(Bloomberg) -- Countries in central Africa are racing to contain a multinational outbreak of a mutated mpox strain that’s killed almost 500 people in the Democratic Republic of the Congo alone since January.
The fast-spreading virus is suspected to have infected more than 12,300 people in 2024 in the DRC, where it was first reported less than a year ago. Recent cases in Ivory Coast, Kenya and at least three other African countries have raised concern of an explosive contagion carried along newly built roads and highways connecting remote mining sites to cities and camps housing hundreds of thousands of conflict-displaced Congolese.
World Health Organization Director General Tedros Adhanom Ghebreyesus said he’s considering convening a panel for advice on whether to declare the outbreak an international public health emergency.
“Local governments and partners are further scaling up the response to interrupt disease transmission,” he said Sunday on the social media site X. “But more funding and support for a comprehensive response are needed.”
Mpox is caused by the monkeypox virus, the most life-threatening form of poxvirus to arise since the eradication of smallpox in the 1970s. Although it’s been spilling over from rodents and infecting humans with increasing frequency for decades, the current outbreak is unprecedented, driven by a variant that’s undergone genetic changes that scientists worry might have made it more dangerous.
“The uninterrupted human-to-human transmission for at least the last eight months, possibly more, has never been seen in mpox spread in the region before,” said Sylvie Jonckheere, an adviser on emerging infectious diseases at the medical aid group MSF, or Doctors Without Borders.
Africa is the only continent where mpox is endemic, yet has struggled to get vaccines made by Bavarian Nordic A/S and KM Biologics Co. The DRC is working to get supplies of shots, according to an emailed statement from the MSF relief group. Bavarian Nordic, maker of Jynneos vaccine, said it has pledged to donate doses for African countries. KM Biologics didn’t respond to a request for comment.
“We can only plead, like so many others, for the vaccines to arrive in the country as quickly as possible and in large quantities so we can protect people in the areas most affected,” Louis Albert Massing, MSF’s medical coordinator in the DRC, said in the statement.
Bavarian Nordic shares rose as much as 7.7% Tuesday in Copenhagen, reaching their highest price in more than a year.
Children and adolescents have been most affected in the outbreak, with more than 60% of known fatal cases under the age of 5. The variant is reported to be spreading faster through sexual contact, like the milder strain known as clade IIb that erupted globally in 2022. A report in June found 29% of confirmed cases of the new strain were among sex workers.
Deadlier Strain
However, the current virus is more closely related to the dangerous clade I strain; the rate of deaths among reported cases in the DRC is almost 5%. Stemming the spread is also proving difficult in the country, roughly the size of Western Europe and wracked by decades-long conflict and poverty. About three-fourths of its 100 million people lived on less than $2.15 a day in 2023, according to the World Bank.
The nation’s cobalt resources — the world’s largest — have lured billions of dollars of infrastructure investments from Chinese state-owned companies. Newly paved roads improve access to foods and health care, yet help spread infectious threats. Viruses like Ebola that were once contained largely in remote communities are now transported to densely populated African cities and the rest of the world.
“Diseases follow people and people are traveling faster and further than they did in the past,” said Jonckheere, who has long worked in the DRC. “In the 1980s you were not seeing motorbikes, or very few, in deeper Congo. Now people mostly travel on them.”
Transnational Travel
Health authorities recently reported mpox at a border crossing in southern Kenya in a person traveling from Uganda to Rwanda. Central African Republic also reported an outbreak, including cases in its densely populated capital, Bangui. Uganda’s Ministry of Health reported two new cases last week that it said were imported from the DRC. Rwanda, Burundi, and Ivory Coast have also recorded cases.
The large volume of people moving between Kenya and other East African countries “is a significant risk for regional transmission” of mpox, Kenya’s public health department said Wednesday in a statement.
Genetic changes in the circulating virus have added to chal
lenges diagnosing cases and establishing their links to the outbreak in the DRC, where the government last month reported an exponential increase in infections.
“We don’t have the data to show this spread is the same strain, but certainly the eastern part of Congo and Burundi and Rwanda were not really affected in the past,” Jonckheere said.
Containing the disease has been further complicated by renewed fighting in the DRC earlier this year that increased the number of displaced people living in crowded camps. In addition, people in more remote areas tend not to present themselves at clinics — and may not even be aware of mpox risks.
Another concern is the possibility that some mpox patients are also infected with HIV, which cuts the body’s ability to fight disease. Africa has the world’s biggest number of HIV infections.
“It’s clear there’s a big problem,” with fighting mpox, said Marion Koopmans, who heads up the the department of viroscience at Erasmus University Medical Center in the Netherlands. “We’re now trying to get a sense of how it’s spreading. It’s a difficult area in which to work.”
--With assistance from Jason Gale.
(Updates with WHO comment, Bavarian Nordic shares from third paragraph.)
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