Mpox (formerly known as monkeypox) is back in the news. As of early September, the World Health Organization reported more than 5,000 laboratory-confirmed cases this year. Given the well-documented shortcomings of mpox surveillanceThese figures underestimate the true magnitude of the disease burden.
He The highest number of cases is recorded in the Democratic Republic of the Congo, and the current outbreak has spread to several other countries in Africa. The first case outside that continent Appeared in Swedenin a patient who returned from Africa; it is only a matter of time before a case appears in the United States, although the scope of a possible outbreak in that country is uncertain.
To combat the spread of the human immunodeficiency virus (MPOX), the Africa Centers for Disease Control and Prevention and the World Health Organization have declared a public health emergency. How the world and the United States of America respond to this latest outbreak will test whether we are better prepared to deal with global public health emergencies since the COVID-19 pandemic.
The current surge, driven primarily by a new strain of the virus, clade I, is different from the mpox surge of 2022, which was successfully controlled by the US and other countries. Unlike 2022, More than half of the reported cases and most of the deathshave occurred in children younger than 5 years old. During the previous outbreak, the virus spread primarily through sexual contact between men who have sex with men, while evidence shows that the current outbreak is spreading through heterosexual, nonsexual contact. In the US, the 2022 outbreak was contained by health authorities working with groups that included men who have sex with men to increase vaccine uptake and reduce the risk of transmission; this year's outbreak requires a broader approach.
For now, in the United States, waiting for clade I cases to be detected before acting will be too late. The best way to control an outbreak is to prevent it.
There are some steps that can help us prepare. Ensuring an adequate supply of vaccines should be the top priority. Danish vaccine manufacturer Bavarian Nordic is one of the few companies in the world with a mpox vaccine approvedPrior to the 2022 outbreak, it did not have a large inventory of mpox vaccines and doses were produced on demand, which delayed its availability in 2022 and hampered outbreak control in the initial days.
Since then, the company has maintained an inventory of mpox vaccine doses. More than 250,000 doses have been shipped to the Democratic Republic of Congo and the company indicated it could produce additional doses. 2 million by the end of the year. However, the precise timing of availability of these doses is uncertain, and the 2 million would cover only a fraction of the doses needed to vaccinate According to estimates by the Africa CDC, an estimated 10 million people are expected to die in the coming months. Meanwhile, rich countries, including the US and Canada, They have donated or pledged modest amounts of vaccines and have additional stockpiles that could provide some emergency donationsProviding adequate vaccines to Africa will be essential to control the outbreak and prevent wider spread.
Another urgent need is to evaluate the efficacy of the mpox vaccine against the new strain. Previous evaluations have focused primarily on efficacy against clade II. While it is reasonable to use the current vaccine as it is the best available tool to protect against mpox, a more accurate estimate of its efficacy against clade I will help ensure that the optimal number of doses and the appropriate vaccination schedule are used.
Modest investments in the early stages of outbreaks can prevent the much higher financial costs associated with widespread epidemics. If high-income countries fail to secure the financial resources needed to fight this disease now from the World Health Organization and the Africa Centre for Disease Control and Prevention, a much more costly outbreak could occur within months.
Rapidly spreading outbreaks also tend to increase the spread of misinformation. In the past, public health agencies would ramp up their communication efforts only after rumors began to spread. Evidence from behavioral science supports preemptive “inoculation” of the public against misinformation, such as what we’ve seen with respect to the COVID vaccine.
There is a window of time to mount an effective national and global response to control the pandemic and avoid past mistakes. If we fail to respond within that window, we could have déjà vu of our imperfect response to COVID, when delays in getting ahead of outbreaks caused so much unnecessary suffering.
Saad B. Omer is an epidemiologist and vaccine expert.
