On Aug. 14, the World Health Organization (WHO) classified Mpox virus, which is surging across several African countries, as a public health emergency of international concern. This action will help mobilize global and regional public health resources to better monitor and respond to the threats posed.
Naturally, in the wake of COVID-19, this has many people worried were about to relive the collective trauma of lockdowns and fears of acquiring a potentially deadly virus. As an epidemiologist who studies the intersection of infectious diseases and social life, I share these concerns, but, at this point, I believe the WHOs announcement should raise caution, not cause panic.
Mpox, once referred to as monkeypox, is a virus that causes flu-like symptoms and skin blisters across the body. Fortunately, the virus is mostly spread through direct contact with infected lesions or bodily fluids, or through contaminated materials like bedding. This means it is not typically as contagious as respiratory diseases such as COVID. However, it can also spread through respiratory droplets, although this only typically occurs with prolonged close contact in areas with limited ventilation.
These characteristics explain why historically Mpox outbreaks have typically been limited to densely interconnected sexual networks and in venues where physical contact may be prolonged, such as in night clubs.
However, the current situation in Africa is showing that some of these characteristics are changing. In the Democratic Republic of Congo (DRC) and neighbouring countries, it appears that a more deadly, more virulent version of the virus arising from a strain referred to as Clade 2 is taking hold. This is evidenced by the fact that several African countries that had not previously seen transmission are now seeing increased spread.
As well, public health officials note transmission in children, suggesting that this more virulent form may require less physical contact than we observed in the transmission of Clade 1, which caused a global outbreak in 2022.
There is also evidence this strain is more deadly, with mortality rates of between three and five per cent, which considerably exceeds the average mortality rate of COVID-19.
With all this in mind, its natural to ask, Should we be worried?
At the moment, the WHOs actions indicate that the international public health community should pay attention and prepare for a possible large-scale international outbreak of Mpox something it has failed to do in recent decades.
Most importantly, its declaration allows for enhanced global collaboration to monitor the situation in the Democratic Republic of Congo and surrounding countries. It also makes it possible to prioritize the availability of vaccines in those regions to bring viral transmission under control.
We are fortunate, in Canada, to have an excellent public health surveillance system and to have some access to vaccine supplies for Mpox. The existing Mpox vaccines are safe and effective. Currently, their use is prioritized for high-risk populations, such as gay and bisexual men and people employed in sex work.
If transmission begins in other populations, it is likely that production of the Mpox vaccine could be increased and supplies would be more broadly available to meet demand and need. But it is important to note that redirecting those vaccines will limit their availability to African countries that lack the necessary biomanufacturing capacity to produce them.
As well, Canada is fortunate to have world-class medical facilities that can provide necessary treatment and care to people who might experience vulnerability to Mpox virus. All of these factors suggest that Canada will be well equipped to respond to potential outbreaks, provided, of course, that we all do our part.
Perhaps the most valuable insight and lesson from this situation is the importance of global health equity. Mpox has been endemic in African countries for decades first attracting attention in the 1960s and 1970s. Our global failure to address the transmission sooner has directly contributed to the threats we are facing today.
Allowing uncontrolled spread of a virus as potentially dangerous as Mpox has been a massive public health failure especially since there are effective vaccines that could lead to the eradication of Mpox if appropriately used.
This of course is not the first time weve learned the importance of health equity. During the 2022 outbreak of Mpox, which primarily affected gay and bisexual men, it is clear that transmission only halted because communities worked closely with public health officials. Individuals took action to limit their personal risk and public health systems helped fund awareness and vaccine promotion efforts.
The same level of collaboration among communities at high risk will be needed should this new more virulent strain of Mpox reach the global stage.
While the current situation with Mpox is concerning, there is not yet any reason to panic.
However, as the situation develops, we must pay attention to the advice of public health leaders and be ready to take appropriate actions. In doing so, we must be especially ready to adopt a reasoned public health response that prioritizes vaccines for the communities that need them the most.
The World Health Organization (WHO) has declared the growing mpox outbreak, formerly known as Monkeypox, a public health emergency of international concern.
The mpox outbreak originated in the Democratic Republic of Congo (DRC) and is spreading rapidly across central Africa. On August 15, a case was confirmed in Europesparking memory of the 2022 mpox outbreak that impacted 122 countries.
The International Rescue Committee (IRC) is scaling up our response in affected communities to help prevent the spread of the disease and help those affected survive, recover and rebuild their lives.
Mpox is a virus found primarily in central and western Africa that can infect humans and animals. Last year, a more severe strain of the diseaseknown as clade 1bwas identified in the DRC and is now spreading rapidly across the region.
The DRC has recorded more than 12,000 suspected mpox cases and 447 deaths between January and mid-July 2024. The disease has also spread to other countries where the IRC operates including Burundi, Kenya and Ugandaand to Europe.
Symptoms of mpox include fever, headache, muscle aches, swollen lymph nodes, chills, exhaustion and a distinctive rash that can look like pimples or blisters. Previous outbreaks of clade 1 mpox have had a mortality rate of 10%.
