Conflict Alerts # 663, 22 August 2024
Anu Maria Joseph In the news
On 20 August, the World Health Organization Europe (WHO Europe) director Hans Kluge stated: “Mpox is not the new COVID” and that “we know how to control mpox. And, in the European region, the steps needed to eliminate its transmission altogether.”
On 19 August, the Philippines reported the first clade Ib variant mpox case. Subsequently, the health ministries of South Korea, Japan, Malaysia and Indonesia announced precautions and alerts to avoid a spread.
On 15 August, the WHO declared a public health emergency of international concern (PHEIC) amidst the Mpox outbreak in Africa. WHO chief Tedros Adhanom Ghebreyesus stated that the possibility of a spread beyond Africa "is very worrying." He added: "A co-ordinated international response is essential to stop this outbreak and save lives."
On 16 August, the European Centre for Disease Prevention and Control (ECDC) advised travel warnings for the regions affected by mpox virus. It came after the first clade Ib variant case was detected in Sweden.
Previously, on 13 August, the Africa Centres for Disease Control and Prevention (Africa CDC) declared a health emergency in Africa. It reported that since January more than 13,700 cases and 450 deaths due to clade Ib mpox variant have been recorded in the Democratic Republic of Congo. It has spread to other African countries including Burundi, the Central African Republic, Kenya and Rwanda.
On the same day, Africa CDC Director General Jean Kaseya stated: “We didn’t start vaccinations yet. We’ll start in a few days, if we are sure that everything is in place. End of next week vaccines will start to arrive in DRC and other countries.”
Issues at large
First, the mpox virus, origin, symptoms, mutants, and cure. Mpox, also known as monkeypox, was first identified in monkeys in a laboratory in Denmark in 1958. It is a zoonotic disease which can be transmitted from animals to humans. The first human case was reported in 1970. Mpox spreads through close contact with an infected via sex, skin-to-skin contact and body fluids. The symptoms are skin lesions and flu-like symptoms. The disease is at times fatal. It is similar to smallpox which was eradicated from the world in 1980. According to public health and virology professor at Texas State University, Rodney Rohde, mpox is a DNA virus, which does not mutate rapidly unlike RNA viruses. However, 50 variants of the mpox virus have been identified so far; all having a low impact on the severity of the disease. The strand which has been spreading in the DRC is clade 1b. It is highly contagious and deadly, and was described by the scientists as "the most dangerous yet." Meanwhile, smallpox vaccines are said to be 80 per cent effective in mpox.
Second, previous mpox outbreaks. This is not the first time the mpox outbreak has been reported worldwide. The first outbreak of the disease was reported in the US in 2003 with 70 cases. The virus was believed to be brought to the US through an infected prairie dog from Gambia. Cases were also reported in the UK, Israel, and Singapore, and among people who recently travelled to African countries. In May 2022, another mpox clade II variant outbreak was reported with active cases in the US, the UK, Australia, Canada and several other countries, affecting nearly 100,000 people. In January 2023, a major outbreak of mpox clade I in the DRC reported 19,000 cases and 900 deaths.
Third, vulnerable gender, age and geographies. The disease has been endemic in Africa since 1970 and limited to several western and central African countries. However, presently, the new variant has been identified in other African countries including Burundi, Kenya, Rwanda, South Africa and Uganda. The lack of access to vaccines and vaccination facilities, and slow precautions and responses have accelerated the spread. Africa CDC reported that children and women are highly affected in number and have an increased fatal risk. The conflict-hit regions in eastern DRC, especially internally displaced camps in the North Kivu province, are vulnerable to a rapid spread as isolation is impossible.
In perspective
The frequency of the outbreak has increased, new strands are appearing and rapidly spreading, and the fatality rate is increasing. It seems that the virus is more concerning, unlike the previous outbreaks. Besides the DRC, conflict-hit regions in Africa including Sudan, Chad, Somalia and Ethiopia are more vulnerable to the spread of the disease. The absence of state apparatus, health facilities, and disrupted life in the conflict-hit regions make it susceptible to the spread of disease.
An endemic in African countries gained international concern when the number of cases and the possibility of a global spread increased. It implies Africa's double burden of carrying communicable diseases while international actors remain ignorant. African countries lack state-level capacity to take precautions to control such a virus spread. Regional and international responses to the DRC outbreak were too late and too little, despite the WHO acknowledging Africa’s disease burden. The outbreak needs to be controlled by vaccinating the vulnerable groups in the vulnerable geographies. As Madeline Barron says, "diseases don't know boundaries," something the world learned from the COVID-19 pandemic.