W.H.O. Declares Global Health Emergency for Monkeypox

The World Health Organization on Wednesday took the long-discussed step of declaring a global health emergency over the monkeypox or “mpox” outbreak in the Democratic Republic of Congo (DRC), which has begun spreading into neighboring African nations.

“This is something that should concern us all,” said W.H.O. director Tedros Adhanom Ghebreyesus. “The potential for further spread within Africa, and beyond, is very worrying.”

The W.H.O. advisory came a day after the Africa Centers for Disease Control (Africa CDC) declared a continental public health emergency over monkeypox.

Africa CDC said it took action after the virus was detected in 13 African nations, cases increased 160 percent over last year, and fatalities increased by 19 percent. 

Doctors say the strain of monkeypox currently flourishing in Africa is much more dangerous than the strain which briefly caused a global health panic in 2022. Africa CDC said 70 percent of the cases detected in the DRC were children under 15, and 85 percent of the fatalities have been among children in the same age group. Infectious disease experts said African children tend to be malnourished and more susceptible to disease, so children in other parts of the world probably would not experience such high infection and mortality rates.

The new strain is also harder to detect. The earlier version of monkeypox caused large and hideous lesions on the chest, hands, and feet of its victims, while the more dangerous new version has milder symptoms and smaller lesions concentrated on the genitals, so it is more difficult for patients and doctors to identify the infection. Monkeypox in 2022 caused very few fatalities, but the death rate for the new strain could be as high as four percent.

W.H.O. said one reason it was inspired to declare a global health emergency was that new cases have appeared in Burundi, Kenya, Rwanda, and Uganda, despite efforts to prevent the Congo outbreak from spreading. A traveler from Africa arrived in Sweden last week with a case of the new mpox variant.

Meanwhile, the “old” version of monkeypox is still around, and infections have recently been flaring up in South Africa and the Ivory Coast.

Global health emergencies are the highest level of alert for the W.H.O. The last global health emergency was declared in July 2022 during the previous monkeypox outbreak, and the one before that was for the novel coronavirus first identified in Wuhan, China.

The designation is not used often – and, in theory, it should prompt more attention from health officials around the world and more funding for disease prevention – although in practice it does not always “move the needle” much, as Emory University infectious disease expert Dr. Boghuma Titanji told the Associated Press (AP) on Thursday.

Some experts thought it was prudent to declare the highest state of emergency to intensify efforts at containing the disease in the Congo, including more funding for disease prevention and vaccination, because the great fear is that mpox will hit crowded refugee camps in the area and detonate into a terrible epidemic.

Although the new strain of mpox has yet to spread outside Africa – aside from a few travelers, like the one in Sweden mentioned above – it could be more of a problem than the older strain if it does break out across the world, because the new strain recently developed certain mutations that make it spread more rapidly between humans. Infectious disease experts theorize these mutations were produced as mpox spread between Congolese sex workers and their clients.

The DRC government has thus far approved two vaccines for use against the new monkeypox epidemic. One is a product called LC16 manufactured in Japan, while the other is Jynneos, a vaccine produced by Danish drugmaker Bavarian Nordic.

Bavarian Nordic has donated 200,000 doses of Jynneos to the Congo outbreak, and on Thursday the company said it can provide 10 million more, provided it receives funding. The company said it could ship 300,000 more doses immediately, two million by the end of 2024, and all ten million doctors say the Congo needs by the end of 2025.

“We have inventory and we have the capabilities. What we’re missing are the orders,” Bavarian Nordic CEO Paul Chaplin said on Thursday.

“We are in late August already, so it really does need some speed in the decision making to be able to do that,” Chaplin added.

Jynneos was used successfully during the 2022 mpox outbreak, while LC16 was introduced in Japan near the end of the earlier crisis. Japan reported only two cases of mpox in 2022, but manufacturer KM Biologics said it received “several inquiries from overseas” for its freeze-dried vaccine.

W.H.O. preparedness chief Tim Nguyen said at a briefing on Wednesday that LC16 is not currently “commercially available,” but Japan developed a “considerable” stockpile after the 2022 outbreak.