What Africa needs to do in response to the outbreak of clade 1b MPXV

By guest contributor Misaki Wayengera

Once again, Africa is faced with a regional emergency driven by an infectious agent, reminding us of the Ebola crisis in West Africa that assailed the period between 2013-2016, when over 11,000 lives were lost to Ebola disease and countries’ economies were brought to their knees.

Only this time it’s happening in the Great Lakes region of East Africa. An outbreak of MPOX disease that started in Kamituga area, South Kivu has rapidly grown to engulf all its neighbors, namely Burundi, Rwanda, Uganda and Kenya. Yet the spread beyond these countries seems eminent and unstoppable, with Gabon recently reporting its first case in Gabonese citizen who had traveled to Uganda. Given the long incubation period of mpox, it is likely that – like an iceberg – a lot more is buried under the sea than we able to see on the surface. The long incubation period gives the disease a stealth entry into the community, until cases suddenly start showing symptoms. The early indications that the clade 1b lineage evades capture by existing tests developed to target orthopoxyviruses, has not helped. Another challenge is the absence of approved point-of-care rapid diagnostic tests (POC-RDTs) to deploy in remote settings like Kamituga.

So, what should Africa do?

There is a lot that Africa needs to do to mitigate the negative impact of the clade 1b MPXV outbreak in East and Central Africa.

1.Strategic leadership:

The Africa CDC, by organizing the regional mpox meeting in April 2024 and declaring a public health emergency of continental security just a few days ahead of the WHO’s declaration of a PHEIC, has provided the needed leadership that was absent during the earlier days of the 2013-2016 outbreak of Ebola Virus Disease (EVD) in West Africa. African governments and people must therefore follow heed to Africa CDC’s strategic leadership and guidance. In compliance to the IHR-2015/2024, affected African nations should implement mechanisms to enable the detection and sharing of information, about on-going transmission. The WHO issued seven expectations, starting with the need to develop national strategic plans.

2. Operational research:

Affected African countries need to be supported by the global community to validate the utility of the existing medical countermeasures against mpox, (most of which were originally developed for other orthopoxviruses like smallpox or earlier lineages of mpox, that are different from the latest, heavily mutated clade 1b lineage). Already, we have seen affected African countries doing well with monitoring and reporting the genomic epidemiology of the isolates involved.

It is also important, especially in light of the recent interim reports of the inability of tecovirimat to provide benefit in context of clade 1b, to appreciate that even the other existing countermeasures like vaccines might not work as expected. Therefore, any roll out of MCMs inclusive of vaccines should be backed with research to evaluate their real-world effectiveness.

3. Discovery research:

The COVID-19 pandemic, with its associated breakdown of global supply chains, taught Africa how to innovate around its problems in isolation. Therefore, while Africa was spared of the predicted worse-case scenarios, COVID-19 forced many African countries to muscle up their home-grown capabilities, to make facemasks, PPE, sanitizers etc. Efforts were also launched to bring an mRNA hub to Africa, and invest in regional manufacturing of vaccines. Similar efforts are needed to manufacture diagnostics and medicines on the continent, following the COVID-19 experience.

4. Accountability:

While global partnerships and solidarity are essential, Africa should also work on accountability. The leaders of Africa must show greater leadership and accountability, and ensure that the bad practices of corruption, nepotism, and lack of transparency are rooted out. That also means that, If and when an effective intervention becomes available, it goes first to those at the highest risk, before it trickles to those at lower risk profiles. These evidence-based principles of prioritizing access according to risk, are what is needed to nip the epidemic in the bud.

5. Community-centered interventions:

Lastly, it is important to appreciate that mpox is ultimately a community disease that will, in absence of sufficient counter measures, spread until herd immunity is attained, or the virus burns itself out by mutating into lesser virulent forms. Therefore, the most urgent thing to do is to educate and equip communities with necessary information regarding the prevention and control to titrate the rates at which cases emerge and to protect the already weak health systems of many African countries.

Equally, the worst-case scenario must be anticipated and strategies for home isolation of cases contemplated. Targeted messaging to interrupt transmission and spread, especially from those deemed at high risk such as truck drivers and their sexual contacts, and travelers from areas with established community transmission. We also need to mitigate the negative psycho-social and physical impact of mpox among children under 15yrs, particularly since many do not rationalize or even appreciate infection control measures like hand washing. Moreover, crowded school settings increase the risk of transmission in this age group, through shared inanimate, amenities like toilets, water taps, door handles etc. While the 4.2% case fatality ratio for clade 1b mpox disease might seem small, its much higher than was for COVID-19, particularly considering that much of COVID-19 (>85%) was asymptomatic.

Conclusion

In conclusion, I think that rather than just raise an alarm, Africa needs to reach deep in itself to harness whatever possible potential there is to face the mpox epidemic. Even as the rest of the world comes to our aid, we must first help ourselves.  

About the author:

Dr Wayengera is assistant professor of human and pathogen genetics & genomics at Makerere University. He is currently chair of the Uganda Ministry of Health Ministerial Scientific Advisory Committee on Epidemics. Twitter: @MWayengera

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.