4 years after the beginning of the upheaval that humanity experienced due to the covid pandemic, against the background of continuous local military conflicts and humanitarian disasters, the human community has opened another “Pandora’s box”. The continent, which at one time became the cradle of humanity, threatens the world with a new deadly infection – monkey pox. The rapid spread of the Mpox virus is a global emergency that could have been avoided, scientists and public health officials say.
IA “FACT” already reported, that monkeypox continues to circulate at low levels around the world. However, there is an unprecedented spread of the virus in Africa, primarily Clade I and Clade 2 strains.
The world media is sounding the alarm about the statistics of the disease in Central Africa. Thousands of infections and hundreds of deaths have been recorded here. The World Health Organization has assigned the highest level of alarm to the situation. Countries are intensively monitoring their borders for the rapid spread of the virus,
However, it is unlikely that this disease can be considered a devil from a snuff box. Edition Bloomberg notes with regret that smallpox has been growing unchecked in Africa for decades.
Mpox was first discovered in humans in the 1970s in Congo, Central and West Africa. After the eradication of smallpox in the 1980s and the cessation of vaccination against it, cases of Mpox began to gradually increase again. Finally, in 2022-2023, a new peak of morbidity occurred.
The scale of the epidemic
WHO declared the last global smallpox emergency in May 2023, even though the smallpox virus continued to circulate. According to the latest data from the African Center for Disease Control and Prevention released on Sunday, about 575 people have died from it in the Democratic Republic of Congo since the beginning of 2024, and more than 30 times more have been infected.
Mpox, which used to spread locally, is now threatening to spread beyond Africa. Congo has reported nearly 20,000 cases this year, including a new strain that has infected more than 700 people in Burundi. Cases have also been reported in Rwanda, Uganda, Kenya, Asia and Europe.
African leaders have criticized the previous response to the outbreak by the US and Europe. They call for a fairer distribution of vaccines and therapeutics. The WHO said no donor funds had been invested in smallpox control in the two years since the last outbreak.
A new method of infection with monkey pox
In January, a new pattern of human-to-human transmission of the virus was discovered in the Congo. “What we saw really surprised me,” says one of the medics, “it was a completely different outbreak.” If decisive action had been taken then: vaccination, large-scale testing and surveillance – the last emergency declared by the WHO on August 14 could have been avoided. “But of course you often don’t get credit for an outbreak that was avoided,” he adds, “that’s always the paradox of infectious diseases.”
History develops cyclically. As half a century ago, HIV spread from Africa to the world, one of the ways of infection with which is sexual, so monkey pox was assimilated to this already known plague of mankind. “Nobody has a clear picture of what’s going on,” says an infectious disease doctor and professor emeritus at Aarhus University in Denmark, who sees a parallel with HIV. “The early spread of HIV showed how quickly sexually transmitted infections can actually spread in Africa.”
For decades, mpox has been transmitted from infected squirrels and rodents in rainforests, mostly to young people under the age of 25 who hunt and engage in wildlife activities. It rarely extended beyond their families.
Sex workers, who were not previously a major driver of the disease in the Congo, are now playing an important role in an escalating smallpox outbreak in the country’s gold-rich east. Currently, the epicenter of the outbreak is South Kivu.
The first such case was recorded in September 2023, when a young merchant went to the doctor with lesions on the genitals and the whole body. Within two months, 34 cases were confirmed, more than half of them among sex industry workers. A further 46 infections were suspected in the provincial capital Bukavu and in Kamituga, a mining town 170 miles away. By January 2024, 51 people were hospitalized with the disease.
What is Mpox, how is it spread, and is there a vaccine
In South Kivu, there was a lot of disease among the elderly, and long chains of human-to-human transmission of the virus appeared. Now that genetic changes in the mpox virus have been identified and a new subtype of clade Ib has been named, doctors have called for increased surveillance and vaccination.
“We haven’t had the funds to fix transmission mechanisms or any other problems for two decades,” – says the epidemiologist, who has been working in the Congo for 22 years and studies methods of infection and prevention of transmission.
Sexual slavery as an additional factor in the spread of monkey pox
Living conditions on the tropical continent for the 4.2 million people displaced by military conflict in South and North Kivu provinces – heat, overcrowding, unsanitary conditions, hunger – mean disease can spread exponentially, aid agencies and charities have warned. Unfortunately, children who were probably infected through skin-to-skin contact are dying en masse.
The level of abuse and sexual relations in the camps creates the conditions for smallpox to flourish. Just imagine – one in ten women between the ages of 20 and 44 in North Kivu camps reported that they had been raped in the past few months! Horrible circumstances are driving people to promiscuous sex and brothels are on the rise.
Adding to the drama of the situation is the fact that the real level of infection is probably much higher, since less than one in five cases are confirmed by PCR tests. Congo lacks resources for research and the government is struggling to control the eastern provinces, where more than 100 armed groups operate.
What stands in the way of full vaccination
“The DRC and Africa have a lot of experience, but they just don’t have the resources to do the research.”, says Professor of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine. Until now “there really wasn’t a coordinated effort.”
“If we don’t act quickly and properly,” commented the zonal director of the World Vision charity in Eastern Congo, “I think we’re going to see a much more difficult situation not only for Congo, but for 6, 7, 10 countries.”
Congo faces major challenges due to poor infrastructure and ongoing conflict, which makes health care difficult. Malaria and measles caused thousands of deaths in 2023. Vaccination is a key solution, but delivery of vaccines to remote areas remains difficult due to impassable roads, large area, which complicates logistics. As well as ongoing conflicts disrupting transport routes and the work of medical institutions, the necessary equipment for storing and transporting vaccines.
The US has stockpiled millions of vaccine doses, but the humanitarian batch for Congo is only 50,000 doses. Other countries – including Great Britain and Germany – have also accumulated stocks. The Bavarian Nordic vaccine has been in use since 2022, but the lack of WHO approval makes it difficult for low-income countries to purchase. Because of this, organizations like Gavi and Unicef are unable to purchase and distribute vaccines in the Congo. The WHO said it would complete an emergency review to allow vaccine procurement.
Vaccinating young people could help Congo contain Mpox
This year, researchers modeled the potential impact of a vaccination program in the Congo. The study predicted 14,500 cases of smallpox and 700 deaths within a year if the vaccine was not used. also found that immunizing 4 out of 5 children under the age of 15 – almost half the population – in all provinces where mpox is persistently present would reduce cases and deaths by more than half. Currently, the number of registered cases in Congo has already exceeded the forecast. 40.7 million doses are needed for success, although Congo’s health minister believes 3.5 million doses are sufficient.
The price of the vaccine is prohibitively high for most countries, says the founder of the Institute of Reproductive Health and HIV in Johannesburg and an adviser to WHO. She is sure that against the background of the global nature of the threat, developed countries should subsidize the cost of immunization.
“We know there’s a vaccine that works and we know where the outbreak is, it’s not that hard to figure out how to deal with it.” says the adjunct professor of immunology at the University of Cambridge. “It’s a solvable problem, and it hasn’t been solved not because the science doesn’t tell us what to do or how to deal with it, but because of geopolitical and economic issues.”
The chief executive of Bavarian Nordic believes that the production of injections for supply to the affected countries should begin immediately. “We have to make a decision very quickly if we can deliver a capacity of 10 million doses by the end of next year.”
Tatyana Morarash