Mpox can spread through direct contact with an infected person or animal, as well as through direct contact with materials contaminated by the virus.
Dr. Silas examines a patient at the IRCs Hagadera Refugee Camp Hospital in Kenya, where the IRC has been providing services to displaced people since 2009.
Photo: Fahmo Mohammed for the IRC
The CDC warns that people with weakened immune systems, young children, individuals with a history of eczema and those who are pregnant are particularly at risk of mpox. The IRC is also deeply concerned about the wellbeing of displaced people, who often lack access to the water, sanitation and health care facilities needed to prevent the spread of disease and stay safe.
The IRC is monitoring the mpox outbreak in Africa and has launched responses in the DRC and Burundi. Our teams are also preparing to scale up our response in countries like Kenya and Uganda if necessary.
The DRC is bearing the brunt of the global mpox outbreak. Protracted displacement and a weakened health system have created conditions conducive to the rapid spread of the virus.
As of August 12, 2024, the North Kivu Ministry of Health had reported 300 suspected cases and 54 confirmed cases, including 21 cases in three camps [housing displaced communities]. In the face of these challengeslack of awareness about Mpox among the population, the absence of prevention mechanisms, and the shortage of on-the-ground actorsthe IRC is conducting awareness-raising activities and measures to prevent and control the spread of infection, says Heather Kerr, IRC country director in DRC.
The IRCs response will focus on supporting displaced people living in three camps near the city of Goma in eastern DRC.
Our efforts will include:
Learn more about our work in the DRC.
Mapendo, an IRC client, runs a small business in the Don Bosco Ngani camp for displaced people, just outside Goma, DRC. The IRC is providing services in camps for displaced people where access to water, sanitation and hygiene facilities are often limited.
Photo: Mireille Ngwamba for the IRC
Heavy seasonal rains in April 2024, exacerbated by the El Nio weather pattern, caused severe flooding that impacted nearly 250,000 people and led to a cholera outbreak in several provinces of Burundi. Conditions in the country have left families exceptionally vulnerable to the spread of mpox.
In response to the escalating mpox outbreak, the IRC is scaling up its emergency response in Burundi by:
Learn more about our work in Burundi.
Flooding in Burundi displaced approximately 50,000 people in 2024. Mpox spreads more easily in communities that lack reliable access to water, sanitation and hygiene services.
Photo: UNOCHA/Camille Marquis
The IRC is on the ground supporting communities affected by mpox in the DRC and Burundi. We are monitoring the spread of the disease and are prepared to scale up our services in places like Kenya and Ugandawhere the IRC is already providing support.
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The Africa Centres for Disease Control and Prevention says mpox has been detected in at least 13 African countries, and cases have been confirmed in other continents, too. How can people protect themselves?
Published On 19 Aug 202419 Aug 2024
The Director-General of the World Health Organization (WHO), having concurred with the advice offered by the International Health Regulations (2005) (IHR or Regulations) Emergency Committee regarding the upsurge of mpox 2024 during its first meeting, held on 14 August 2024, has determined, on the same date, that the ongoing upsurge of mpox in the Democratic Republic of the Congo (DRC) and in a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC) under the provisions of the Regulations. The communication of the Director-General regarding the determination of the above-mentioned PHEIC on 14 August 2024 is available here.
The Director-General is hereby transmitting the report of the first meeting of the IHR Emergency Committee regarding the upsurge of mpox 2024.
Noting that the Director-General will be communicating to States Parties a 12-month extension of the current standing recommendations for mpox, the temporary recommendations, issued by the Director-General in relation to the PHEIC associated with the ongoing upsurge of mpox are presented in the last section of this statement and reflect the advice offered by the Committee.
The Director-General is taking the opportunity to express his most sincere gratitude to the Chair, Vice-Chair, and Members of the IHR Emergency Committee, as well as to its Advisors.
Sixteen (16) Members of, and two Advisors to, the Emergency Committee were convened by teleconference, via Zoom, on Wednesday, 14 August 2024, from 12:00 to 17:00 CEST. Fifteen (15) of the 16 Committee Members and the two Advisors to the Committee participated in the meeting.
The Director-General of the World Health Organization (WHO) joined in person and welcomed the participants. The opening remarks by the Director-General are available here.
The Representative of the Office of Legal Counsel briefed the Members and Advisers on their roles and responsibilities and identified the mandate of the Emergency Committee under the relevant articles of the IHR. The Ethics Officer from the Department of Compliance, Risk Management, and Ethics provided the Members and Advisors with an overview of the WHO Declaration of Interests process. The Members and Advisors were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or actual conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and the work of the Committee. Each Member and Advisor was surveyed, with no conflicts of interest identified.
The Representative of the Office of Legal Counsel then facilitated the election of officers of the Committee, in accordance with the rules of procedures and working methods of the Emergency Committee. Professor Dimie Ogoina was elected as Chair of the Committee, Professor Inger Damon as Vice-Chair, and Professor Lucille Helen Blumberg as Rapporteur, all by acclamation.
