growing number” of countries in Africa constitutes a public health emergency of international concern (PHEIC). Dr Tedros’ decision is based on the advice of the Emergency Committee’s, comprising independent experts, who met to review data. The Committee considered the “upsurge” in mpox a PHEIC with potential to spread throughout Africa and outside the continent.
Opening remarks
Dr Tedros opened the meeting, commenting on a significant increase in reported cases in the Democratic Republic of the Congo. The emergence and “rapid spread” of clade 1b and its detection in neighbouring countries is “especially concerning”, and Dr Tedros suggested that this was “one of the main reasons” for his decision to convene the Committee. Not only is the emerging clade a concern, but “we are dealing with several outbreaks of different clades in different countries”.
“Stopping these outbreaks will require a tailored and comprehensive response, with communities at the centre, as always.”
WHO is reportedly already working with governments in the affected countries, as well as Africa CDC and other partners, to “understand and address the drivers of these outbreaks”. It has also developed a regional response plan, which will require an initial US$15 million for surveillance, preparedness, and response activities. $1.45 million has been released from the WHO Contingency Fund for Emergencies; more is planned to be released in the coming days but WHO is also appealing to donors for funding.
The standing recommendations under the IHR, issued at the declaration of the end of the previous mpox PHEIC, were due to expire next week. However, Dr Tedros elected to extend them for another year.
PHEIC declared
Dr Tedros will share the Committee meeting reporting and issue temporary recommendations to countries. As he declared the PHEIC, he highlighted the need for a “coordinated international response” to “stop these outbreaks and save lives”. WHO Regional Director for Africa Dr Matshidiso Moeti echoed this, commenting that “significant efforts are already underway”.
“With the growing spread of the virus, we’re scaling up further through coordinated international action to support countries bring the outbreaks to an end.”
Chair of the Committee, Professor Dimie Ogoina, stated that this is an emergency “not only for Africa, but for the entire globe”.
“Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself.”
Infectious disease inequality
Vaccine efforts have already begun, with donations of Bavarian Nordic’s vaccine secured by HERA. However, Dr Boghuma Tianji, Assistant Professor of Medicine, Department of Medicine at Emory University, identified a tension over donations.
“While there has been substantial criticism of foreign donors for inadequate support, the over-reliance on external aid has highlighted a major flaw in the current response efforts.”
Indeed, the PHEIC declaration in 2022 “did not lead to significant improved access” for African countries. Professor Jonathan Ball, Deputy Director of Liverpool School of Tropical Medicine and Professor of Molecular Virology, Liverpool School of Tropical Medicine (LSTM) hoped that international recognition of the emergency will “kick-start mobilisation of the necessary infection control measures”.
“Low- and middle-income countries suffer most from infectious diseases yet have insufficient capacity for surveillance and control. Infectious diseases thrive on these health inequalities so it is essential for other countries to help build capacity – infections do not respect international borders, so this isn’t just someone else’s problem.”
Professor Marion Koopmans, Head of the Institute for Virus Research and Director of the Pandemic and Disaster Management Centre, Erasmus University Rotterdam, shared insights into the significance of the declaration before it was announced.
“It raises the level of alert, globally, and may allow WHO to access funds for emergency response. Other than that, the same priorities remain: investing in diagnostic capacity, public health response, treatment support, and vaccination.”
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