[link to previous work]The new international spread of mpox clade I is spurring concerns that a deadlier mpox pandemic might be on the horizon and has triggered the Africa Centres for Disease Control and Prevention and the World Health Organization to designate the ongoing mpox outbreaks as health emergencies.

Africa CDC is the public health agency of the African Union, which represents 55 African states.

It is the first time the agency has designated any outbreak a continental emergency.

Other African countries are also facing resurgent mpox outbreaks caused by the clade II virus.

In May, there were a total of 567 mpox cases documented across all African countries, a 22 percent increase from the previous month.

'We declare today this public health emergency of continental security to mobilize our institutions, our collective will, and our resources to act swiftly and decisively,' said Africa CDC Director General Jean Kaseya in a press briefing Tuesday.

Outbreak response efforts in the DRC and other African countries have once again been hamstrung by the same challenges health officials faced during previous outbreaks and pandemics: a lack of global solidarity and an unwillingness to share life-saving resources.

While vaccine doses were rapidly disseminated in the US and Europe in 2022, vaccines are only now starting to trickle into the DRC.

But even so, only a couple hundred thousand vaccines will be available for a population of more than 90 million people.

Slowly, national governments and multinational organizations such as the African Union are working to build domestic public health infrastructure and technical capacity and to reduce dependency on donor countries.

While Africa CDC’s unprecedented move to designate the mpox outbreaks a regional health emergency signals a continuation of these efforts, it is unclear if the designation will help spur the rapid influx of resources needed to respond to the mpox outbreaks.

Mpox was first discovered in 1958 in a colony of monkeys in a research facility in Denmark, and the first case of mpox in a human—a nine-month-old infant—was not documented until 1970 in the Democratic Republic of the Congo.

Researchers and physicians could not determine exactly how the infant became infected; however, close contact with an infected monkey may have caused the infection.

Small rodents, monkeys, and other mammals can transmit the virus to humans, but outbreaks typically take off when humans infect each other.

In 2005, additional mpox cases in humans were recorded in the DRC, and thousands of suspected cases have been reported every year since then.

Since 2017, mpox has also caused frequent infections in Nigeria.

Although mpox has been around for a long time, there are still many unknowns about how the virus spreads and why it suddenly spread around the world in 2022.

What researchers do know is that the virus has been rapidly mutating in recent years.

Interestingly and maybe worryingly, while most genetic mutations have no effect at all, some can cause viruses to become deadlier or more effective at spreading.

When geneticists compared the 2022 mpox genome to a sample collected in 2017, they found some genetic changes had occurred.

Some researchers have hypothesized that these mutations have improved how easily the virus can spread from person to person, but there is no firm evidence yet.

In September 2023, an entirely new mpox clade I variant, tentatively called clade IB, was identified in the DRC.

The World Health Organization has not confirmed if the new variant causes more severe disease or can be spread more easily.

Rosamund Lewis, the mpox technical lead at the World Health Organization, posits that genetic mutations are not behind the sudden global surge of mpox.

Instead, she suggests that the virus happened to start infecting new populations—sex workers and men who have sex with men—and that has in turn fueled wider transmission.

Mpox is reminiscent of the origins of HIV, which infected humans in southwestern Cameroon before taking hold in the booming urban center—and among the large sex worker population—of Kinshasa, the capital of the DRC.

Sexual transmission among adults may only be one of the main drivers of mpox transmission.

In the DRC, some of the mpox cases recorded this year were among children who were likely exposed through close contact with infected animals or household members who were infected.

One of the biggest risk factors for severe mpox infection and death is preexisting HIV.

Unfortunately, about 25 million people in Africa have HIV, more than any other region in the world, meaning many African nations may experience deadlier outbreaks than other parts of the world.

The dual burden of mpox and HIV was also a major factor that prompted the Africa CDC to declare the mpox outbreaks a continental emergency, Kaseya explained.

There are at least two vaccines—Jynneos, also called Imvanex in Europe, which is made by Danish company Bavarian Nordic, and LC16, which is manufactured by Japanese company KM Biologics—that are effective against mpox.

The US Food and Drug Administration approved the Jynneos vaccine for use against smallpox and mpox in 2019.

LC16 was developed for smallpox but is also effective against mpox.

When the US and Europe started recording mpox cases in 2022, health officials quickly disseminated millions of doses of existing vaccines.

For the first two years of the pandemic, however, no vaccines were available in the DRC.

The DRC, like most countries in Africa, lacks the infrastructure to produce its own vaccines nor can it afford to pay for millions of doses.

(The mpox vaccine costs just under $100 per dose, according to Kaseya; GDP per capita in the DRC is about $500.

) Thus, these countries must rely on donations from the US, Europe, and other countries.

Following the Covid-19 pandemic, the Africa CDC started leading efforts to fill this crucial gap, but progress has been slow.

In the void, officials in the Democratic Republic of the Congo and other African countries have been carrying on their outbreak responses without vaccines.

It wasn’t until last month that the first shipments of mpox vaccines started arriving in the DRC.

But the country received only 200,000 doses, according to Lewis, forcing