Urgent and equitable action needed to prevent mpox becoming the next pandemic, say experts

As the mpox outbreak continues to ravage Africa, global health leaders and scientists are calling on world leaders to take urgent action to stop the spread of the virus.

Published in PLOS Global Public Health is an opinion piece written by scientists from esteemed academic institutions, including Burnet Institute, entitled “Neglect has led to a more dangerous virus now spreading across borders, harming, and killing people. Leaders must take action to stop mpox now.”

When the mpox (caused by the monkeypox virus) Clade 2b unexpectedly spread into wealthy countries two years ago (having been ignored for years in African countries), the World Health Organization (WHO) declared a first public health emergency of international concern (PHEIC) and the international community rapidly invested in contain the epidemic, through vaccines, research on treatments and community mobilization with the at risk community, largely gay, bisexual, and other men who have sex with men (GBMSM).

But two years on, African countries, where mpox continues to remain a threat, have been forgotten. A second PHEIC was declared in August 2024 by the WHO to support increased international coordination. Despite some progress, such as vaccine donations and the approval of a rapid test, the response remains inadequate. Vaccines continue to remain out-of-reach as they are stockpiled by wealthy countries, surveillance and diagnostics are limited, and treatments are unavailable.

This regional outbreak has been caused by multiple strains of mpox, spreading in different communities, including through households, and affecting children. What is of even deeper concern is the spread of the more severe strain, Clade 1.

Most cases have been reported in the Democratic Republic of Congo, with cases also reported in 18 countries across Africa, Sweden, and Thailand, having spread through travel. Since the start of the year, more than 30,000 suspected cases have been reported across the region, exceeding the total number of cases reported to the WHO in 2023.

At the same time, the clade 2 strain of mpox is surging, with Australia recording the second highest number of cases in the world in August, prompting renewed health warnings.

Burnet Director and CEO Professor Brendan Crabb AC, who is one of the authors of the publication, said it was not equitable and not smart to allow the disease to spread rapidly and uncontrolled in Africa or at-risk communities globally.

“It is both a moral and public health failing not to do everything in our power to contain the spread of mpox,” he said. “If we have learnt anything from the lessons of COVID-19, it is that equitable and community-led responses are central to stopping outbreaks and preventing pandemics.”

By allowing mpox to spread uncontrolled, it can mutate and infect more people, leading to morbidity and mortality, creating a bigger global threat.

“Access to tools like vaccines has been inadequate in endemic countries. We need to change this if we want to combat the spread of these types of diseases and prevent future pandemics,” Professor Crabb said.

The opinion piece calls on the Australian Government, the WHO and Member States, and world leaders to respond in an effective, internationally coordinated, and equitable way to contain the outbreak, while accelerating research and safeguarding vulnerable populations in the region. It states: “mpox is a growing regional health crisis in Africa, and without urgent action to stop the epidemics when and where they occur, there is every reason to believe it will continue to spread across borders, including to other continents.”

So far, according to the Africa Centers for Disease Control, just 280,000 doses of mpox vaccine have been pledged towards the outbreak, far less than the 10 million doses that are required to contain the outbreak.

Available funding pales in comparison to what is required to control the outbreak and is a fraction of the eventual costs of a pandemic or globally endemic disease, which is what mpox will become if left uncontrolled.

“We want the Australian Government, the WHO, and the global community to do all they can to support international efforts to limit the spread of mpox where it is currently at its worst, to minimize its impact locally and globally,” Professor Crabb said.