African countries worst affected by mpox have rapidly expanded their diagnostic capacity, with more laboratories and better-trained health workers, said Dr Jean Kaseya, head of the Africa Centres for Disease Control and Prevention (Africa CDC).

The Democratic Republic of Congo (DRC), the epicentre of the mpox outbreak, has increased its laboratories from two in January 2024 to 69, Kaseya told a media briefing on the first anniversary of the declaration of mpox as a Public Health Emergency of Continental Security (PHECS).

Despite mpox vaccine shortages, some 886,000 people have also been vaccinated in 12 countries, he added.

Mpox has affected 24 African countries, with over 97,000 suspected cases and almost 600 deaths. But weak diagnostics mean fewer than a third of cases( 29,849) and deaths (197) were confirmed.

Conflict and poor infrastructure are affecting the DRC’s ability to identify and treat cases, which accounts for most of the untested cases. 

Other high-burden countries – Sierra Leone, Burundi and Uganda – have been able to test almost all their suspected cases.

Africa CDC and the World Health Organization (WHO) have coordinated countries’ responses via an incident management support team (IMST), which has trained 3,000 health workers on case management.

The IMST has developed continental Mpox Preparedness and Response Plans and co-led the implementation.

“Our collective efforts have been crucial in strengthening measures for an effective response,” said Dr Otim Patrick Ramadan, WHO Africa’s programme area manager for emergency response. “It is critical to sustain what works, which includes rapid case detection, timely targeted vaccination, strong laboratory systems, and active community engagement.”

Professor Yap Boum, deputy incident manager for Africa CDC, said: “With limited resources, there is a critical need to be more efficient which means working as one team, with one plan budget and monitoring framework,” said

Mpox is declining on the continental and Africa CDC’s independent expert panel will soon decide whether to suspend the PHECS, said Kaseya.

However, challenges persist including imited access to vaccines, competing emergencies, funding gaps, inadequate access to care, and stigma and the conflict in eastern DRC, according to WHO Africa in a media release on Thursday.

“Our priorities for the next six months are to  expand community-based surveillance in high-risk areas, continue to procure and distribute essential supplies to hotspots, support the integration of mpox response into other health programs for sustainability, support targeted vaccination and advocate for more funding for vaccine deployment,” said Otim.

However, the infrastructure that has been set up to address mpox is also being used to address another health emergency: cholera. 

Twenty-three countries are facing cholera outbreaks, usually caused by a lack of clean water,  which are being fanned by “humanitarian crises and natural disasters”.

So far, over 220,000 cholera cases have been recorded this year – already close to the case load of 254,000 for the whole of 2024.

By month-end, Zambia will host a meeting on cholera to develop a common continental approach, said Kaseya.

Africa CDC is also encouraging countries to integrate their HIV and mpox responses, testing people for both diseases. People with HIV are more susceptible to mpox, which can also be sexually transmitted.

Health financing

When asked whether any African group was taking forward the proposal that tourists to the continent should be charged a tax levied via airlines to help cover the cost of healthcare, as suggested by last week’s summit on African health sovereignty, Kaseya simply deferred to Rwandan President Paul Kagame.

“The meeting in Ghana … is just a continuity of what is already done, because there is, there is nothing new that will come there if it was not discussed in AU,” said Kaseya. “Our champion for health financing is President Kagame. And in Africa, we like to respect to that. For the next steps, if there is a leader who must talk about health financing and bring other leaders together, it is  President Kagame.”

However, Kaseya reiterated that the solutions to the funding crisis lie in countries allocating more domestic resources to health; innovative solutions including the airline tax and taxes on unhealthy products ,and blended finance. The DRC is taxing all imported goods and allocating some of that revenue to health, he added.

There has been a 40% reduction in development aid to the continent in the past two years – the steepest cuts taking place over the past eight months since US President Donald Trump assumed office.

“We have a number of areas of engagement with the US , and we hope that that we can get a positive outcome from this engagement,” said Kaseya.

Image Credits: Africa CDC.