A vial of vaccine for mpox, the virus previously known as monkeypox. Photo from iStock
Published September 4, 2024 under Commentary
A critical shortage of vaccines and antivirals is driving an outbreak of mpox in sub-Saharan Africa, a situation the World Health Organization recently called a global health emergency. But social and political instability in the region where the virus is spreading may complicate efforts to control it, says Chris Beyrer, M.D., director of the Duke Global Health Institute and an expert on mpox.
The current outbreak, fueled by a new variant of mpox that is proving to be deadlier and easier to spread than earlier forms, has now reached more than a dozen countries in Africa and caused more than 500 deaths. The WHO declared a global health emergency on Aug. 14, noting a significant risk of the virus, which was previously known as monkeypox, spreading further in Africa and beyond. Cases have been detected in Sweden and Thailand among people who had traveled in endemic regions.
Vaccines and supportive care exist for the virus, making a pandemic on the scale of COVID-19 unlikely, notes Beyrer, an epidemiologist who studies infectious diseases in Africa and other parts of the world. He currently serves on the WHO’s scientific and technical advisory committee on HIV, viral hepatitis, STI and mpox.
"We have what we need to stop mpox,” Beyrer said in an Aug. 16 article from the Associated Press that appeared in more than 100 media outlets worldwide. “This is not the same situation we faced during COVID when there was no vaccine and no antivirals.”
But vaccines and treatments are scarce in sub-Saharan Africa, making it critical for other countries to provide access, Beyre says.The WHO also needs to move more quickly to approve new vaccine candidates that are ready for use.
"“We're stuck in bureaucratic approvals and regulatory approvals that are basically barriers between vaccine supply – which is not enough – and people who need to be protected,” Beyrer said in a Sept. 1 article in The National, an English-language news service in the United Arab Emirates.
Efforts to control the outbreak are also having to work around ongoing conflicts in the areas most affected by the virus, which are centered around the South Kivu region of the Democratic Republic of the Congo. Multiple militias are active in the region, which is near a disputed border between the DRC and Rwanda. It is also a locus of legal and illegal mining activity.
Beyrer says the majority of mpox cases in the region are among miners and sex workers who congregate around mining communities. Sex workers often travel from other countries in the region, increasing the risks that the virus will move into new areas, he adds.
“There is a political and human rights dimension to this outbreak,” he says. “All of this complicates the situation and will hugely challenge both WHO and the Africa CDC in responding.”
Mpox spreads primarily through skin-to-skin contact, and people infected with the virus can show symptoms similar to smallpox, including rashes and lesions on the skin. A multinational mpox outbreak in 2022, which led to around 100,000 cases in more than 100 countries, was caused by a different strain of the virus that was primarily transmitted through sexual contact among gay men.
