“Words must now be matched with deeds,” Africa CDC Director General Jean Kaseya said after the official declaration.

The Africa Centers for Disease Control and Prevention (Africa CDC) has officially declared the surging mpox outbreak a “public health emergency of continental security” – the first time it has made such a declaration on its own.

Jean Kaseya, Africa CDC’s Director-General said the centre’s historic move represents a pivotal moment in Africa’s fight against the long-simmering and now rapidly spreading disease.

“Today, Tuesday, 13 August 2024, I declare with a heavy heart, but with an unwavering commitment to our people, to our African citizens, we declare mpox as a public health emergency of continental security in Africa,” Kaseya stated at a Tuesday afternoon press briefing.

In just the past week,  more than 2500 new mpox cases and 56 deaths were reported in some five African Union member states, Africa CDC officials noted at the briefing.  Those included Burundi, the Central African Republic, Congo, the Democratic Republic of Congo (DRC), and South Africa.  Since the beginning of the year, 17,541 mpox cases have been reported across 13 AU states, according to the latest Africa CDC epidemic intelligence report, published 9 August.

❗️Breaking. In an historic first, @AfricaCDC declares continental health emergency over the recent surge in #mpox cases across 13 countries – with 2,000 new cases reported in just the last week. @pauladepoju https://t.co/Zj6jIAyL3r

— Health Policy Watch – Global Health News Reporting (@HealthPolicyW) August 13, 2024

In the days leading up to the declaration, Health Policy Watch reported that a new variant of the mpox virus, known as Clade 1b, is fueling an outbreak in eastern Democratic Republic of Congo (DRC) that has now spread to neighboring countries. 

In other areas of DRC, Clade 1a of mpox is also spreading, according to WHO reports. Historically Clade 1a variants of mpox have seen high mortality rates of up to 10%. A mix of Clade I and II cases also continue to be reported in multiple other countries of West, Central and East Africa, affecting children and adults and spread through multiple modes of transmission. 

The case fatality rate (CFR) from this mix of mpox clades and variants is a startling high 2.95%, according to Africa CDC.

In Africa and throughout the world, the milder Clade IIa variant, spread mainly through men having sex with men, also continues to spread.  

A consultation process involving more than 600 people

Describing the journey to the declaration, Kaseya said it was not made lightly. He noted it was the culmination of an extensive consultative process involving a diverse array of stakeholders at various levels, as mandated by the Africa CDC statutes. 

“Africa CDC didn’t sit in its office and make a decision. No, it was a constructive, consultative process led at various levels by capable people…at least 600 people were reached in various capacities to discuss data and evidence and to provide a way to move forward for this outbreak,” the DG said at the press briefing.

The Emergency Consultative Group (ECG), comprising African and international experts, reviewed epidemiological data and unanimously recommended declaring a public health emergency. 

“We resolved to make a recommendation to the Director-General of the Africa CDC to declare mpox a public health emergency of continental security,” Professor Salim Abdool Karim, the ECG chair, said at the briefing.

Karim expressed concerns, in particular, that the virus variants are now spreading almost entirely between humans – well beyond traditional animal reservoirs. 

“The evidence we have does not seem to be that it’s zoonotic transmission, in other words, from an animal reservoir. It seems to be almost all, mostly from human to human transmission,” he said. 

“We are seeing new cases in countries that didn’t have cases before,” Karim added, saying  saying the declaration should help “ensure that the disconnected attempts that are being made are brought together in a large plan with some coordination to improve the efficacy of our intervention measures.”

Africa CDC aims to leverage the emergency announcement to coordinate a stronger international response, mobilise resources, enhance surveillance, accelerate research and development, and foster global solidarity, Kaseya said. 

All of those have been sorely lacking in previous months. 

“Words must now be matched with deeds, and today, I commit to you that Africa CDC will lead this fight with every resource at our disposal, together with our partners,” Kaseya added.

Africa’s growing mpox disease burden – 60% children

According to the DG, the decision to declare a public health emergency was driven by the new modes of transmission, including sexual transmission; a growing proportion of cases involving children; late detection of cases; and limited access to countermeasures like vaccines and diagnostics. “This is one of the aspects that is alarming us…you will see it’s mostly driven by cross-border transmission linked also to sexual transmission,” Kaseya added.

