GENEVA – Outbreaks of mpox in Central Africa can be stopped, the World Health Organisation (WHO) said on Monday, but US$135 million may be needed to stop the disease from spreading. 

Earlier this month, WHO declared an international health emergency after a surge in cases linked to a new mpox strain in the Democratic Republic of Congo (DRC), which has since spread beyond its borders. 

“The mpox outbreaks in DRC and neighbouring countries can be controlled, and can be stopped… But, doing so requires a comprehensive and coordinated plan of action,” WHO chief Tedros Adhanom Ghebreyesus said in a media statement. 

Launched on Monday, the WHO Strategic Preparedness and Response Plan covers the period from September 2024 to February 2025, predicting a US$135 million need to carry it out. WHO will soon launch an appeal to finance the global response, which would be carried out with partners including the African Union’s public health watchdog. In the meantime, the organisation has released around US$1.5 million from its emergency reserve fund. 

Funding

On Tuesday WHO said it needed US$87.4 million, from September to February, to implement its plans to contain the mpox outbreak. Meanwhile, the UN refugee agency has warned that displacement camps in the DRC and other impacted countries in Africa could be severely affected. 

“Without additional, urgent support, the recently declared mpox outbreak could become devastating for refugees and displaced communities,” said UNHCR public health chief Allen Maina. 

He said implementing mpox prevention measures among those fleeing violence was a “tremendous challenge”, with people being driven into overcrowded shelters with poor sanitation, while others were cut off from humanitarian assistance.

Transmission

On Tuesday WHO said droplets were a minor route of transmission for mpox compared to physical contact, adding that more research was needed to understand how the outbreak is spreading. The health organisation declared an international emergency on mpox on 14 August, concerned by the surge in cases of the Clade 1b strain in the DRC and its spread to nearby countries. The UN health agency says on its website mpox spreads between people mainly through close physical contact with someone who has the virus. 

“Close contact includes skin-to-skin (such as touching or sex) and mouth-to-mouth, or mouth-to-skin contact (such as kissing). It can also include being face-to-face with someone who has mpox (such as talking or breathing close to one another, which can generate infectious respiratory particles),” said the organisation. 

WHO spokeswoman Margaret Harris explained what happens when a person with the virus has lesions.

“If you’re talking closely to someone, breathing on them, physically close, face-to-face, there is a possibility of viral spread, but this is a minor source. Instead, what we are seeing is the close, physical skin-to-skin contact as the chief route of transmission. When you’re talking to somebody, you’re spitting out droplets, but it’s not a very major form of transmission and it’s not a through-the-air, long-distance sort of transmission. More research is needed to fully understand the transmission dynamics,” she told a briefing in Geneva on Tuesday. 

WHO recommends the use of facemasks for those with mpox, their close contacts, and health workers treating them. 

There are two subtypes of mpox: Clade 1, endemic in the Congo Basin in central Africa; and Clade 2, endemic in West Africa. The surge in the DRC cases is being driven by surges of two different Clade 1 strains. The first is an outbreak in northwest DRC of what was previously known as Clade 1, now called Clade 1a. 

The second, in northeastern DRC, is a new offshoot of Clade 1 called Clade 1b, which was first detected in September last year, and is spreading rapidly. The spread of Clade 1b, and its detection in nearby countries, were the main reasons behind the WHO sounding its top emergency alarm. 

Clade 1 mpox is known to be more virulent than Clade 2 mpox and has a higher fatality rate. As for whether Clade 1b is more dangerous than Clade 1a: “We don’t have that data. Studies are underway to understand the properties of the new strain. But available epidemiological data doesn’t really suggest that the clade 1b variant causes more severe cases and deaths,” Harris said.

Formerly known as monkeypox, mpox is an infectious disease caused by a virus transmitted to humans by infected animals that can also be passed from human to human through close physical contact. 

It causes fever, muscle pains and skin lesions, and in an increasing number of cases, death. The resurgence of the disease and the detection in the DRC of a new strain, dubbed Clade 1b, prompted WHO to declare its highest international alert level on 14 August. 

It had previously declared an emergency over the international spread of the Clade 2b strain of mpox, which mostly affected men who have sex with men. That alarm was lifted in May 2023. At the strategic plan’s presentation to WHO member states on Friday, Tedros said more than 100 000 confirmed cases had been reported since the outbreak in 2022. 

The DRC has been worst-hit with 90% of reported mpox cases in 2024, with more than 16 000 suspected cases – including 575 deaths this year alone. -Nampa/AFP