The meeting was handed over to the Chair who introduced the objectives of the meeting, which were to provide views to the Director-General on whether the event constitutes a public health emergency of international concern (PHEIC), and if so, to provide views on the potential proposed temporary recommendations.
The WHO Secretariat presented an overview of the global epidemiological situation of mpox, highlighting that, during the first six months of 2024, the 1854 confirmed cases of mpox reported by States Parties in the WHO African Region account for 36% (1854/5199) of the cases observed worldwide. Of these confirmed cases in the WHO African region in 2024, 95% (1754/1854) were reported in the Democratic Republic of the Congo (DRC), that is experiencing an upsurge of cases of mpox, withmore than 15,000 clinically compatible cases and over 500 deaths reported, already exceeding the number of cases observed in the DRC in 2023.
The upsurge of mpox cases in the DRC is being driven by outbreaks associated with two sub-clades of clade I monkeypox virus (MPXV) clade Ia and clade Ib. Clade I mpox was classically described in studies conducted by WHO in the 1980s to have a mortality rate of approximately 10%, with most deaths occurring in children.
MPXV clade Ia is endemic in the DRC, the disease primarily affects children, data available for 2024 show an aggregated case fatality rate of 3.6%, and the spread is likely sustained through multiple modes of transmission including person-to-person transmission following zoonotic introduction in a community.
MPXV clade Ib is a new strain of MPXV that emerged in the DRC is transmitting between people, presumed via sexual contact, which has been spreading in the eastern part of the country. Although first characterized in 2024, estimates suggest it emerged around September 2023. The outbreak associated with clade Ib in the DRC primarily affects adults and is spreading rapidly, sustained largely, but not exclusively, through transmission linked to sexual contact and amplified in networks associated with commercial sex and sex workers.
Since July 2024, cases of mpox due to MPXV clade Ib, epidemiologically and phylogenetically linked to the outbreak in the eastern provinces of DRC, have been detected in four countries, neighbouring the DRC, which had not reported cases of mpox before: Burundi, Kenya, Rwanda and Uganda.
Additionally, in 2024, cases of mpox linked to MPXV clade Ia have been reported in the Central African Republic and the Republic of Congo, and cases linked to MPXV clade II have been reported in Cameroon, Cte dIvoire, Liberia, Nigeria and South Africa.
The clinical presentation of mpox associated with MPXV clade Ia has historically been characterized by more severe disease than that associated with MPXV clade II. Clade IIb viruses circulated during the multi-country outbreak that constituted a PHEIC from July 2022 to May 2023. There is, as yet, insufficient information available to fully characterize mpox severity due to clade Ib as data are emerging and, so far, few deaths were recorded, precluding age-stratified analyses.
The secretariat outlined challenges in understanding the true extent of infection, epidemiologic trends and morbidity and mortality, thus cautioning overinterpretation of available data to calculate crude CFRs by different clades/outbreaks.
The assessed risk presented by the WHO Secretariat grouping geographical areas as a result of the assessment of population groups affected, predominant modes of transmission, and MPXV clades involved , was: high for eastern DRC and neighbouring countries; high for areas of the DRC where mpox is known to be endemic; moderate for Nigeria and countries of West, Central and East Africa where mpox is endemic; and moderate for other countries in Africa and around the world.
The WHO Secretariat additionally provided an overview of the actions already taken to support readiness and response interventions in States Parties experiencing the upsurge of cases of mpox and facing such risk. These include, inter alia: the release of USD 1.45 million from the WHO Contingency Fund for Emergencies; initiating the process for including Emergency Use Listing two mpox vaccines; coordinating with partners and stakeholders, including to facilitate equitable access to vaccines, therapeutics, and diagnostics; the development of a regional response plan, costed at an initial USD 15 million, and more.
Representatives of Burundi, the Democratic Republic of the Congo, Kenya, Rwanda, South Africa and Uganda updated the Committee on the mpox epidemiological situation in their countries and the current response efforts, needs and challenges. Although most reported few cases of MPXV clade Ib related mpox, Burundi reported one hundred confirmed cases of mpox associated with clade Ib since July 2024, identified in multiple districts and 28% of cases were amongst children less than five years of age.
Members of, and Advisors to, the Committee then engaged in questions and answers with the presenters. The questions and discussions focused around the issues and challenges enumerated below:
Following the session open to invited States Parties, the Committee reconvened in a closed session to examine the questions in relation to whether the event constitutes a PHEIC or not, and if so, to consider the temporary recommendations drafted by the WHO Secretariat in accordance with IHR provisions.
The Chair reminded the Committee Members of their mandate and recalled that a PHEIC is defined in the IHR as an extraordinary event, which constitutes a public health risk to other States through the international spread of disease, and potentially requires a coordinated international response.
The Committee was unanimous in expressing the views that the ongoing upsurge of mpox meets the criteria of a PHEIC and that the Director-General be advised accordingly.
The considerations underpinning the unanimous views of the Committee further elaborated upon issues and challenges addressed during the question and answers session.
