Two years ago, the United States and other western countries mounted an aggressive — and successful — response to mpox. But the virus, formerly known as monkeypox, is coming back deadlier than before. Western countries must curb this threat before it once again wreaks havoc around the world.
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Western nations need to mobilize against mpox — before it’s too late
Most recovered after a bout of itchy skin lesions and flu-like symptoms, but some developed complications such as pneumonia and brain swelling. In total, 58 Americans died. That number likely would have been worse if not for extensive outreach efforts and a targeted vaccination campaign.
Several factors make this year’s outbreak especially worrisome. First, this version of mpox is different. Mpox itself is not a new disease; sporadic cases have been reported in central and East Africa for more than 50 years. Before the 2022 outbreak, cases generally involved people who contracted the virus from wild animals, and there was little human-to-human transmission.
The strain of mpox that caused the 2022 outbreak, called clade 2, was primarily transmitted through sexual contact. Now, it’s clade 1 mpox that is raging through the Democratic Republic of Congo. More than 27,000 suspected cases have been reported, with more than 1,300 deaths.
Already, clade 1 mpox has spread to neighboring countries including Burundi, Rwanda, Uganda and Central African Republic. Two diagnoses have also been made in Sweden and Thailand, both in people who recently traveled to the African region.
In Congo, two groups are especially vulnerable. The first includes female sex workers, their male customers and men who have sex with men. The second — in a notable departure from the 2022 outbreak — are children. The Africa Centers for Disease Control and Prevention reports that nearly 70 percent of cases in Congo are in children under 15, who make up about 85 percent of deaths.
Children might be especially vulnerable because mpox has similarities to smallpox, and older generations who received the smallpox vaccine are thought to have some immunity to mpox. Plus, many Congolese children are malnourished or have untreated HIV, making them more susceptible to infections.
Another reason for rapid spread is ongoing unrest. In the eastern provinces of South and North Kivu, where mpox is raging, nearly 1 million people are displaced and living in crowded refugee camps, including hundreds of thousands of children. Since mpox can be transmitted through sharing contaminated objects such as clothing and face-to-face contact with an infected person, it’s not hard to see how transmission here is so hard to control.
These conflict-ravaged areas are also struggling with outbreaks of other diseases, such as cholera, measles, malaria and polio. Testing is scarce, so it’s almost certain the number of reported cases is a dramatic undercount. And health-care workers able to diagnose and care for infected individuals are in short supply.
On top of these challenges, the emergence of new forms of mpox means there are now multiple outbreaks that have different epicenters and at-risk groups. Sexual and intimate contact remains a key modality of transmission, and it is difficult to reach sex workers and gay and bisexual men in countries where prostitution and homosexuality are criminalized.
The Africa CDC has declared mpox a public health emergency, the first time the agency has made such a pronouncement since its founding. The World Health Organization has as well, and it called upon wealthier countries to contribute resources, including vaccines, to combat the spread.
About 200,000 vaccine doses are set to arrive in Congo, a small fraction of the 10 million that the Africa CDC estimates is needed. Distribution will be a major hurdle; of the two main vaccines, one requires refrigeration and another uses a rare specialized needle for administration.
And although the vaccines are effective against clade 2, it is not known whether they work as well against clade 1. The same is true for treatments. A recent National Institutes of Health study concluded that the antiviral tecovirimat, which has shown promising results against clade 2, did not reduce illness severity with clade 1. The same study, however, found that hospitalized patients were more than twice as likely to survive as those who did not receive supportive care.
All these factors make it even more important for Western counties to dedicate resources to bolster the health-care infrastructure of Congo and other hard-hit countries. Failure to do so means that a new, deadlier mpox variant will inevitably make its way within our borders, costing far more resources — and preventable suffering — down the line.