The Africa Centres for Disease Control and Prevention (Africa CDC) just declared mpox a Public Health Emergency of Continental Security (PHECS), a first in the agency’s history. The announcement comes as suspected cases of the disease across the continent in 2024 have risen past 17,000, a massive increase on the 2022 and 2023 figures.

Mpox – previously known as monkeypox before it was renamed – is a zoonotic infectious disease caused by the monkeypox virus (MPXV). The virus is a member of the Poxviridae family, which also includes the agents responsible for cowpox and smallpox. It was first discovered in 1958 in captive monkeys at a research facility in Denmark, and the first human case was reported in the Democratic Republic of the Congo (DRC) in 1970.

As with other poxviruses, mpox infection causes a rash that progresses into blisters that can be itchy or painful. The sores can appear anywhere on the body, and a person remains infectious until all the blisters are healed.

Symptoms such as fever, muscle pains, and a sore throat typically appear before the rash, and the disease typically lasts for about a month. During that time, patients can experience serious complications that may even be fatal, such as secondary bacterial infections, pneumonia, and sepsis. While most people will recover, people with compromised immune systems or with HIV that is not under control are at greater risk of severe illness.

Mpox burst onto the international stage in 2022 when a strain of the virus began to spread around the world, leading to local and global declarations of a public health emergency. However, experts remained concerned that another strain of the virus – which has been responsible for regular outbreaks in the DRC for several decades – might also get a foothold in other countries, with potentially more lethal consequences.

The first mpox public health emergency officially ended in July 2023. We do have a vaccine against the disease, which can be given as a preventative or post-exposure prophylaxis, as well as some antiviral drugs that were originally developed to treat smallpox. The most recent guidance in the US suggests that people who are deemed at higher risk of infection, primarily through sexual contact, get two doses of the vaccine.

But just because a vaccine exists, it doesn’t mean it is always available where it is most needed.

In a statement, Africa CDC highlighted the fact that during the response to the global mpox outbreak, African nations were neglected. “We urge our international partners to seize this moment to act differently and collaborate closely with Africa CDC to provide the necessary support to our Member States,” said Director General Dr Jean Kaseya.

This year, 13 African nations – including ones that had previously not been affected by the disease, like Burundi and Rwanda – have reported mpox outbreaks. There have been 2,863 confirmed cases and 517 deaths, mostly in the DRC, although suspected cases have soared above 17,000. For context, in 2023, there were 14,957 cases, and 7,146 in 2022. Many cases have been put down to the more lethal strain that has, until now, mostly been confined to small outbreaks in Central Africa.

Africa CDC points to infrastructure issues affecting lab testing and surveillance, meaning that the confirmed cases are likely “just the tip of the iceberg”. Combined with the at-best patchy availability of vaccines and treatments, it’s a concerning picture.

“The number of cases has significantly increased compared to 2022 when WHO [the World Health Organization] declared Mpox a public health emergency. It’s clear that we’re facing a different scenario with far more cases, resulting in a higher burden of illness,” said Professor Salim Abdool Karim, head of a South Africa-based AIDS research program called CAPRISA.

“Our concern is that we may be seeing more fatalities in Africa due to the association with HIV.”

The fact that mpox is now spreading across borders to new nations is another major cause for concern. Africa CDC has set up an Incident Management Team to coordinate the ongoing response and has secured a partnership with European authorities that should see 215,000 doses of the vaccine arriving on the continent.

Meanwhile, the WHO says it too is working to increase vaccine availability in Africa. An emergency meeting has been convened today to discuss the ongoing outbreaks – it remains to be seen whether mpox will once again be declared a global public health emergency.