August 13, 2024

expert reaction to Africa CDC announcing that mpox is a Public Health Emergency of Continental Security

Scientists react to the African CDC announcing that Mpox is a public health emergency. 

Dr Boghuma Titanji Assistant Professor of Medicine, Department of Medicine at Emory University, said:

“The Africa CDC’s declaration of mpox as the first Public Health Emergency of Continental Security is a crucial step towards enhancing coordination among African countries to address the ongoing mpox outbreak. As the first such declaration by the agency, which, despite being relatively young, has already played a pivotal role in improving epidemic responses on the continent, this move holds significant promise. It is hoped that this declaration will prompt African governments to allocate funds to combat the outbreak, which is currently affecting several countries.

“While there has been substantial criticism of foreign donors for inadequate support, the over-reliance on external aid has highlighted a major flaw in the current response efforts. The WHO’s PHEIC declaration in 2022 did not lead to significant- improved access to diagnostics, therapeutics, or vaccines for African countries. The Africa CDC is demonstrating its readiness and capability to lead a continental response, but this effort must be supported by adequate funding structures. Without the necessary resources and support, the impact of this declaration may remain limited, but only time will tell.

“The declaration responding to the new mpox variant reveals our persistent reactive stance toward infectious disease outbreaks. Even before clade Ib emerged, mpox was a significant threat across the continent, disproportionately impacting children and suffering from decades of neglect. This latest development underscores a critical flaw in our approach: waiting for crises to act places us in a perpetual game of catch-up, with the virus consistently staying several steps ahead and maintaining the upper hand.”

Prof Jonathan Ball, Deputy Director of Liverpool School of Tropical Medicine and Professor of Molecular Virology, Liverpool School of Tropical Medicine (LSTM), said:

“Since the eradication of smallpox and associated decline in smallpox vaccination, reduced population immunity has given the related monkeypox virus an opportunity to cause devastating outbreaks. 

“Hopefully the declaration of the current epidemic as a public health emergency will kick-start mobilisation of the necessary infection control measures, including increased production and deployment existing and highly effective vaccines to bring this infection under control.

“Low- and middle-income countries suffer most from infectious diseases yet have insufficient capacity for surveillance and control. Infectious diseases thrive on these health inequalities so it is essential for other countries to help build capacity – infections do not respect international borders, so this isn’t just someone else’s problem.” 

Dr Nicole Lurie, CEPI’s Executive Director of Emergency Preparedness and Response, said:

“The declaration of a Public Health Emergency of Continental Security (PHECS) by Africa CDC is a wake-up call for the world that urgent action is needed to protect those most at risk and halt the spread of the alarming mpox outbreak.

“Supporting the Africa CDC’s and Africa Taskforce for mpox coordination’s response to the multi-country outbreak is a priority for CEPI and we are closely engaged with Africa CDC and WHO.

“The DRC recently approved two mpox vaccines for emergency use. While further studies are needed to assess the vaccines in specific populations to optimize vaccination strategies, vaccination in affected countries cannot wait.

“For its part, CEPI is funding two studies of Bavarian Nordic’s MVA-BN® mpox vaccine to assess its immunogenicity in children and to evaluate whether post-exposure vaccination could reduce the risk of secondary mpox cases or whether it could reduce the severity of illness after infection. The evidence generated from these studies could be crucial in shaping mpox vaccination strategies to help tackle this large and deadly outbreak.

“CEPI is also supporting the development of BioNTech’s next-generation mpox vaccine that is in early clinical development.

“CEPI stands ready to support generation of clinical and real-world evidence and gather additional data to better understand disease epidemiology to inform how mpox vaccines can best be used to support the outbreak response and improve access to vaccines.

“Working with vaccine manufacturers, CEPI is exploring avenues to support both scale up and scale out of vaccine manufacturing to increase available supply and will support accelerated development of potential new vaccine candidates, if proven to be safe and effective.”

(A comment from our colleagues in Germany on mpox situation more generally, and WHO emergency meeting tomorrow) Prof. Marion Koopmans, Head of the Institute for Virus Research and Director of the Pandemic and Disaster Management Centre, Erasmus University Rotterdam, Netherlands, said:

Recent clade I (b) is characterised, compared to clade II, by higher mortality and infectivity through human-to-human contact. What factors favour transmission? What is the R-value?

“There are rather big claims in the popular media for which evidence is limited, both about severity and about transmissibility of the new sublineage Ib. What we do know is that Clade I is associated with more severe disease than Clade II.  At this stage, it is not yet clear if Clade Ib, the new sublineage of clade I that was detected in South Kivu has similar properties as the other Clade I viruses found in other parts of DRC. There is some speculation about more efficient transmission, but that can also be explained by the mode of transmission in South Kivu, where spread seems to be driven by  (hetero)sexual transmission. 

“In terms of R value: this is very much determined by circumstances in which the virus is found. Mpox is not that transmissible. It is spread by direct contact, and therefore – in theory – relatively easy to stop i fit is recognised and acknowledged.   

What are the relevant differences between current infections and the situation in 2022? How does clade Ib drive infections in the DRC and possibly international chains of infection in the future?

“There is an increase in infections across DRC, and that involves different viruses, so not „ only“ clade Ib. More studies are needed to fully understand the situation. Virus typing / sequencing is not done in most cases so it is unclear how widespread Clade Ib is. So far, it has been detected in South and North Kivu, and in bordering regions or related infections in travellers.

What is the likelihood of virus mutations that could further increase infectivity and mortality?

“As with other viruses, mpox may evolve when there is more opportunity for spread. Poxviruses may change properties when parts oft he genome are deleted. But as mentioned above, there is no evidence for increased severity of sublineage Ib viruses to my knowledge.

(if WHO declares an international state of emergency tomorrow) What impact will an international state of emergency have on containment measures locally, internationally and in Germany? What about vaccine availability and production capacity?

“It raises the level of alert, globally, and may allow WHO to access funds for emergency response. Other than that, the same priorities remain: investing in diagnostic capacity, public heath response, treatment support and vaccination. This will not be easy. DRC has had cases of monkeypox over many years, but resources are lacking to provide the basic response capacity. This is a problem for DRC but also for other countries, currently particularly neighbouring countries.

“A PHEIC would also redraw attention to the problem of mpox outside of the African region, caused by lineage II viruses. We have to recognize that – despite having the resources and basic public health capacity in place, the international outbreak that started in 2022 was not contained, and new cases continue to be detected outside of the Africa region as well.

What is the likelihood of this 1b clade spreading to the EU and Germany?

“So far, likelihood of that is considered to be small although it is of course possible. Therefore, also outside of the African region, continuing to monitor the situation and typing of newly diagnosed cases should be a minimum”

*https://x.com/AfricaCDC?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor

Declared interests

CEPI is working with Africa CDC and WHO and funding two studies of Bavarian Nordic’s MVA-BN® mpox vaccine and supporting BioNTech’s work on a next generation mpox vaccine (see comments)

None others received