Global Call to Action: Renewed Efforts Needed to Combat Resurgent Monkeypox Outbreak

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Global Call to Action: Renewed Efforts Needed to Combat Resurgent Monkeypox Outbreak

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Global Call to Action: Renewed Efforts Needed to Combat Resurgent Monkeypox Outbreak

Monkeypox Virus Continues to Spread Among Humans, Requiring Global Cooperation.

On August 14, 2024, the World Health Organization (WHO) once again declared the monkeypox outbreak a “Public Health Emergency of International Concern” (PHEIC) due to a sharp rise in infections and fatalities. A recent editorial in *The Lancet* emphasized that this declaration is intended to mobilize international efforts, drawing political attention, encouraging action, and securing financial support to curb the spread of the disease and ultimately end the outbreak. The global community now bears the responsibility to unite and confront this challenge together.

On May 11, 2023, the WHO had previously lifted the PHEIC designation for the 2022-2023 monkeypox outbreak. However, the resurgence of infections and deaths prompted the renewed PHEIC status on August 14, 2024. Just a day earlier, on August 13, the Africa Centres for Disease Control and Prevention (Africa CDC) issued a similar statement, marking its first declaration of a health emergency affecting the continent since gaining new responsibilities in late 2022.

These concerns are not unfounded. Since September 2023, cases of monkeypox caused by the “clade 1b” strain have surged.

This strain is genetically distinct from the one responsible for the 2022-2023 global outbreak and has a higher reported fatality rate—up to 10%, though studies suggest that with proper care, it could be reduced to less than 2%.

The virus is spreading among humans, with children under 15 in the Democratic Republic of the Congo (DRC) being the most affected group. Cases among adults over 40 remain rare, likely due to residual immunity from smallpox vaccinations administered in the 1960s and 1970s.

To date, over 16,000 cases and 500 deaths have been reported in the DRC in 2024, though many mild cases—still capable of spreading the virus—may go undetected. Other affected countries include the Central African Republic, Rwanda, Burundi, Uganda, and Kenya.

As of the upcoming issue of *The Lancet* (August 17), Sweden and Pakistan have also reported imported cases. More countries are expected to report cases soon.

In response to the re-declaration of monkeypox as a PHEIC, immediate priorities include supporting healthcare infrastructure, training healthcare workers, enhancing genomic and epidemiological surveillance, conducting clinical trials for emergency medical products, and monitoring animal hosts. Policies must involve communities and vulnerable populations in disease monitoring, contact tracing, prevention, and treatment. Additionally, addressing the stigma associated with the disease is critical, particularly among LGBTQ+ communities, who may avoid seeking help due to fear of criminal prosecution. It is essential to prevent the spread of misinformation. Collaborative research and scientific responses are crucial, and significant funding is urgently needed to improve epidemiological studies of monkeypox, strengthen diagnostic capabilities, and prepare vaccination plans. Unfortunately, previous PHEIC declarations have often failed to prompt the necessary global response.

After the last monkeypox PHEIC ended, the WHO called for long-term monitoring and control plans. Public health experts and virologists warn that we still know very little about the epidemiology of monkeypox. There has been little progress in expanding vaccine production, improving diagnostic tools, or investing in clinical trials for vaccines and antiviral drugs. Since the end of the last PHEIC, international attention to monkeypox has waned. Available diagnostic methods are scarce, and the antiviral drug tecovirimat was found ineffective against the “clade 1b” strain in a clinical trial. The supply of monkeypox vaccines is also limited. Although the European Union and the United States have pledged to donate vaccines, it appears that a few high-income countries have monopolized the supply, disadvantaging the nations most in need. As with COVID-19, we are witnessing another inequitable vaccine race, with public health suffering due to the lack of a binding, fair global pandemic agreement.

Equity in response measures is essential, including policies and funding to ensure that affected and vulnerable groups have access to vaccines and treatments. We have ample guidance for pandemic preparedness, and the lessons learned from COVID-19 highlight the importance of early and decisive action. The first 100 days are critical for implementing scalable disease management and containment strategies. However, equity must extend beyond vaccines and emergency medical products; attention and response efforts must also be fair. The rise in monkeypox cases and changes in its nature are not just problems for the countries where cases are emerging or for Africa alone. These are global threats to human health, requiring the coordinated attention and response of leaders worldwide. This is the core message of the latest PHEIC declaration. Now, the international community must step up, unite, and face this challenge together.

Global Call to Action: Renewed Efforts Needed to Combat Resurgent Monkeypox Outbreak

References:

[1]. Comment Lancet 2024; 404:

[2]. For more on the genomics of the virus see Nat Med 2024; published online June 13.

[3]. For more on the case fatality rate

[4]. For more on cases by age group

[5]. For more on supply of vaccines

[6].  World Report Lancet 2024; 404: 18 

[7]. For more on the 100 Days Mission

Related articles

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01260-1/abstract

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00287-1/fulltext

(source:internet, reference only)

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