The Committee considered the event as extraordinary because of (a) the increase in mpox clade I disease occurrence in the DRC and the emergence of the new MPXV clade Ib, the human-to-human transmission context in which it is occurring, its rapid spread in some settings, and available evidence suggesting that MPXV clade I is associated with a more severe clinical presentation with respect to MPXV clade II; (b) the diverse, complex, dynamic, and rapidly evolving epidemiology observed across States Parties in the WHO African Region in terms of: overall rapid increase of the number of cases reported in some settings, differences in population age-groups affected, routes and modes sustaining transmissions in different contexts; and (c) the severity of the clinical presentation in children and immunocompromised individuals, including people living with uncontrolled HIV infection or advanced HIV disease, as well as the long-term consequences of MPXV infection.
Additionally, the Committee strongly underscored that its level of concern is further heightened by (a) uncertainties and gaps in knowledge and evidence related to (i) multiple epidemiological aspects, including drivers of transmission, morbidity and mortality associated with infections with different MPXV sub-clades; (ii) the incompleteness and uncertainties of available epidemiological data and considered by the Committee, due to the limitations of current surveillance (e.g., sub-optimal levels of case detection and case reporting), the availability and performance of laboratory diagnostics, and ongoing conflicts and humanitarian challenges in certain areas of the DRC experiencing the upsurge of mpox, that, ultimately, hamper the implementation of control measures; (iii) the impact of control measures, including the targeted use of vaccines and their overall effectiveness; and (b) the risk of occurrence of additional mutations of MPXV clade I and clade II, and their subsequent emergence and spread in the context of limited capacity to implement control measures.
The Committee considered that the event constitutes a public health risk to other States through the international spread of disease because of (a) the documented recent spread of MPXV clade Ib from eastern DRC to Burundi, Kenya, Rwanda and Uganda; (b) the limited capacity to control transmission in endemic situations and in areas of upsurge through enhanced surveillance enabling the implementation of targeted response interventions that are ultimately subordinated to (i) the unavailability of sustainable funding, and (ii) the limited ability to access vaccines, therapeutics, and diagnostics; and (c) the challenges in implementing concerted surveillance and response interventions in contiguous areas of bordering States Parties, in particular where borders are porous.
The Committee considered that the event requires a coordinated international response. The Committee noted that (a) mpox is endemic in parts of Africa, with surges increasingly reported, and also resulting in a multi-country outbreak determined to constitute a PHEIC in 2022-2023; and (b) the event is occurring in the context of standing recommendations issued by the Director-General in August 2023 under IHR provisions and following the termination of the afore mentioned PHEIC; the presence of the WHO Strategic framework for enhancing prevention and control of mpox- 2024-2027; and the activation for mpox of the i-MCM-Net. In that light and noting the declaration of the event as a Public Health Emergency of Continental Security by the Africa CDC on 13 August 2024, the Committee considered that international cooperation requires enhanced and coordination, in particular with respect to (a) the facilitation of equitable access to vaccines, therapeutics, and diagnostics; and (b) the mobilization of financial resources.
The Committee subsequently considered the draft of the temporary recommendations proposed by the WHO Secretariat, briefly presented during the meeting. The Committee indicated that it would be giving further consideration to the proposed temporary recommendations while finalizing the report of the meeting.
The Committee noted that, in his opening remarks, the Director-General communicated the 12-month extension of the current standing recommendations for mpox, which were set to expire on 20 August 2024. The Committee also noted that, should the Director-General determine that the upsurge of mpox constitutes a PHEIC, it would be the first time, since the entry into force of the Regulations, that temporary and standing recommendations to States Parties related to the same public health risk would coexist.
Therefore, the Committee underscored that any temporary recommendation that may be issued by the Director-General should be very specific and targeted, and hence, not duplicate the standing recommendations.
Notwithstanding that both, temporary and standing recommendations constitute non-binding advice to States Parties, the Committee advised that mechanisms to monitor the uptake, implementation and impact of such recommendations should be embedded in the set of temporary recommendations to States Parties that the Director-General may issue in relation to the event considered.
The Committee reiterated its concern regarding the evolution of the multi-faceted upsurge of mpox, including the many uncertainties surrounding it and the capacities in place to control the spread of mpox in States Parties experiencing the outbreaks, or in States Parties that may have to do so as a result of further international spread.
The Committee recognized the critical role of coordinated international cooperation in supporting States Parties efforts to control the spread of mpox in the WHO African Region including in facilitating access to and use of vaccines, therapeutics, and diagnostics; mobilizing financial resources for States Parties experiencing the upsurge of disease; and synergic initiatives by WHO and partners, including Africa CDC.
Nevertheless, the Committee indicated that the development of strategic approaches for States Parties to become more self-reliant in controlling the spread of mpox are warranted. To that effect, the Committee considers that the determination by the Director-General that the upsurge of mpox constitutes a PHEIC would stimulate States Parties facing the outbreaks to more effectively commit and employ domestic resources.
