WHO Director-General Dr Tedros Adhanom Ghebreyesus has determined that the resurgence of monkeypox (mpox) in the Democratic Republic of the Congo and a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC) under the International Health Regulations (2005) (IHR). [2005]).
Dr Tedros made the statement following advice from an IHR Emergency Committee of independent experts that met earlier in the day to review data submitted by WHO and affected country experts. The Committee has informed the Director-General that it considers the resurgence of mpox to be a PHEIC with the potential to spread further across African countries and possibly beyond the continent.
The Director-General will transmit the report of the Committee meeting and, based on the Committee’s advice, issue temporary recommendations to countries.
Declaring the PHEIC, Dr Tedros said: “The emergence of a new mpox virus clade, its rapid spread in eastern DRC and the reporting of cases in several neighbouring countries are very worrying news. Coupled with outbreaks of other mpox virus clades in DRC and other countries in Africa, it is clear that a coordinated international response is needed to stop these outbreaks and save lives.”
WHO Regional Director for Africa, Dr Matshidiso Moeti, said: “Important efforts are underway in close collaboration with communities and governments, and our country teams are working on the front line to help strengthen measures to curb MPOX. With the virus spreading further, we are further scaling up our response through coordinated international action to help countries end outbreaks.”
The Committee Chair, Professor Dimie Ogoina, said: “The current resurgence of mpox in different parts of Africa, coupled with the spread of a new sexually transmissible strain of the virus causing the disease, constitutes an emergency, not only for Africa, but for the entire planet. mpox did not receive the attention it deserved in Africa, where it originated, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself.”
This is the second time in two years that a PHEIC has been identified in relation to mpox. This disease, caused by an orthopoxvirus, was first detected in humans in 1970 in the Democratic Republic of the Congo. The disease is considered endemic to countries in central and western Africa.
In July 2022, the multi-country mpox outbreak was declared a PHEIC as it spread rapidly through sexual contact in a number of countries where the virus had not been observed before. The PHEIC was declared over in May 2023 after a sustained decline in cases worldwide.
In the Democratic Republic of the Congo, cases of mpox have been reported for more than a decade, and the number of cases reported each year has increased steadily over that period. Last year, reported cases increased significantly, and already the number of cases reported so far this year has surpassed last year’s total, with more than 15,600 cases and 537 deaths.
The emergence last year and rapid spread of a new strain of the virus in the Democratic Republic of the Congo, clade 1b, which appears to spread mainly through sexual networks, and its detection in countries neighbouring the Democratic Republic of the Congo are of particular concern and one of the main reasons for the declaration of the PHEIC.
More than 100 laboratory-confirmed clade 1b cases have been reported in the past month in four countries neighbouring the Democratic Republic of the Congo that had not previously reported mpox cases: Burundi, Kenya, Rwanda and Uganda. Experts believe the actual number of cases is higher, as a large proportion of clinically compatible cases have not been tested.
Several outbreaks of different clades of mpox virus have occurred in different countries, with different modes of transmission and different levels of risk.
The two currently used mpox vaccines are recommended by the WHO Strategic Advisory Group of Experts on Immunization, and are also approved by national regulatory authorities listed by WHO, as well as by countries such as Nigeria and the Democratic Republic of the Congo.
Last week, the Director-General launched the procedure for listing mpox vaccines for emergency use, which will accelerate access to these vaccines, especially by lower-income countries that have not yet issued their own national regulatory approval. Emergency use listing also allows partners, including Gavi and UNICEF, to procure vaccines for distribution.
WHO is engaging with countries and vaccine manufacturers on potential vaccine donations, and is coordinating with partners through the interim medical countermeasures network to facilitate equitable access to vaccines, treatments, diagnostics and other tools.
WHO anticipates an immediate funding need of USD 15 million to finance surveillance, preparedness and response activities. A needs assessment is underway at all three levels of the Organization.
To allow for an immediate surge, WHO has released USD 1.45 million from the WHO Contingency Fund for Emergencies and may need to release more in the coming days. The Organization is appealing to donors to fund all mpox response needs.
