The World Health Organization (WHO) is considering issuing a Public Health Emergency of International Concern (PHEIC) in response to the rapidly escalating mpox outbreak in central Africa. The WHO’s emergency committee is set to meet on Wednesday to deliberate on the decision.
If declared, this would mark the eighth PHEIC issued by the WHO. The most recent declaration, in May 2022, was also for mpox, but that outbreak involved the less dangerous clade 2 variant of the virus.
This time, the focus is on the more lethal clade 1b variant, which has demonstrated the ability to spread directly between humans through sexual contact.
In a parallel move, the Africa Centres for Disease Control and Prevention (Africa CDC) is poised to declare a Public Health Emergency of Continental Security. This would be a first for the Africa CDC and would enable African Union member states to coordinate their response to the outbreak.
Aiming to Prevent the Next Pandemic
Both emergency declarations are part of an urgent effort to curb the spread of mpox, which is showing signs of becoming the next global pandemic.
A PHEIC designation could expedite the process for African nations to purchase mpox vaccines without undergoing lengthy national licensing procedures. It would also allow them to acquire larger quantities than currently available through donations.
However, bureaucratic delays have already hindered vaccine distribution. For example, the 50,000 doses donated by the United States to the Democratic Republic of Congo (DRC) months ago are not expected to arrive for at least another two months. Even then, the logistical challenges of transportation, refrigeration, trained health personnel, and necessary supplies like syringes must be addressed before the vaccines can be administered.
Jean Kaseya, the head of Africa CDC, noted that the African emergency declaration would facilitate joint negotiations for existing and new mpox vaccines. This includes an mRNA vaccine expected to be manufactured in Rwanda next year by BioNTech, the German pharmaceutical company known for pioneering COVID-19 mRNA vaccines.
WHO Director-General Tedros Adhanom Ghebreyesus stated that he decided to convene the expert committee to assess the situation due to the “spread of mpox outside the DRC, and the potential for further international spread within and outside Africa.”
Signs of a Major Epidemic
Clade 1b of the mpox virus appears to be in the early stages of a significant epidemic. Rosamund Lewis, WHO’s emergency manager for mpox, told SciDev.Net that “it’s climbing disproportionately faster than cases elsewhere in DRC,” where the older, non-sexually transmitted clade 1a variant predominates.
While clade 1a is also on the rise, it involves animal-to-human transmission, which limits its pandemic potential compared to clade 1b, which can sustain transmission solely among humans.
The response to this threat lies in the two mpox vaccines currently available on the market: one produced by Bavarian Nordic in Denmark, and the other by KM Biologics in Japan. These vaccines could help contain the virus if administered to those at risk of contracting and spreading it.
In July, the Coalition for Epidemic Preparedness Innovations (CEPI) launched trials in the DRC to determine if vaccinating individuals already exposed to mpox can prevent illness and halt transmission.
However, scaling up vaccine procurement across Africa will require the WHO’s emergency designation. Last week in Geneva, Tedros initiated the process for Emergency Use Listing (EUL) of both vaccines, a crucial step toward making them available at the needed scale.
Nevertheless, the EUL process is time-consuming. A WHO technical committee must first approve the listing, after which companies submit offers, and countries negotiate prices and import approvals.
The DRC alone estimates it will need 10 million doses to contain the potentially pandemic clade 1b and protect children from clade 1a. The Bavarian Nordic vaccine, which uses a virus grown in hen’s eggs, faces challenges in producing the required quantities quickly.
As the situation unfolds, the world watches closely, hoping that swift international action can prevent another pandemic from taking hold.