These temporary recommendations are issued to States Parties experiencing the upsurge of mpox, including, but not limited to, the Democratic Republic of the Congo and Burundi, Kenya, Rwanda, and Uganda.
They are intended to be implemented by those States Parties in addition to the current standing recommendations for mpox, which will be extended until 20 August 2025 and are presented at the end of this document for easy reference.
In the context of the global efforts to prevent and control the spread of mpox disease outlined in the WHO Strategic framework for enhancing prevention and control of mpox- 2024-2027, the aforementioned standing recommendations apply to all States Parties.
All current WHO interim technical guidance can be accessed on this page of the WHO website. WHO evidence-based guidance has been and will continue to be updated in line with the evolving situation, updated scientific evidence, and WHO risk assessment to support States Parties in the implementation of the WHO Strategic Framework for enhancing mpox prevention and control.
Pursuant to Article 3 Principle of the International Health Regulations (2005) (IHR), the implementation of these temporary recommendations, as well as of the standing recommendations for mpox, by States Parties shall be with full respect for the dignity, human rights and fundamental freedoms of persons, in line with the principles set out in Article 3 of the IHR.
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Emergency Coordination
Collaborative Surveillance and Laboratory Diagnostics
Safe and Scalable Clinical Care
International traffic
Vaccination
Risk communication and community engagement
Governance and financing
Addressing research gaps
Reporting on the implementation of temporary recommendations
A. States Parties are recommended to develop and implement national mpox plans that build on WHO strategic and technical guidance, outlining critical actions to sustain control of mpox and achieve elimination of human-to-human transmission in all contexts through coordinated and integrated policies, programmes and services. Actions are recommended to:
B. States Parties are recommended to, as a critical basis for actions outlined in A in support of the elimination goal, establish and sustain laboratory-based surveillance and diagnostic capacities to enhance outbreak detection and risk assessment. Actions are recommended to:
4. Include mpox as a notiable disease in the national epidemiological surveillance system.
5. Strengthen diagnostic capacity at all levels of the health care system for laboratory and point of care diagnostic conrmation of cases.
6. Ensure timely reporting of cases to WHO, as per WHO guidance and Case Reporting Form, in particular reporting of conrmed cases with a relevant recent history of international travel.
7. Collaborate with other countries so that genomic sequencing is available in, or accessible to, all countries. Share genetic sequence data and metadata through public databases.
8. Notify WHO about signicant mpox-related events through IHR channels.
C. States Parties are recommended to enhance community protection through building capacity for risk communication and community engagement, adapting public health and social measures to local contexts and continuing to strive for equity and build trust with communities through the following actions, particularly for those most at risk. Actions are recommended to:
9. Communicate risk, build awareness, engage with aected communities and at-risk groups through health authorities and civil society.
10. Implement interventions to prevent stigma and discrimination against any individuals or groups that may be aected by mpox.
D. States Parties are recommended to initiate, continue, support, and collaborate on research to generate evidence for mpox prevention and control, with a view to support elimination of human-to-human transmission of mpox. Actions are recommended to:
11. Contribute to addressing the global research agenda to generate and promptly disseminate evidence for key scientic, social, clinical, and public health aspects of mpox transmission, prevention and control.
12. Conduct clinical trials of medical countermeasures, including diagnostics, vaccines and therapeutics, in dierent populations, in addition to monitoring of their safety, eectiveness and duration of protection.
13. States Parties in West, Central and East Africa should make additional eorts to elucidate mpox-related risk, vulnerability and impact, including consideration of zoonotic, sexual, and other modes of transmission in dierent demographic groups.
E. States Parties are recommended to apply the following measures related to international travel. Actions are recommended to:
14. Encourage authorities, health care providers and community groups to provide travelers with relevant information to protect themselves and others before, during and after travel to events or gatherings where mpox may present a risk.
15. Advise individuals suspected or known to have mpox, or who may be a contact of a case, to adhere to measures to avoid exposing others, including in relation to international travel.
16. Refrain from implementing travel-related health measures specic for mpox, such as entry or exit screening, or requirements for testing or vaccination.
F. States Parties are encouraged to continue providing guidance and coordinating resources for delivery of optimally integrated clinical care for mpox, including access to specic treatment and supportive measures to protect health workers and caregivers as appropriate. States Parties are encouraged to take actions to:
17. Ensure provision of optimal clinical care with infection prevention and control measures in place for suspected and conrmed mpox in all clinical settings. Ensure training of health care providers accordingly and provide personal protective equipment.
18. Integrate mpox detection, prevention, care and research within HIV and sexually transmitted disease prevention and control programmes, and other health services as appropriate.
G. States Parties are encouraged to work towards ensuring equitable access to safe, eective and quality-assured countermeasures for mpox, including through resource mobilization mechanisms. States Parties are encouraged to take action to:
19. Strengthen provision of and access to diagnostics, genomic sequencing, vaccines, and therapeutics for the most aected communities, including in resource-constrained settings where mpox occurs regularly, and including for men who have sex with men and groups at risk of heterosexual transmission, with special attention to those most marginalized within those groups.
