A family nurse practitioner prepares a syringe with the mpox vaccine for inoculating a patient at a vaccination site in the Brooklyn borough of New York, on Aug. 30, 2022.Jeenah Moon/The Associated Press
The World Health Organization and the Africa Centres for Disease Control and Prevention have both declared the escalating outbreak of mpox to be a global public-health emergency of international concern (PHEIC).
The immediate question that springs to mind is: Is mpox the next global pandemic? Are we going to live through another COVID-like situation?
It’s too early to make any definitive pronouncements about how the volatile situation will unfold, but it’s fair to say it’s unlikely.
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Mpox, previously known as monkeypox, isn’t a novel virus. It’s been around for a long time, and so have its cousins, like smallpox. (We even eradicated smallpox back in 1980, but not before it ravaged humanity for millennia.) Mpox doesn’t appear to spread as readily as COVID-19. It’s also easier to prevent and contain, and we already have vaccines.
Mpox has been around in Central and West Africa for decades (it was first discovered in 1958); historically there have been small outbreaks, usually via spillover from contact with infected animals such as rodents and monkeys.
What is disturbing is how the spread of mpox is eerily similar to the spread of HIV in the early days of the AIDS pandemic.
Back in 2022, a milder strain of mpox that originated in West Africa known as “clade II” (a clade is similar to a variant) was spreading largely in Western countries among men who have sex with men. There have been more than 100,000 cases of the mpox clade II strain in 116 countries, but few deaths.
Simultaneously, mpox continued to spread in Africa, and it mutated. Clade Ib emerged and appears to spread more easily through casual contact, and is more deadly. To date, there have been more than 15,600 mpox cases reported and 537 deaths in the Democratic Republic of the Congo alone. There is also little doubt that the true numbers are quite a bit higher because there is little testing or surveillance happening. Children are currently at greatest risk, accounting for 70 per cent of cases and 85 per cent of deaths in Central Africa.
Meanwhile, mpox remains present in Western countries like Canada. The City of Toronto has reported an uptick in cases, with 93 cases to date this year, almost five times the number of cases reported last year.
In other words, what we’re seeing is not so much an explosive COVID-like pandemic that affects much of the world at the same time and then becomes endemic, but rather more of a slow burn like the AIDS pandemic, where the virus devastates specific marginalized communities and sticks around for a long time.
The difference in response to these two simultaneous outbreaks is striking.
In Western countries, there are vaccines and treatments available, as well as active surveillance, and contact tracing to find the partners of those infected. Here, mpox is just another sexually transmitted infection; a treatable nuisance.
In Africa, there is little access to vaccines, minimal surveillance, and little access to care. Furthermore, mpox is not necessarily top-of-mind. In the DRC, the epicentre of the outbreak, children are also starving, armed conflict is rife, and the health system is in a perpetual state of collapse.
In declaring a global PHEIC, both the WHO and the Africa CDC hope to mobilize action, notably the sharing of vaccines. The Africa CDC says 280,000 doses of vaccine are currently available, but 10 million are needed. (There are two predominant vaccines; Bavarian Nordic, a Danish pharmaceutical company, makes a shot called Jynneos; KM Biologics, a Japanese company makes LC16. Only the latter is approved for use in children.)
During the COVID vaccine rollout, we saw Western countries buy up supplies and hoard vaccines. We’re seeing that ugly reflex once again with mpox. Canada initially said it had no plans to donate any of its stockpile, but as of Wednesday PHAC noted it was “actively working” to consider possible vaccine donations. Other countries have made modest promises to do so.
But vaccines are only one part of the solution. Information and education programs are needed. So is tracking.
As we learned with both AIDS and COVID, getting an outbreak of infectious disease under control is a daunting task, especially when it’s spreading in conditions of war and abject poverty. The fact that we’re also living with donor fatigue and pandemic fatigue makes it all the more challenging.
All of this means that unfortunately, we haven’t heard the last of mpox. Not by a long shot.