Mpox Update 18/08/2024
And greetings from beneath an insanely beautiful African sky ⭐
Dear Friend of Global Health Conversations,
A couple of fortnights ago I wrote We need to talk about Mpox. Well, now the virus has been brought to the fore and I feel that this new designation and attention will result positively for patients and populations. At the start of this fortnight I imagined writing something flowery related to Health Equity and French Philosophy, perhaps a commentary on HIV co-morbidites or a deep-dive on femicide following a summer of three high profile tragedies in the UK; alongside the Q2 Pharma financials.
But I’ve come back to this pressing topic to share an update on what’s happened, what it means and what’s next following the announcement of the PHEIC RE Mpox. There has been some controversy about how the announcement/s came about. But as I say in the audio version of this fortnight’s Mpox update, the important thing is that we are all aligned and on the same page on this crucial issue. Dr Ebere Okereke of Chatham house discusses this.
Since we last spoke, I have had a long, happy and peaceful time in South Africa, followed by a brief visit to Addis Ababa – spending time with an old friend, making new ones and enjoying Africa’s tiniest breakfast in Africa’s largest hotel. Thoroughly savoring my offline time. Tonight, I write to you from Congo, Brazzaville, with an absolutely beautiful view overlooking the Congo River and the city of Kinshasa. It is said that these are the world’s closest capital cities.
I have appreciated the coincidence of spending the past days in the epicentres of African public health policy making and governance at this important time. It gave me the opportunity to ask questions, to observe and to listen. Particularly on today’s topic.
I’m grateful, as always, to have you here. Thank you for reading. I am grateful for so many things. Wherever you are, Friend, I hope you’re peaceful too and enjoying the summer months. Stay safe.
Christiana
Mpox Update 18/08/24
On Thursday August 14, 2024, the Director General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, declared the ongoing Mpox outbreak a Public Health Emergency of International Concern (PHEIC), marking the second such declaration for Mpox in just over two years.
On Wednesday August 13th, the Africa CDC declared mpox a Public Health Emergency of Continental Security. The current outbreak of the more severe Mpox clade Ib, first identified in South Kivu, eastern DRC, has rapidly spread to Central and East and Southern Africa, with new cases being reported in several nearby countries including Burundi, Kenya, Rwanda, and Uganda and even as far afield as South Africa. This week, the first European case of the new clade was identified in Sweden.
On Friday evening August 15th, WHO’s ACT-A and FIND convened a meeting bringing together all of the most senior leaders across all the major organisations in Global Health to coordinate efforts with WHO to tackle the outbreak as swiftly and efficiently as possible. Effective Surveillance to identify epidemiological trends has been emphasized including an appropriate research agenda and strategic co-ordination of efforts.
On Tuesday 12 August, WHO’s Global Preparedness Monitoring Board released a statement on Mpox focussing on both systems and medical countermeasures. Two factors that will be vital in the response. It’s worth reading here. While you’re on that page, it’s also worth reviewing their May 2024 report on Equity in the context of Pandemics and epidemic response. This underpins our entire conversation today.
1. What happened?
New cases are being reported daily. On Friday alone, Nigeria reported 39 new cases and a new case was reported in Pakistan.
Mpox, formerly known as monkeypox, is a zoonotic viral disease caused by the mpox virus, an Orthopoxvirus characterized by symptoms such as fever, rash and pustules and swollen lymph nodes. Mpox has historically been endemic to parts of Central and West Africa but the current strain circulating, known as clade Ib, is more virulent and transmissible. Additionally, infants and children are more at risk. With 75% of new cases in certain parts of DRC being in children under 10.
We really don’t know the case fatality rate for this new clade. There are estimates, but experts are not yet sure or decided on this particular strain of Mpox.
Check out the 21st July 2024 GHC Newsletter: ‘We Need to Talk About Mpox’ for further details and granularities around the situation to date; as well as information about MPXV, numbers of cases and deaths and how it is spread. This week is an ‘update’ of that with the latest information.
2022 - Present: First PHEIC in 2022
The first Mpox PHEIC was declared by WHO in July 2022 in response to a rapidly spreading outbreak that affected over 95,000 people across 115 countries. The outbreak was primarily driven by human-to-human transmission through close contact, particularly among men who have sex with men. The global response included the deployment of vaccines and antivirals, which helped control the outbreak. This declaration highlights the urgent need for a coordinated response.
2. What does it mean?
The PHEIC designation by WHO triggers a coordinated global response, including the mobilization of resources, increased surveillance, and the implementation of public health measures to contain the virus. This includes enhancing diagnostic capabilities, expanding vaccine distribution, and improving access to treatments, particularly in the most affected regions and those where infrastructure is weakest.
It is vital to contain the virus where it is. And that should inform the deployment of medical countermeasures. That is the most effective way to contain the outbreak and limit its spread.
The response to this crisis will test the international community’s commitment to equitable health interventions. The experiences from the COVID-19 pandemic underscored the importance of swift and fair distribution of medical resources to prevent the exacerbation of health inequities. Despite the tireless and ongoing work in pandemic preparedness that a number of committed organisations have been doing; there are still significant gaps in global health preparedness, particularly in Africa, where the response has been hampered mainly by access issues.
