WHO has ended its declaration of a Public Health Emergency of International Concern (PHEIC) for Mpox, announced in August 2024, saying that cases in the most affected areas of Africa had leveled off or were declining.

However, continued vigilance in testing – along with regular supplies of vaccines and drug treatments remains essential to ensure that the outbreak of a new and more deadly strains of mpox remains under control, particularly in a period of diminished donor support for African health systems, the global health agency warned.

“This decision is based on sustained declines in cases and as in the Democratic Republic of the Congo, and in other affected countries, including Burundi, Sierra, Leone and Uganda,” said WHO Director General Dr Tedros Adhanom Ghebreyesus, at a press briefing on Friday, noting that he was lifting the emergency upon the recommendation of WHO’s Mpox Emergency Committee of experts, that had met Thursday.

“We also have a better understanding of the drivers of transmission, the risk factors for severity and the most affected countries have developed a sustained response capacity,” Tedros said.

But  “lifting the emergency declaration does not mean the threat is over, nor that our response will stop,” Tedros added, noting that only yesterday, Africa Centers for Disease Control had met and declared that mpox remains a “continental health emergency.”

“We note…the possibility of continued flare ups and new outbreaks remains requiring adequate surveillance and response capacity. Ongoing efforts are needed to protect the most vulnerable groups, particularly young children and people living with HIV.”

Mpox affected 29 African states – as well as Asia, Europe and Americas

The global health emergency was first declared after the deadly Clade 1 mpox, which has a fatality rate as high as 10%, surged in the Democratic Republic of Congo, followed by a less virulent but more contagious Clade 1b variant, as well as Clade 2. The variants spread across some 29 African ,member states as well as to other far flung countries from China to the Philippines. Unlike the previous global mpox outbreak of 2022-2023, which primarily affected men who have sex with men, the new Clade 1b variant raced through communities infecting  women and children as well.

In recent months, however, cases on the continent, the epicenter of the outbreak, have tailed off, with a 28% decline in new cases between June and July according to a recent Africa CDC update. Cases in the Americas and Europe both declined by 31% – prompting the Mpox Emergency Committee to recommend that the international health emergency alert could be lifted.

Sustained decline – but ….

“There have been a sustained decline in the number of cases of mpox in the African continent overall, and also in the most affected countries of Uganda, DRC, Sierra, Leone and Burundi, there has also been a remarkable decline in the case fatality rate,” said the head of WHO’s Mpox Emergency Committee, Professor Dimie Ogoina, of Niger Delta University, speaking from Nigeria.

“There has also been a remarkable decline in the case fatality rate, in the DRC endemic regions from 3.6% to about 1% over the period of one year,” he added, along with a big increase in testing capacity – from only 30% to around 60% of suspected cases – and 54% for the conflict-ridden DRC.

“We know, of course, this is still very suboptimal, but many of the countries, have improved the ability to to diagnose and case findings, search for impacts, and also there have been local investment from the ministries,” Ogoina added.

Meanwhile, nearly 6 million vaccines have been pledged to African communities, said Tedros, with more than 3 million doses delivered to 12 countries – although just under 1 million vaccine doses have in fact been administered to date.

“So we have made much progress, but we still face significant challenges,” Tedros said. “Mpox clades continue to circulate surveillance and access to diagnostics remains patchy. Response capacities are under strain from limited funding and community engagement requires sustained investment and local partner coordination, who and our partners are working to mitigate these risks and sustain support to countries. Financial resources are still very much needed to support this work.”

New Ebola outbreak in DRC

Meanwhile, just as mpox is winding down, DRC health authorities are rushing to contain a new outbreak of the even more deadly Ebola virus, in Kasai province, a small and isolated area in the southwest of the country, WHO said.

The index case is a 34-year-old pregnant woman admitted to hospital last month with symptoms including high fever and repeated vomiting. Laboratory tests have confirmed the Zaire strain of Ebola. Investigations are ongoing to determine the source of exposure.

Kasai province last reported an Ebola outbreak in 2008, while nearby Equateur province experienced one in 2022.

The virus has already led to the deaths of some 15 people, with another 28 suspected cases, four of them among health workers. WHO surge teams and vaccine supplies are being mobilized from Kinshasa to cope with the outbreak, said WHO and Africa CDC officials in separate statements.

Image Credits: Katson Maliro/ WHO, Africa CDC , Africa CDC .