The World Health Organization (WHO) reports that basic public health measures can stop the outbreak of mpox. Such measures also have the potential to end transmission of the virus that has sickened 99,176 people and killed 208 globally since 2022.
“We know how to control mpox. And, in the European region, measures are needed to end all transmission,” Dr. Hans Kluge, WHO's regional director for Europe, told reporters Tuesday in Geneva.
“Two years ago, we controlled mpox in Europe, thanks to direct engagement with the most affected group, men who have sex with men,” he said. “We implemented robust surveillance. We thoroughly investigated the contacts of new cases. And we provided good public health advice.”
Speaking via video link from Copenhagen, Kluge said the WHO was able to control the outbreak through behavioural change and non-discriminatory public health measures, as well as the mpox vaccination.
“Learning from our success, we urged governments and health authorities to maintain these measures – to help eliminate mpox from Europe,” he said. “But due to a lack of commitment and lack of resources, we failed to reach the final stage. Today, we see around 100 new cases of clade 2 mpox in the European region every month.”
WHO declared mpox a public health emergency of international concern (PHEIC) in July 2022 following an outbreak in several countries and rapid global spread through sexual contact. WHO declared the PHEIC to end in May 2023.
However, the increasing number of mpox cases in the Democratic Republic of the Congo (DRC) and other countries in Africa this year prompted the second declaration of a PHEIC for mpox on August 14 by WHO Director-General Tedros Adhanom Ghebreyesus.
“The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighboring countries are deeply concerning,” Tedros said. “It is clear that a concerted international response is needed to stop this outbreak and save lives.”
Three clades of mpoxviruses have been identified. Clade 1, previously called the Congo Basin clade, has long circulated in the DRC and Central Africa. Although clade 1 is primarily transmitted through sexual contact, it has caused outbreaks caused by zoonotic (animal-to-human) transmission. It is more virulent than clade 2, which circulated globally in 2022 and is predominantly spread among homosexual men.
“In the African context, we have seen the rise of a new clade 1b, which is human-to-human transmission,” said Dr Catherine Smallwood, WHO regional manager for the emergency operations programme.
“We have not detected zoonotic transmission in clade 1b. It appears to be a virus that circulates exclusively in the human population, and some of the viral changes identified by virologists suggest that it may be more effectively transmitted from human to human,” he said.
Last week, Sweden became the first country outside Africa to record a clade 1b patient, and “this patient had mild symptoms,” Smallwood said.
WHO reported that the emergence last year and rapid spread of the new clade 1b strain “is of great concern and is one of the main reasons for declaring a PHEIC.”
“The greatest need for a concerted response right now is in the African region,” Kluge said, noting that the Africa Centers for Disease Control and Prevention “declared mpox a continental emergency shortly before the WHO global declaration.”
“Europe must choose to act in solidarity,” he said, warning that European countries need to learn from the experience of the COVID-19 pandemic and not “hoard vaccines for themselves.”
He expressed the promise that the European Commission's Health Emergency Response and Preparedness Authority is donating vaccines and that Belgium is also strongly committed to donating vaccines to Africa.
“The challenge is if there is a need for more vaccines for the European region,” he said, adding: “This is a defining test of global equity.”
WHO has recommended the use of two vaccines for mpox: MVA-BN and LC16. The UN health agency also recommends a third vaccine, ACAM2000, “if the others are not available.” (uh/ns)
