MPOX: Urgent Action And Investment Required Now To Protect People And Stop More Spread

The continued outbreak of mpox, including its spread into several African countries, is of grave concern, and urgent investment and action from stakeholders across the international community is essential now to protect people, save lives, and contain the mpox clades I and II outbreaks.

8 August 2024

We welcome the Director-General of the World Health Organization’s announcement that he will convene the International Health Regulations (IHR) Emergency Committee to assess the current mpox situation and then determine whether it is a Public Health Emergency of International Concern (PHEIC). This meeting is urgently required as cases of mpox clade I are now also being reported in countries neighbouring the Democratic Republic of the Congo where most cases and deaths have occurred.

We also call on the WHO and Member States to now apply the amended IHRs to this outbreak, which embrace the principles of equity and solidarity, and includes an obligation for WHO to assist countries to access health products, strengthen research and development, and support local production, and for State Parties to help facilitate access to health products.

There is every indication that without urgent action, mpox will continue to spread within the traditionally endemic countries and across borders, and that transmission could occur into other regions globally as it did in 2022 when people in more than 100 countries were affected. Mpox, particularly the more dangerous clade I with higher rates of mortality, especially in immunocompromised individuals and in young children, cannot be allowed to become a widespread endemic disease across Africa or anywhere.

Attention and action to contain the escalating spread of mpox has been wholly inadequate. We urgently call for:

Political attention and leadership at national, regional, and global levels to save lives, address gendered impacts, stigmatisation and discrimination and stop the spread.

Millions more dollars in international funding to be made available to work with communities to contain this outbreak. The lack of funding to date is likely a contributing factor to this now expanding outbreak.

Immediate increased access to more testing, and provision of millions of doses of vaccines to ensure protection of people at risk.

Effectively engage with and work in partnership with communities to contain this outbreak and leave no one behind - particularly those at risk to promote prevention measures, vaccine uptake, contact tracing and care to those affected.

Enhanced surveillance to track and understand the spread of this outbreak and better target the response.

Massively increased Investment in research and development and support for Africa-based researchers to learn more about all aspects of mpox and develop locally-based and tailored solutions.

Access to tests, treatments and vaccines for mpox in Africa is completely insufficient. As an example, just 50,000 doses of mpox vaccine have been sent to the Democratic Republic of the Congo, a country of 99 million people, where spread of mpox clade I is countrywide, is affecting people of all ages, and is leading to deaths of children.

The international community must now work with affected States, the WHO and the Africa CDC to provide millions of doses of mpox vaccines and roll-out vaccination strategies that are adapted to the local context, increase vaccine production, rapidly improve and scale up diagnostic testing, supportive care and antiviral treatments where useful, risk communication and community engagement in order to save lives, prevent stigma and discrimination, protect people and stop the outbreaks from spreading further.

Mpox can spread internationally rapidly

After having been largely ignored by the international community, despite a history of regular outbreaks in West and Central Africa, mpox rose to international attention with the widespread transmission of mpox clade IIb in wealthy countries in 2022. Following an mpox PHEIC in July of 2022, the virus was eventually detected in 111 countries. Most of the people affected were men who have sex with men, who activated their networks, and together with public health authorities helped to secure community engagement, prevent stigmatisation, and where available mainly in high-income countries, access to testing, treatment and vaccines.

Huge gaps persist while outbreaks spread

When the mpox PHEIC was lifted on May 11 2023 after the surge of cases in wealthy countries subsided, the international response fell flat despite concerns from the IHR Emergency Committee about the lack of support to stop the outbreaks on the African continent. Meanwhile, most low-income countries including those with a history of mpox outbreaks did not receive the support required to strengthen diagnostics capabilities and outbreak response, and remained without access to the vaccines and treatments that had been made available in wealthy countries. This lack of attention, leadership, political will and financing to effectively address outbreaks when and where they occur has likely contributed to the worrying increases in cases we are witnessing today.

Current information from the outbreak in African countries indicates a steady increase in reported cases, including extensive cross-border spread of the clade Ib variant. While many aspects of the current outbreak are still under study, there is clear concern about sustained human-to-human transmission within household and community infections through skin contact, and now also within sexual networks.

