By Magda Robalo

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The current multicountry Mpox outbreak started in January 2022. It has now been declared a Public Health Emergency of Continental Security (Phecs) by the Africa CDC and, for the second time, a Public Health Emergency of International Concern (Pheic) by WHO, under the International Health Regulations (2005) highlighting critical deficiencies in the global public health response.

Endemic to West and Central Africa, the first human case of Mpox was detected in 1970 in the Democratic Republic of Congo (DRC). Nigeria experienced a large outbreak in 2017 and 2018. Only sporadic cases occurred outside endemic areas before 2022.

According to the World Health Organisation, most people suffering Mpox recover within two to four weeks. The disease is transmitted through close, personal, skin-to-skin contact with someone who has Mpox, contaminated materials, or with infected animals. Transmission could also occur during pregnancy or childbirth and among people with multiple sexual partners, who represent a high-risk population. 

Despite early warnings, failures in implementing robust surveillance, contact tracing, and containment strategies have allowed the virus to spread across at least 120 countries. In the DRC, where the outbreak has been particularly severe, two distinct outbreaks are evolving, caused by clade Ia and the newly emerged clade Ib.

Read: New Mpox strain is changing fast, scientists say

Increasingly, and rightly so, voices are coalescing to demand an urgent, coordinated international action and global solidarity toward an equity-driven, focused response to curb the virus's spread and mitigate its impact.

Loud calls for equitable vaccine distribution are being heard, a reminiscence of the Covid-19 dramatic experience. But vaccines are only one complementary tool in the box of interventions against the outbreak. Two fundamental questions we should be asking are: whether we have done enough to prevent the outbreak from becoming Pheic and Phecs, and if we are doing all we can to contain it, beyond placing our hopes on the still scarce doses of vaccine.

The Mpox outbreak underscores the urgent need for a comprehensive, equity-driven pandemic treaty, to coordinate global efforts to improve pandemic prevention, preparedness and response. The potential impact of this treaty is substantial, promising to address critical areas such as public health infrastructure, equitable access to treatment, vaccines and other supplies, and enhanced international cooperation during health emergencies.

The spread of Mpox across multiple continents in the aftermath of the Covid-19 pandemic confirms the persistence of significant vulnerabilities in national and global health systems, particularly in surveillance and rapid response—areas a well-crafted treaty could strengthen.

A united voice from Africa is critical to the negotiations. Without systemic changes, the world risks repeating the mistakes of Covid-19 and the ongoing Mpox outbreak in future outbreaks. Global health security depends on timely action, transparent communication, and a commitment to protecting all populations, regardless of geographic or socioeconomic status. It depends on strong health systems, based on a primary health care strategy and underpinned by the principles of universal health coverage.

There is no doubt that the world is facing an emerging threat. The scientific community is confronted with knowledge gaps in relation to Mpox. Several unknowns persist on the real pace of the evolving outbreak, its modes of and transmission dynamics, evolutionary routes and the human-to-human transmission chains. It is uncertain if we are moving toward a sustained human-to-human transmission and its potential scale and impact.

However, despite the fragility of health systems in most of its countries, Africa has decades of vast, diverse, cumulated experience in dealing with major epidemics, such as HIV/Aids, Ebola and most recently Covid-19, in addition to the decades of surveillance for polio eradication and containment of outbreaks.

In recent decades, African countries have improved their human, technical and infrastructural capacities and capabilities to detect, diagnose, and respond to outbreaks and large epidemics. Expertise and skills have been built in disease surveillance, infection prevention and control, diagnosis, epidemiological data management, including pathogen genomic sequencing.

Communities have developed systems to fight stigma and discrimination, built resilience and capacity to respond to and address their unique challenges, including poor access to information, education, communication tools, as well as to treatment and prevention interventions.

Admittedly, the response to this outbreak continues to expose significant flaws, particularly inconsistent and inadequate surveillance and monitoring systems to track the spread of the virus, contact tracing, and infection prevention measures (isolation, handwashing, use of masks and condoms, etc).

Many countries still lack the necessary infrastructure or have relaxed these measures, leading to delayed detection and widespread transmission. Moreover, a reluctance to deploy aggressive contact tracing and isolation protocols, partly due to concerns about stigmatisation, resulted in missed opportunities for early containment.

While negotiating for potential vaccine doses to protect high-risk populations, countries should invest in and deploy what they have learned and now know how to do best, based on the lessons from polio, HIV/Aids, Ebola and Covid-19. It is imperative that we contain the Mpox outbreak before it is too late. It is time to put our best foot forward. We have no reasons for helplessness and hopelessness.