When Mpox virus finds home in Africa
Dr. Olukayode Oyeleye, Business a.m.’s Editorial Advisor, who graduated in veterinary medicine from the University of Ibadan, Nigeria, before establishing himself in science and public policy journalism and communication, also has a postgraduate diploma in public administration, and is a former special adviser to two former Nigerian ministers of agriculture. He specialises in development and policy issues in the areas of food, trade and competition, security, governance, environment and innovation, politics and emerging economies.
MONKEY POX EPIDEMIC in Africa is on the rise. The recent disclosures about potential public health risks are a bit belated, though unsettling. They betrayed the lackadaisical attitude of those who should be in charge of surveillance and preventive measures in a manner reminiscent of the way COVID-19 pandemic was initially treated at the onset, which aided its eventual global spread. The current outbreak, which began in DR Congo since January 2023 and from which 27,000 cases and more than 1,100 deaths have been reported — mainly among children — was not considered a public health emergency of international concern or PHEIC until last Wednesday when the official recognition was declared by Dr Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organisation (WHO). What a prompt recognition and a response!
The WHO reportedly made its declaration a day before a case was reported by Swedish health officials, that an index case in Sweden was found in a person that was recently infected while in Africa with the ‘Clade Ib’ type of the Mpox involved in the recent outbreak. Quite ridiculously, the WHO DG reportedly said that “there will likely be more here and in other parts of the world as there are currently no mechanisms in place to stop imported cases of mpox happening.” But, before last Wednesday the WHO was aware of outbreaks elsewhere in Africa as cases were reported of spread from the DR Congo to nearby countries.
The WHO declaration on August 15, after the spread of cases in the DR Congo to nearby countries, was instructive. Considering that PHEIC in the WHO is the highest level of alert, this was particularly troubling as the WHO was only just considering the alert in the wake of the upsurge of Mpox, presumably the second alert since when the outbreak first started in 2022. Something is both grossly missing and evoking curiosity as outbreaks had worsened in DR Congo and surrounding countries, with the over 17,000 infections and more than 500 deaths from mpox in 2024, primarily in DR Congo, according to the Africa Centre for Disease Control and Prevention, which issued its own emergency declaration for the outbreaks earlier on August 13, announcing more than 17,000 suspected cases across the continent, two days before the WHO’s announcement. This, the Centre disclosed, across the continent, “is just the tip of the iceberg when we consider the many weaknesses in surveillance, laboratory testing and contact tracing.” Figures from the WHO were closer but vary slightly as it disclosed 15,664 reported cases and 537 deaths so far in the DR Congo alone. This exceeds the total seen in 2023.
Although Central and Eastern Africa have had a fair share of mpox – formerly known as monkeypox – cases of ongoing outbreaks have nonetheless been reported in Central and West Africa. This is the second time in two years that the disease has spread enough to warrant such a declaration from the WHO, particularly as young adults and children have been mostly affected by the current outbreak, a trend that was missing in the 2022-2023 outbreak. In some provinces of the DR Congo, children under 15 account for up to 69 percent of suspected cases.
Implications of the current epidemic are many and far-reaching. Mpox is a communicable disease and can spread through contact with infected animals such as through bites or scratches, or when people hunt or eat them. But, in 2022, much was said about the human-to-human transmission during and after the global “sexcapades” involving homosexuals. A global outbreak began in 2022, with the virus strain, known as Mpox ‘clade II,’ primarily circulating among men who have sex with men.
While the highly contagious and severe strain of Mpox is reportedly crossing continents and U.S. officials are preparing for its eventual showdown in the event of its arrival, a big question about the spread of the virus is appropriate. Why has there been such a broad time lag on remedial actions since 2022? Considering the attributes and behaviours of the virus, it could be said that the world treated the African case with levity. Mpox is known for being an infectious disease caused by a virus that belongs to the same family as that which causes smallpox. Its spread among animals in Central and West Africa such as rodents and monkeys has been acknowledged as very regular, but occasionally jumps to people, causing small outbreaks. The fact that the currently prevalent Mpox variant has now spread to at least 11 other African countries, including four that had previously never reported Mpox, should be a cause for alarm. Such outbreaks can threaten and dampen the economies of Kenya and Rwanda that earn a bulk of their national revenues from tourism, as this Mpox can drive international tourists away for an extended period. Burundi and Uganda are likely to suffer similar fate, especially in agriculture and mining. Its spread through skin contact is well documented. The Mpox virus currently circulating in Congo and a dozen other African countries, and now Sweden, is a different strain from the one that has circulated in the U.S. since a global outbreak began in 2022.