According to the Africa CDC, more than 14,500 cases of Mpox have been detected in 10 African countries from January-June 2024, leading to 461 deaths - a 19% increase in deaths over the same period last year. WHO reported in a news conference on 7 April 2024 that 88% of recent deaths linked to clade I are in children under 15 years of age.

AU and WHO provide funds, much more required

We are encouraged by the African Union’s pledge of US$10.4 million to address the outbreak and by the WHO’s announced release of US$1 million from its emergency contingency fund. Much more funding will be urgently needed including for health products, and for Africa-based and international networks to collaborate on learning more about the virus and developing local solutions.

Stop outbreaks before they become pandemics

We recognize that disease outbreaks can be sensitive, and that all efforts must be made to protect the people and economies of affected countries. We also stress that allowing disease to spread and become further endemic also has great human and economic costs. The risks of new pathogens and spread of existing pathogens to previously non-endemic areas is only growing with climate change and human encroachment on forested areas.

This is why outbreaks must be identified early and stopped in their tracks, and that all regions must have the capacities to research, develop and manufacture locally suitable health products that serve public health and protect their populations. The focus must be on equity and leaving no one behind.

Leaders must take action and make the investments required to contain mpox and protect people now. The world has learned how expensive global spread of a virus can be to human lives, economies and societies - it’s beyond time to apply the lessons of COVID-19 and stop outbreaks before they become pandemics.

Signed,

Dr. Ayoade Alakija, Board Chair, FIND and Special Envoy to ACT-A and Co-Chair of the ACT-A Principals

Mr. Aggrey Aluso, Executive Director, Resilience Action Network Africa

Dr. Mauricio Cárdenas, former Minister of Finance of Colombia, and Member of The Independent Panel*

The Rt Hon. Helen Clark, former Prime Minister of New Zealand, Member of The Elders, Co-Chair of The Independent Panel

Professor Brendan Crabb AC FAA FAHMS, Director & Chief Executive Officer, Burnet Institute

The Honorable Dr. Mark Dybul, diplomat, physician and medical researcher, Member of The Independent Panel

Prof Patricia J. Garcia, Former Minister of Health of Peru, and Member of the PGPHC**

Prof Lawrence O. Gostin, Professor and Chair in Global Health Law and Member of the PGPHC

Ms Jane Halton, Chair, Coalition for Epidemic Preparedness Innovations (CEPI) and Member of the PGPHC

Associate Professor Adam Kamradt-Scott, Cummings Foundation Professor of One Health Diplomacy, Fletcher School of Law and Diplomacy, Tufts University

Dr. Michel Kazatchkine, former Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria and Member of The Independent Panel

Dr. Helena Legido-Quigley, Professor in Health Systems, Imperial College London, George Institute for Global Health

Dr Joanne Liu, former International President of Doctors Without Borders and Member of The Independent Panel

Associate Professor Suman Majumdar, Chief Health Officer - COVID and Emergencies, Deputy Program Director, Health Security and Pandemic Preparedness, Burnet Institute

Ms Rosemary McCarney, former Ambassador and Permanent Representative of Canada to the Office of the United Nations and to the United Nations Conference on Disarmament based in Geneva, Switzerland, and advisor to The Independent Panel

The Rt Hon. David Miliband, former Foreign Secretary of the United Kingdom, and Member of The Independent Panel

Dr Winnie Mpanju-Shumbusho, Former WHO Assistant Director General and Member of the PGPHC

Dr. Selina Namchee Lo, Executive Director, Australian Global Health Alliance

Dr. Anders Nordström, former Global Health Ambassador for Sweden and former Head of Secretariat of The Independent Panel

Dr. Raj Panjabi, Former White House Senior Director for global health security and biodefense and former Advisor to The Independent Panel

Dr Jorge Saavedra, Executive Director, AHF Global Public Health Institute and Member of the PGPHC

Dr. Nina Schwalbe, Founder and CEO, Spark Street Advisors

Dame Barbara M. Stocking, Former President, Murray Edwards College, University of Cambridge and Chair of the PGPHC

Ms. Eloise Todd, Executive Director & Co-founder, Pandemic Action Network

Dr. Els Torreele, Independent Researcher and Advisor

Dr. Clare Wenham, Associate Professor of Global Health Policy, Department of Health Policy, London School of Economics and Political Science

*The Independent Panel for Pandemic Preparedness and Response 
** The PGPHC is The Panel for a Global Public Health Convention

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