In May 2022, the World Health Organization (WHO) declared its first post-COVID Public Health Emergency of International Concern (PHEIC). The cause: an outbreak of the Mpox virus, formerly known as Monkeypox. Unlike what happened with COVID-19, scientists had been aware of Mpox for decades before its global debut because the virus was endemic in parts of Africa. Additionally, many people had protective immunity to Mpox due to vaccination against the closely-related Smallpox virus. Of course, none of that stopped Mpox from exploding in 2022, affecting dozens of countries from Europe to the Americas—places where it had never been seen before.
The 2022 outbreak saw the Mpox virus suddenly spread to every populated continent after being largely confined to Africa for decades. Source: OurWorldinData
Fortunately, a combination of vaccination and behavioral changes helped slow that outbreak, though not before tens of thousands were infected.
However, 2022’s global outbreak pales in comparison to the one currently raging in the Democratic Republic of Congo. Though the DRC epidemic has only been afforded a fraction of the media coverage, it has been far more lethal, with 265 reported dead in just the first 9 weeks of 2024. Additionally, trends indicate that things will only get worse. 2023 was already the worst year on record for Mpox outbreaks in the DRC, putting 2024 case rates in uncharted territory.
Suspected cases of Mpox in 2024 have already exceeded the 2023 peak to smash all records. Source
A different, deadlier strain
A major distinction to note is that the Mpox strain behind this outbreak, Clade 1, is distinct from the Clade 2b virus from 2022. Historically, Clade 1 has been several times deadlier, which is likely contributing to the DRC’s high death toll. However, like its cousin, Clade 1 is showing more and more signs of sustained sexual transmission, which was key to Clade 2b’s global spread. Additionally, at least some of the Clade 1 viruses in the DRC have lost a crucial gene targeted in PCR tests, making it hard to determine which strain is which.
Compounding the situation, the DRC is extremely vulnerable to any disease outbreak. The growing population is increasingly encroaching on wildlife, allowing the virus to jump from animals to humans with greater frequency. At the same time, the country itself is in no state to mount an effective response. Other diseases like Cholera, Ebola, and even plague regularly circulate. Additionally, millions of people are being displaced by armed conflict in what the UN calls “one of the world’s longest and most complex humanitarian crises."
The good news is that we have vaccines against this virus. However, as with so many other medical tools, there are significant disparities in the Mpox vaccine's allocation. While wealthy countries were able to use millions of doses to fight the 2022 outbreak, no vaccines are currently available in the DRC. As a result, the country’s immunity to Mpox can only deteriorate as immunity from 20th century Smallpox vaccinations wane.
Lessons not learned
In 2017, a report from the World Bank described our response to pandemics as a cycle of “panic and neglect,” and Mpox is no exception.
Less than two years ago, health leaders worldwide went into a panic when the Clade 2b Mpox virus defied expectations and infected over 100 countries. Then, once the outbreak slowed, Mpox disappeared from the minds of most, and we entered the neglect phase.
Now, a different and far more lethal strain of Mpox is brewing, with little response from the international community. Once again, outbreaks in lower-income countries are being ignored, and as neglected viruses tend to do, this particular strain of Mpox will find a way to expand. As the DRC experiences more and more cases, some may hop on flights to London, New York, Beijing, or Paris. Before long, the world could face a repeat of the 2022 epidemic, only with a much deadlier strain of Mpox, and we will have no excuse for not stopping it entirely.
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