The recent announcement by the WHO, involving its second emergency declaration in two years due to the recent outbreak in and around the DR Congo, showed the limited concerns for Africa in the global public health space. Now that DR Congo has become the centre for dissemination of the disease beyond Africa, the world seems to be noticing Africa. The current outbreak originating in a small mining town in the DR Congo could have been easily ignored if not associated with a communicable disease that could escape to the wider world. While the highly contagious and severe strain of Mpox is reportedly crossing continents and U.S. officials are preparing for its eventual arrival there, the reality is worrisome and a big question about the spread of the virus is appropriate.
Why has there been such a wide time lag on remedial actions since 2022? Considering the attributes and behaviours of the virus, Africa should ordinarily have no cause for alarm. But it could be said that the world treated the African case with levity. The fact that Mpox is caused by a virus that belongs to the same family as that which causes smallpox should provide a basis for making use of the knowledge of smallpox helpful in its control. Its spread among animals in Central and West Africa such as rodents and monkeys has been acknowledged. It becomes communicable when it occasionally jumps to people. What used to be considered small outbreaks may no longer be so in the context of increasing numbers of strains, introducing further complications to the control measures. The current spread of the prevalent Mpox variant to at least 11 other African countries, should be a cause for alarm.
Short term and long term impacts and multiplier effects of the outbreaks on the economies of Kenya and Rwanda that depend largely on tourism can be better imagined, remotely or directly. Burundi and Uganda are likely to suffer similar fate, especially in agriculture and mining. Clinical manifestations might become obvious sooner or later. The global community has therefore allowed avoidable gaps in global public health, capable of threatening lives as well as economies once again. Although the Mpox epidemic is unlikely to have the same severity of impact as did COVID-19, it will nonetheless disrupt the global economy to some extent as travels are restricted, cases of morbidity and mortality rise and healthcare facilities are once again overwhelmed, especially in Africa.
The leadership within the continent of Africa will once again come under scrutiny for not being proactive in staving off the spread of the Mpox epidemic. It could be safely assumed that all African countries are already exposed to the Mpox and steps need to be taken very urgently to apply sustainable remedial measures. It is ironic that the national borders that still pose serious barriers to trade and travel across countries actually pose no barrier to disease transmission.
Even where there are possibilities of applying vaccines, a number of factors still have to be examined. The range of coverage of the vaccines in response to diverse strains is of great essence. Bivalent and polyvalent vaccines might be more desirable than monovalent vaccines for more effective coverage. The Mpox vaccine, which provides the best protection after two doses is also a good idea to explore. Smallpox vaccines have also been found to protect against Mpox, though it isn’t clear if any of these vaccines will be effective against the new Mpox variant. But, more important is the issue of availability, handling during cold storage and transportation. It is doubtful if any progress will be made in protecting the people in Africa if countries are unable to fund massive vaccine purchase. The politics of self pity, playing the victim, relying on foreign aid or financial donations will not help Africa this time. It will not be a bad idea to accept vaccine donations if given. But it is undesirable to wait for such handouts.
It is hoped that the opportunistic hawks will not introduce the straitjacket idea of vaccinating everyone except those who are at high risk of contracting Mpox. Rapid assessment at national, regional, provincial, state and county levels are essential. These are needed for proper determination of exposure through risk analysis, contact tracing, deployment of cutting edge diagnostic tools to help in properly handling the cases, directing attention and intervention funds and vaccines. They are recommended as risk levels remain low for people who are not in close proximity to areas affected by the current outbreak. Mpox should not be allowed to slow down our continent this time. Something urgent and pragmatic must be done to rein it in early.
Moreover, countries should not go it alone, but should collaborate by embarking on information sharing, expertise sharing, support of the weaker countries by stronger ones and utilisation of the strength of the regional economic blocs as well as African Union at this time. The Mpox war is one that Africa must win early, decisively and permanently.