20. Make mpox vaccines available for primary prevention (pre-exposure) and post-exposure vaccination for persons and communities at risk of mpox, taking into account recommendations of the WHO Strategic Advisory Group of Experts on Immunization (SAGE).
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On 14 August, the World Health Organization (WHO) declared the simian smallpox epidemic, known as Mpox, to be an international health emergency following an outbreak of cases in Africa. The next day, a case was reported in Sweden.
Monkeypox is an infectious disease caused by a virus transmitted to humans by infected animals, but it can also be transmitted from human to human through close physical contact. Smallpox is characterized by a rash or skin lesions generally concentrated on the face, hands and feet.
In most cases, the disease heals spontaneously within two or three weeks.
Click here for complete information on symptoms and WHO advice in the event of transmission.
Africa is facing the spread of a new strain of the virus, detected in the Democratic Republic of Congo (DRC) in September 2023 and dubbed clade Ib, which is more deadly and transmissible than previous strains.
According to the WHO, more than 15,600 cases and 537 deaths have been reported since the beginning of the year in the DRC, already exceeding last years total. The mortality rate remains below 4%.
The DRC and other African countries have been experiencing Mpox outbreaks for over ten years.
In July 2022, WHO had already issued a global alert following an outbreak of cases. These alerts are used to coordinate responses and contain epidemics.
On 6 August, WHO urged countries to share tools such as vaccines and apply lessons learned from previous public health emergencies of international concern to address the current epidemic.
WHO encourages all countries to strengthen surveillance, share data and work to better understand the transmission of the virus.
There are two licensed and effective vaccines against Mpox.
Several studies have shown that vaccination against classic smallpox is 85% effective in preventing Mpox. Previous smallpox vaccination may result in less severe disease. However, the smallpox vaccine has not been administered since the disease was eradicated in 1980.
Its been a bad month for public health.
On August 14, the World Health Organization declared mpox as an international health emergency, given the unprecedented spread of a new, more deadly variant. In the United States, bird flu, formally known as H5N1, has spread to 10 agricultural workers in Colorado, an alarming development since only three other cases have been reported this year.
Mpox and bird flu are distinct infectious diseases; however, they have been united by assumptions that containment is easily achievable and thus a complacent public health response. Indeed, almost 100,000 people got infected with mpox after the 2022 outbreak, and while the disease shrinked away from public view, mpox continued to spread and evolve into deadlier variants. Similarly, while bird flu first jumped into mammals around the same time in 2022, the response in the U.S. was anemic with little consistent messaging or concrete action.
This is part of a larger inertia around infectious diseasesone we believe is driven by two key factors.
First, public health leaders have grown overly cautious after the COVID-19 pandemic, seeing how bold efforts to contain the pandemic were met with anti-science aggression, populist outrage, relentless lawsuits, and at least 30 states limiting public health powers. The impending U.S. elections have added to the polarization and disinformation. As such, instead of proactive action, we are seeing trepidation.
Second, there is a sense that another pandemic cannot happen so soon after COVID-19that these infectious diseases will inevitably burn themselves out like before. This is a gamblers fallacy, and because of it, the U.S. may be underestimating the risks posed by mpox and bird flu, allowing two potential pandemics to brew on the global stage.
This has manifested in several failures for both diseases. For instance, the U.S. saw 1800 mpox cases between October 2023 and April 2024, while the more dangerous Clade 1b variant, which combines efficient sexual transmission with high mortality, started to spread in Africa. However, the U.S. Centers for Disease Control and Prevention (CDC) stopped updating their mpox outbreak case count in January, downplaying this added threat since case counts were not yet increasing. The CDC restarted the public reporting in May, suggesting its discontinuation may have been overly expedient and optimistic.
Our mpox global health response mirrors such underestimation and delayed action. On August 7, the U.S. announced that it was donating 50,000 vaccines to the Democratic Republic of the Congo, almost a year after Clade 1b was first reported there. For reference, Africa CDC estimates it needs 10 million doses to control the current outbreak on the continent. In 2022, the U.S. failed to tackle mpox while it was confined to Africa, dragging its feet until the disease was spreading uncontrollably at home; we are seeing history repeat itself in 2024.
Read More: Health Experts are Watching a More Dangerous Version of Mpox
For bird flu, the mortality rate can be as high as 52%, given WHO case data. But as the New York Times noted, Only recently has the [CDC] begun to mobilize real funding for a testing push, after a period of months in which various federal groups batted around responsibility and ultimate authority like a hot potato. In the U.S., ignorance is bliss, with our public health leaders rolling the dice that this too shall pass.
So, perhaps we shouldnt be surprised that the U.S. Department of Agriculture (USDA) detected bird flu in cattle four months after it happened, or that the agency has not required routine testing of cattle (unless they cross state lines) nor vaccination of farmworkers. While decisions to leave these programs voluntary are multifactorial, they are likely influenced by political reticence after COVID-19 and recent Supreme Court rulings striking down vaccination requirements.
