The Africa Centres for Disease Control and Prevention (Africa CDC) for the first time broke the glass today and sounded its loudest available public health alarm about the rapid spread of mpox. “With a heavy heart but an unyielding commitment to our African citizens we declare mpox as a Public Health Emergency of Continental Security,” Africa CDC Director-General Jean Kaseya said at a media briefing this morning.
The declaration of the emergency, known as a PHECS, came after a discussion among health ministers and other experts across the continent. It was not “a mere formality,” Kaseya stressed, but marked the need to change footing. “We can no longer afford to be reactive,” he said. “We must be proactive and aggressive in our effort to contend and eliminate this threat.”
The announcement was not unexpected, given the virus’ rapid strides on the continent. African countries have had 17,541 mpox cases this year, according to an Africa CDC update on 9 August. More than 95% have occurred in the Democratic Republic of the Congo (DRC), which had a surge of more than 2000 suspected cases in the week preceding the report. Over the past few weeks, Kenya, Uganda, Rwanda, and Burundi have all reported confirmed cases of mpox for the first time, according to a 12 August report from the World Health Organization (WHO). Several of those cases were clade 1b, a variant that has recently emerged in the DRC and has quickly spread there.
Tomorrow, WHO will hold an emergency committee meeting that will advise WHO Director-General Tedros Adhanom Ghebreyesus whether to invoke its own alarm, which is called a Public Health Emergency of International Concern (PHEIC).
Africa CDC created the option of calling a PHECS just last year, and the question of how it differs from WHO’s PHEIC has caused some confusion. Kaseya said he is working closely with Tedros so that the two declarations can complement each other. Whereas a PHEIC aims to coordinate a global response, he said, the PHECS speaks more directly to the needs of Africa, the continent currently hit hardest by mpox.
Specifically, the PHECS will trigger the creation of an African joint action plan that Kaseya said will be completed in 2 weeks. Africa CDC plans to coordinate the purchase and distribution of mpox vaccines and diagnostics, both of which are in short supply. Kaseya expressed hope that both African governments and international partners will provide more support.
Others share that hope. “We need to ensure that the disparate attempts … are brought together in an overarching plan with some coordination to improve the efficacy of our intervention measures,” says Salim Abdool Karim, a South African epidemiologist who chaired an Africa CDC expert group that unanimously recommended the agency declare a PHECS.
South Africa has also had an mpox outbreak this year, with 24 cases to date, but Karim told ScienceInsider those cases are caused by the clade 2b variant, which caused the global mpox outbreak that began in May 2022 and has affected nearly 100,000 people in 116 countries. The vast majority of those patients were men who have sex with men, as are all of the South African cases, Karim says. Several of them are living with HIV and have had far more severe mpox infections. Three of the patients from South Africa have died, leading to a case fatality rate of 12.5%—far higher the 0.2% seen in the global outbreak.
WHO declared a PHEIC for the global clade 2b outbreak in July 2022 but ended it in May 2023, after the agency determined that the spread had “subsided significantly.”
Kaseya said Africa should have received more help when that PHEIC was declared. After it ended, he noted, “Cases in Africa continued to increase, and today we are facing a consequence of not having appropriate assistance to African countries.” He says $4 billion is now needed to help the continent build an effective response. “The world cannot afford to turn a blind eye to this crisis.”