The past few weeks we have been talking a lot more about the NCD co-morbidities being faced by HIV positive persons. HIV positive persons, due to their immunocompromised state, are also much more susceptible to contracting Mpox and to succumbing to the virus.
Another critical aspect of the current response is the need for further enhanced surveillance and data collection. The lack of comprehensive data on the spread of the virus, particularly in rural and conflict-affected areas could hinder efforts to track and contain the outbreak.
The incidence of this virus is almost certainly underreported. Improving surveillance and data collection is essential for understanding the true scale of the outbreak and for implementing effective public health measures.
3. What’s next?
One lesson from previous outbreaks that has been flagged by WHO and partners is that of co-ordination between various actors. The competent experts, organisations, DFIs, governments, NGOs, clinical staff, regional and international bodies across different arms and functions will need to take a strategic approach making it clear who will do what.
On the African continent, it is clear that the bulk of the operational and implementation work will be done by those who have boots on the ground, local and regional presence. WHO AFRO along with its regional offices and country offices (WOCs) have decades of history and collaboration as well as established local presence. Collaboration with regional bodies, Africa CDC, governments and organisations working across the value chain is already progressing and is a good first step in containing the spread.
Another important step that WHO emphasizes is adequate and appropriate information and communication to populations as a means of promoting prevention particularly amongst the most vulnerable groups and mitigating misinformation and disinformation. One of the most important considerations emphasized by countries in the South, WHO and many other partners is to be acutely aware of the equity principal in the response to this mpox outbreak.
One of the key challenges in addressing the current outbreak is the limited availability of appropriate diagnostics, vaccines and therapeutics. Here is WHO’s current guide on diagnosing Mpox - very useful resource.
The U.S. government has been actively involved in supporting the response to the Clade I mpox outbreak in the DRC. This involvement includes financial contributions amounting to an additional $17 million to bolster preparedness and response efforts, as well as the donation of 50,000 doses of the FDA-approved JYNNEOS vaccine. The U.S. government’s approach emphasises strengthening surveillance, enhancing laboratory capacity, and ensuring effective risk communication across affected regions. Bavarian Nordic, the manufacturer of the JYNNEOS vaccine, has received substantial contracts from governments to produce and distribute vaccines. Recently, the company secured a $156.8 million contract from the U.S. government to replenish vaccine stockpiles and support ongoing public health preparedness. Additionally, Bavarian Nordic has been actively involved in supporting the response in Africa, announcing a new order from the European Health Emergency Preparedness and Response Authority (HERA) for 175,420 doses of the MVA-BN vaccine, alongside a donation of 40,000 doses specifically for Africa CDC’s efforts.
Looking forward, a strategic and comprehensive response is essential to contain the mpox outbreak. The Africa CDC have proposed an outline for their contribution to the ongoing outbreak. But this is a fast moving situation and it will also be necessary for countries to purchase and procure vaccines and other MCMs. In this regard, it is my hope that these buyers, national governments, health departments, and other partners; will find willing sellers. And perhaps even fair prices. There may be an opportunity to make amends here.
Learning from past diseases. HIV, Ebola & COVID-19. There are lessons to be learned from all three of these recent outbreaks. It is my hope, and you will know this if you read the recent newsletter - We Need to Talk About Mpox - that this disease echoes very loudly in its similarity to HIV due to transmission and the potential for stigma. Ebola in the sense that it long existed and has been researched for decades just not at scale. Nigeria was successful in the last decade’s outbreak - using standard public health measures alongside available medical countermeaures to contain the spread of the disease in one of the world’s most populous nations. This outbreak may also serve as an opportunity to function within a framework of global equity treating all affected patients and potential patients as equally valuable in terms of how both treatment, policy and prevention are undertaken. Here is WHO’s case tracker. A bit out of date currently but I imagine this page will be updated if you wish to bookmark it.
(Additional sources: GAVI, The Conversation, WEF, Chatham House, Nature, UN, USAID, Devex)
Listen to this fortnight’s Mpox Update on Apple Podcasts
Pharma & Global Health Headlines
Prolific Machines receives BMGF grant to develop their novel mAb platform
This story from Devex revealing the interplay of competing priorities for DFIs
The effect of extreme heat and super hot summers on people with disabilities
This op-ed from Gilead - entitled ‘What will it take to end HIV’
Behind the scenes:
Bit of this and that from Joburg, Pretoria, Addis and Brazza. I’m thoroughly enjoying being home on African soil. Below, books, art & music, views of the Congo river & reading a book (Thabo Mbeki - The Dream Deferred, Mark Gevisser - Updated 2022 version) beside the pool. On a time crunch, I enjoyed Africa’s tiniest breakfast at Africa’s largest hotel. According to my Oura Ring - my physical health hasn’t been better in months. I’m grateful, at peace and my laptop and I are in no hurry to leave. 🙂
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