To be clear, the pandemic risk of mpox or bird flu is currently low. The transmission dynamics of mpox, requiring very close contact, make it more difficult to spread than SARS-CoV-2. Similarly, cases of bird flu have thus far been mild and limited in number. However, these are not absolute truths, but day-by-day assessments, which require real preparednessmeasured in testing, ongoing surveillance, and forward planning.
We have no easy answers for overcoming public health paralysis. But at minimum, the U.S. needs better public health communication that not only emphasizes transparency but also holds our leaders accountable. Bringing this COVID-19-era lesson to mpox and bird flu is one way to give Americans a new, positive memory of public health, fostering early, decisive action and realistic risk assessments.
With two rapidly evolving outbreaks, we cannot afford trepidation and false optimism. And, even as we work to make the U.S. safer, we cannot forget our global obligations to share vaccines, medicines, and resources. Global crises require global solidarity and collective action.
For the second time in three years, the WHO has declared an mpox outbreak a public health emergency of international concern.
Since news of the epidemic, the media has circulated images of patients infected with mpox. Some of these photographs show mpox on patients arms, legs, and hands, but others are headshots that resemble mugshots of African people with mpox covering their faces. The photos include an African patient somberly looking into a camera, a doctors hand pointing at vesicles on an African childs face, and a disturbing image of a child who has his hands raised, as if being held up by the police, revealing pustules on his face, hands, and chest. I am purposely not linking to them, because these images tend to pathologize, even criminalize, the patients.
Distributing images of mpox to medical professionals is necessary so they dont misdiagnose it as syphilis or herpes as they did when mpox first erupted in the U.S. in 2022. Ordinary Americans must be made aware of the outbreak and how it presents on the arms, hands, and other parts of the body. But the circulation of these mpox mugshots may reinforce stigma and do more harm than good.
Historical context is vital to understand mpox and to guide our response. The mpox outbreak in Africa has already triggered stereotypes about racial inferiority and endemic tropical disease. Because mpox looks like a deadly plague from the Middle Ages, far removed from our modern world, the growing media representations of Africans covered with unfamiliar pustules further stigmatizes the virus. Mpox looks like its cousin smallpox, but because smallpox was literally wiped off the planet in 1980, very few, if any, Americans have come in direct contact with a persons body covered in vesicles. Mpox, in other words, not only looks foreign but appears ancient which reinforces its stigma.
Certainly, Americans have seen some version of blisters forming on the body from chickenpox to herpes but these viruses dont present the same dramatic symptoms that plague the entire body like mpox or smallpox.
While mpox originated in Africa, we need to resist the implication it can only thrive there, which was how people in the past often explained the origin of epidemics.
Before people understood that invisible agents known as microbes spread infectious disease, they created fictional narratives to explain them. They pointed to concrete markers like the climate, landscape, and people in Africa and Asia as the cause of epidemics. When cholera infected waterways from Asia to Europe to the United States in 1832 and again in 1849, people couldnt see it traveling in the water, so instead they pointed to gray clouds that hung in the air or piles of trash to explain how it spread. They then blamed the epidemic on the poor and other dispossessed populations for creating such conditions.
When yellow fever threatened to invade London in 1845 from British ships arriving from Africa, medical and government authorities did not know that mosquitos were the culprit that caused this vector borne disease. Instead, they theorized that yellow fever originated among Africans and was spread by human contact and carried onto ships that sailed to London. In fact, Scottish doctor James Ormiston McWilliam, who conducted a massive epidemiological study of the yellow fever epidemic, took copious notes of the African peoples racial features, reinforcing the notion that that disease carriers needed to be visualized to be understood.
By distributing mpox mugshots, the media is unwittingly following in that pattern. Though they hope to educate the public, they are framing African people, often children, as the cause of the epidemic. Since Americans are not used to seeing visible manifestations of an epidemic, they risk stigmatizing it.
Even though we just went through a pandemic, that does not mean we know one when we see it. Covid has limited lessons for mpox. Covids major symptoms coughing, lack of breath, fatigue are not only invisible to the naked eye but resemble other respiratory infections. Perhaps the most recent outbreak that resembles mpox came during the early days of the HIV epidemic, when media stories were often illustrated with images of Kaposi sarcomas among some patients with full-blown AIDS. Then, too, alarming images of a marginalized group contributed to stigma.
Mpoxs visual manifestations can be helpful, since they propel people into action, but they also can seem like something out of a zombie movie or a science fiction novel. A perfectly healthy person begins to present mysterious symptoms of infection and then within few days some pustules begin to break through their skin. Within a week, their entire body has been invaded by the virus.
When mpox broke out in 2022, public health authorities sent images of the virus to clinics and hospitals to avoid it from being misdiagnosed as either herpes or syphilis. These clinical images did not include facial shots unlike the current representations of African people. Meanwhile, gay men began recognizing that it was spreading primarily in their community. They took photos of the pustules on their bodies and posted them on social media to show how it was transmitted because of sexual contact.
