Mpox was first declared a Public Health Emergency of International Concern (PHEIC) in July 2022. The World Health Organization (WHO) lifted the PHEIC nine months after cases declined, though mpox remained endemic in several African countries. On August 14, 2024, two years later, the WHO again declares it a global health emergency. This follows the Africa CDC's declaration of the outbreak as a Public Health Emergency of Continental Security (PHECS), the first such declaration since the agency's creation in 2017. These declarations highlight the gravity of the situation and the need for a coordinated global response.
The viral disease is characterised by two genetic clades, I and II. The 2022 outbreak was driven by the clade IIb. Today, there are multiple outbreaks involving different clades of the virus, but the recent PHEIC was triggered by the clade I lineage, which is believed to cause more severe disease.
This year, over 17,000 cases and 500 deaths have been reported across 13 African countries, with some experiencing mpox for the first time. In the Democratic Republic of Congo, most cases have been linked to contact with wild animals like rodents. However, sexual transmission of clade I viruses has also been observed, marking a transition from zoonotic transmission to human-to-human transmission. This led to this variant being classified as clade 1b.
Calling for a global response and surveillance
The Duke-NUS Centre of Outbreak Preparedness (COP) re-affirms its support of the PHEIC declaration, calling for a globally coordinated response to mitigate the spread of the disease. This includes ensuring equitable access to diagnostics, therapeutics and vaccines for mpox with an emphasis on vulnerable communities in resource constrained countries.
There needs to be stronger cooperation and coordination across sectors—including governments, pharmaceutical and biotechnology companies, and multilateral organisations—to expand manufacturing capacity for medical supplies needed to combat the mpox outbreak. This also involves accelerating regulatory and approval processes to ensure these life-saving tools are quickly delivered to those who need it the most.
Advancing access and equity
In June 2024, during the 77th World Health Assembly, a new set of amendments to the International Health Regulations was adopted, introducing a new definition of a 'pandemic emergency.' This definition is intended to trigger a more effective global response to public health events and represents a heightened level of alert beyond a PHEIC.
A Coordinating Financial Mechanism was also established to help identify and secure the financing needed for WHO to swiftly mobilise and equitably allocate resources to resource-constrained countries for pandemic preparedness and response efforts.
While the amendments can only be implemented next year, it is timely and should guide the global health community in this current mpox outbreak. There is no better time to show a commitment to solidarity and equity on strengthening access to health commodities and financing.
COP’s mission: technical assistance and guidance
In response to the current outbreak, our centre has been working proactively with WHO regional offices to provide technical assistance and guidance to member states on standardising genomic sequencing protocols and workflows for improved detection and variant monitoring. In collaboration with manufacturers and suppliers, COP is facilitating the procurement of laboratory kits for mpox detection. With a focus on capacity building, the Centre is also delivering laboratory and bioinformatics training on genomic sequencing for mpox. Additionally, COP will serve as a hub for cross-country knowledge sharing on mpox detection and surveillance through webinars.
Conclusion
The current mpox outbreak demands an even more urgent multi-country, multi-sectoral approach than the previous one, focusing on strengthening health systems, including enhancing disease detection and surveillance capacity with improved access to testing and treatment.
The Duke-NUS Centre for Outbreak Preparedness will continue its work to enhance regional health security through capacity building within infectious diseases surveillance systems, enhancing access to novel diagnostics, therapeutics, and vaccines to address outbreak threats and foster an enabling environment for these processes to thrive.