A staggering 60% of cases in the DRC involve children under 15 years old, according to Africa CDC. Kaseya said this alarming statistic underscores the urgency of the situation and the need for swift action to protect the most vulnerable populations.

Furthermore, the outbreak has spread to non-endemic countries, such as Burundi, Kenya, Rwanda, and Uganda, which have reported their first-ever cases of mpox this year. This unprecedented spread, Kaseya noted, has necessitated a coordinated, continental approach to curbing the disease’s transmission.

Addressing the challenges posed by the outbreak, Kaseya acknowledged the complexity of the situation, citing insecurity in certain regions, limited understanding of the epidemiological and transmission dynamics, inadequate global attention, and the unavailability of countermeasures as significant hurdles. 

Support at the highest levels 

However, Kaseya expressed optimism in light of the fact that the decision to declare the public health emergency had garnered political support at the highest levels in Africa, especially the leadership of the African Union. 

This he said is important to ensure engagement now in a more coordinated, multi-sectoral response.

Already, the African Union has approved the emergency release of $10.4 million to support the continental response to the outbreak, he said. He announced that the funding will aid in securing necessary vaccines, strengthening surveillance systems, and bolstering overall preparedness and response efforts.

“We are advocating strongly and we are going to be creating subcommittees on surveillance and diagnostics, on communication, on vaccines and therapeutics to ensure that we have a holistic view on the way we address this issue,” he added.

Africa needs 10 million vaccine doses – only 200,000 available

One of the critical challenges facing the response efforts is the limited availability of mpox vaccines, as well as multiple hurdles to their rollout. Existing vaccines have been produced by only two manufacturers, Bavarian Nordic, whose production has been constrained, and the Japanese LC16 KMB, produced by KM Biologics. The latter has the advantage of being just one, rather than two jabs, but it requires intradermal administration – a procedure requiring training for the health workers unfamiliar with the technique.  

Currently, Africa requires at least 10 million doses of mpox vaccines. But only 200,000 doses are right now available, said Kaseya.  He said that underlines the urgency of more local vacccine manufacturing. “Local manufacturing of vaccines [and] medicines is the second independence of Africa,” he said.

In a bid to address the vaccine shortage, Africa CDC said it is actively engaging with various partners, including the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) and the German-based BioNTech which partnered with Pfizer to produce the mRNA COVID vaccine, as well as others to finalise contracts and scale up production for millions of doses in 2025. 

In light of the current shortages, however, Karim emphasised the importance of strategic vaccine distribution. 

“We have to be very strategic in who we use the limited number of vaccines on…for example, healthcare workers have been one of the groups that have to be addressed,” he said.

All eyes on WHO

Mpox is an orthopoxvirus, a disease in the same family as smallpox., which was eradicated in 1980. Previously called monkeypox, it was renamed by WHO  in 2022, due to the racist stigma associated with the historic name. In July 2022, WHO declared a public health emergency over the first worldwide outbreak of mpox, involving a milder Clade II variant spreading internationally, parimarily between men who have sex with men; it was declared to be over in 2023. 

In the wake of the Africa CDC announcement regarding this latest outbreak, all eyes are on now WHO – where an emergency expert committee is holding further consultations on Wednesday over the possible declaration of a global mpox public health emergency as well. 

That meeting is convening in Geneva under the auspices of the circa 2005 WHO International Health Regulations (2005) – the framework under which global health emergencies, known as Public Health Emergencies of International Concern (PHEIC), are declared.  

There has been simmering criticism, however, that WHO criteria for issuing global health emergency declarations are always not fit for purpose in the case of many of the outbreaks that Africa has faced first on the continent, alone.  In the wake of the worldwide COVID pandemic, the World Health Assembly in May finally approved amendments to the IHR that now allow  for the declaration of a pandemic emergency. However, in the two years of negotiations leading up to the revisions, member states ultimately rejected proposals to revise the  “binary” system of emergency declarations to a tiered system dubbed a “traffic light”, allowing for a WHO declaration of regional emergencies, or emergencies with global potential. 

In the case of the current outbreak, those long-simmering issues all contributed to the decision of Africa CDC to act on its own first, on Tuesday. 

Image Credits: US Centres for Disease Control , Paul Adepoju, Africa CDC, CDC.