The images were not mpox mugshots but carefully curated photos of how the virus presented on various parts of the body accompanied with captions that provided clinical insight. Seeing these posts propelled tens of thousands of gay men to immediately sign up at city centers and to wait in long lines to get vaccinated, creating one of the most energized vaccination campaigns of the last century. Unlike polio or diphtheria vaccination efforts in the 20th century, which required public health authorities to go door to door to ensure all children were vaccinated, the mere appearance of mpox on gay mens social media timelines propelled them to take immediate action.
We need a similar campaign in the U.S. to inform Americans about mpox. We dont need to circulate mpox mugshots of African children or even adults. We can continue to see images of mpox on arms, hands, and other parts of the body but we dont need to see them presented on the face. If it is necessary to show the face, the media should block out images of the eyes or any other recognizable features. That will help readers train their eyes to see mpox without stigmatizing it as a foreign, even ancient disease.
Jim Downs is the author of Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine (Harvard University Press, 2021) and is the Gilder Lehrman-NEH professor of history at Gettysburg College.
Just one day after the World Health Organization (WHO) declared the highest level of alert for mpox outbreaks in African countries for the second time in two years, the first case in Europe was also reported.
The infected individual is said to have contracted the virus while staying in an African region experiencing a significant outbreak of the disease, according to the Director-General of the Swedish Health Agency during a press conference on Thursday.
These recent developments have led to an increase in discussions on social media, with a noticeable rise in claims about the viral disease many of which are untrue.
Claim:"What they are selling us as MONKEYPOX is, in most cases, actually herpes zoster; one of the most common side effects of the COVID 'vaccine'",wrote this X-user on August 14, 2024, quoting the German doctor and politician Wolfgang Wodarg. The post has already been viewed 2 million times.
DW fact check: False
The claim originates from a video interview with Wolfgang Wodarg , a physician and former Social Democrat (SPD)member of the German Bundestag, who later became a leading candidate for the small party dieBasis (the base), which was founded in the context of protests against COVID-19 measures. The video was released in 2022 by the controversial Austrian broadcaster AUF1.
What the user claims in the accompanying text of the post has also been shared by others: Example 1 (Portuguese, 178K views),Example 2 (Spanish, 498.5K views), Example 3 (Spanish, 117K views).
Most of the posts we found on this topic were in Spanish and Portuguese. According to a study by Loyola University Andalusia , which analyzed the period from May 7 to September 10, 2022, the narrative that mpox is a side effect of COVID-19 vaccines was shared more frequently than any other false claim about mpox.
When asked if there is a connection between the COVID-19 vaccine and the mpox outbreak, microbiologist and immunologist Kari Moore Debbink from the Johns Hopkins Bloomberg School of Public Health in the US said in a DW interview: "The COVID mRNA vaccines were used globally, while mpox cases are typically found in specific countries in Africa, with some low case numbers outside of those regions. Therefore, there is no geographic link between COVID mRNA vaccine use and mpox cases."
William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center in Nashville, US, shares this opinion: "These are two completely different viruses, and of course, the vaccine against COVID has nothing to do with mpox."
We have already thoroughly debunked theclaim that the AstraZeneca COVID vaccine contains weakened viruses from chimpanzees as carriers for the DNA of the coronavirus spike protein in a previous fact-check.
The viral X-post also claims thatmpox isactually herpes zoster, also known as shingles, in most cases.
According to a 2022 study published in the Journal of the European Academy of Dermatology and Venereology , the varicella-zoster virus (VZV), which causes herpes zoster and chickenpox,can be reactivated through vaccinations. The study also shows that individuals vaccinated with various COVID-19 vaccines have an increased risk of herpes zoster outbreaks.
However, there is no connection between the mpox pathogen and VZV, says Kari Moore Debbink: "Mpox and herpes zoster are in different virus groups, so testing is easily able to discern between the two viruses. While both viruses can cause similar symptoms including rashes, fever, swollen lymph nodes, and malaise, there are also distinct characteristics of the rashes caused by each virus making it possible to tell them apart by sight and symptoms."
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Mpox is much less contagious than COVID-19. While the mpox pathogen is transmitted through close physical skin-to-skin contact or contact with contaminated materials (towels, beddingand clothing), the coronavirus is extremely contagious and can be spread through tiny droplets in the air from breathing, speaking, sneezingor coughing. COVID-19 canbe transmitted by others who have the virus, even if they have no symptoms. The California Department of Public Health has listed additional differences between coronaviruses and mpox viruses on its website.
The massive misinformation surrounding vaccinesin generalis a cause ofconcern for medical professionals.
"The misinformation that is being spread about all vaccines, about theCOVID-19 vaccine, and now mpox also just results in a great deal of confusion and mistrust in public health authorities.Thatmakes it much more difficult for countries and their ministries of public health to try to provide the best information and to help people. So, all of thisconfusion makes good intentions much more difficult," says Schaffner.
How to protect yourself from health-related misinformation and which questions can help areillustrated in this DW infographic:
This article was originally written in German.
