In May 2023, the World Health Organization issued a statement declaring the end of MPOX, formerly known as monkeypox, a public health emergency. Just over a year later, a much more severe outbreak occurred across much of sub-Saharan Africa, forcing the World Health Organization to reverse course.
Statistics show that more than 15,000 MPOX cases and 461 deaths have been reported on the African continent since January, with the disease spreading from countries such as the Democratic Republic of Congo (DRC), where it has been endemic for many years, to 13 other African countries not previously affected by the disease, including Rwanda, Kenya, Burundi and Uganda.
To scientists like Bogma Titanj, an associate professor of infectious diseases at Emory University who studies MPOX outbreaks, this new, more deadly outbreak shows the result of the previous global health watchdog not doing enough.
The spread of MPOX first sounded the alarm in the summer of 2022. The virus, which had previously been contained mainly to parts of West and Central Africa, suddenly spread throughout the world. Between early 2022 and December 2023, Confirmed cases: 92,783 MPOX outbreaks occurred in 116 countries, resulting in 171 deaths.
Despite these numbers, the perception of it as a public health threat faded quickly. “95% of cases during the 2022 outbreak occurred among men who have sex with men, with reported transmission through sexual contact or close contact with other infected people,” Taitanzi said. “Because it was a very concentrated outbreak, we were able to prioritize vaccination within that network.”
While developed countries were successful in containing the epidemics at home, Titangji said, increased surveillance of the virus in African countries that have been battling a steady rise in MPOX cases for the past four decades was quickly deprioritized, allowing potentially more worrisome variants to emerge undetected.
Mpox has two main subtypes, lineage 1 and lineage 2. Lineage 1 is thought to be up to 10 times more deadly, especially in populations with weakened or developing immune systems, such as children under 5, pregnant women, and people with compromised immune systems. That’s the virus strain behind this new outbreak, and why infectious disease scientists are on edge. (Another outbreak spreading among HIV-infected people in South Africa is thought to be linked to lineage 2.)
“The 2022 pandemic was lineage 2, with a mortality rate of less than 1%,” says Jean Natxega, an infectious disease physician in the Congo and an associate professor of medicine at the University of Pittsburgh. “Right now we’re talking about up to 10 percent death.”
While previous outbreaks affected mainly gay communities, the data suggests the new virus is spreading more widely, initially through sexual networks and then among family members, Nacega and his colleagues wrote in a paper published last month. In the journal The Nature Medicine journal describes how the MPOX outbreak began among sex workers in Kamituga, a small mining town in eastern Democratic Republic of Congo, and how it spread to neighbouring Rwanda, Uganda and Burundi when infected people returned home to visit family.
