“It was frankly amazing to me that even in the large-scale mpox outbreak we had around the world, there was no funding made available at the international level. There must be a financial commitment to stop this virus.”
– Dr. Michael Ryan, Executive Director, WHO Health Emergencies Programme.[1]
Contact: Natalie Shure, natalie.shure@treatmentactiongroup.org
New York City, August 14, 2024 – Treatment Action Group (TAG) supports the World Health Organization (WHO) in declaring the renewed outbreak of mpox a public health emergency of international concern.[2] Virus variants from several clades are causing disease and deaths in multiple countries on the African continent. As WHO Director-General Tedros Adhanom Ghebreyesus noted today, the number of cases reported in the Democratic Republic of the Congo (DRC) so far this year “has exceeded last year’s total, with more than 14,000 cases and 524 deaths.”[3]
A clade 1b mpox variant has emerged and become more widespread with evidence indicating transmission primarily via sexual networks. Cases of clade 1b mpox have recently been reported in Burundi, Kenya, Rwanda, and Uganda. Clade 1a is also circulating in DRC, and clade 2b is being reported in Cameroon, Ivory Coast, Liberia, Nigeria, and South Africa. The majority of cases in DRC are among people under the age of 18 causing overcrowding at hospitals,[4] with malnutrition potentially playing a role in exacerbating vulnerability. Most cases of clade 2b are occurring among men who have sex with men (MSM), and Professor Salim Abdool Karim has noted that mpox has caused severe disease in MSM living with HIV in South Africa.[5] A global analysis focusing on mpox among people living with HIV has reported: “This international case series includes 27 of the 60 people reported to have died of mpox in the multicountry outbreaks; all 27 were people with HIV and a CD4 cell count of less than 200 cells per mm3,” making mpox a novel AIDS-defining condition.[6]
The unchecked expansion of mpox represents a global failure to address the global health disparities so glaringly highlighted during the COVID-19 pandemic. The Africa CDC declared mpox “a public health emergency of continental security” yesterday,[7] and has estimated that 10 million doses of vaccines are needed.[8] According to reporting by Jon Cohen for Science, the US government has donated 10,000 doses of the Bavarian Nordic JYNNEOS vaccine to Nigeria and 50,000 doses to DRC, but the DRC donation remain unused.[9],[10]
In the near term, the primary source of access in the country is likely to be a new clinical trial that will investigate post-exposure vaccination among contacts of people with mpox; the study aims to enroll 1,560 people at sites in DRC, Nigeria and Uganda.[11] A trial in DRC sponsored by the US CDC of the JYNNEOS smallpox vaccine in adult healthcare personnel has recruited 1,600 participants and remains ongoing.[12] In welcome news today, it was announced that the European Commission’s Health Emergency Preparedness and Response Authority, HERA, is coordinating a donation of 215,000 vaccine doses from Bavarian Nordic to Africa CDC.[13] A study of tecovirimat (TPOXX) as a treatment for mpox is nearing completion in DRC, but there are no known clear plans for expanding access or marketing approval yet.
TAG calls for increased financial support to address mpox including:
- Increasing availability and rollout of vaccines, especially JYNNEOS;
- Expanding access to tecovirimat, currently of limited availability[14],[15];
- Research for improved diagnostics and treatments – there remain few clinical studies of mpox taking place on the African continent
The limited access to vaccines, tecovirimat, and other essential health commodities this far into the current outbreak is yet another demonstration that the existing global health system cannot guarantee the human rights to health and scientific progress for all. Major reforms and a reallocation of resources are necessary. In TAG’s view, the present situation is at least partially the consequence of lingering inequalities from responses to the 2022 mpox outbreak which saw vaccines and other resources concentrate in the Global North with relatively little attention devoted to addressing the drivers of mpox in the DRC and other endemic areas.
Effectively reaching populations at risk for sexual transmission is an essential element of the response to mpox, and in this context right wing forces globally promoting criminalization of sexual and gender minorities — which include prominent American organizations — are not only viciously bigoted and morally reprehensible but an international threat to public health.
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About TAG: Treatment Action Group (TAG) is an independent, activist and community-based research and policy think tank fighting for better treatment, prevention, a vaccine, and a cure for HIV, tuberculosis, and hepatitis C virus. TAG works to ensure that all people with HIV, TB, and HCV receive lifesaving treatment, care, and information. We are science-based treatment activists working to expand and accelerate vital research and effective community engagement with research and policy institutions.
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[1] Anderson S. WHO Weighs Second Mpox Emergency As New Variant Escapes DRC. Health Policy Watch. 2024 July 8.
[2] Mandavilli A. W.H.O. Declares Global Emergency Over New Mpox Outbreak. New York Times. 2024 August 14.
[3] World Health Organization (WHO). WHO Director-General’s opening remarks at the IHR Emergency Committee meeting regarding the upsurge of mpox 2024. 2024 August 14.
[4] Kew J. Mpox Outbreak in DRC Pushes Overcrowded Hospitals to Limits. Bloomberg News. 2024 August 13.
[5] Cohen J. Seeking ‘proactive and aggressive’ response, Africa declares mpox a health emergency. Science 2024 Aug 13.
[6] Mitjà O, Alemany A, Marks M, et al. Mpox in people with advanced HIV infection: a global case series. Lancet.
2023 Mar 18;401(10380):939-949. doi: 10.1016/S0140-6736(23)00273-8. Epub 2023 Feb 21.
[7] Africa CDC (Press Release). Africa CDC Declares Mpox A Public Health Emergency of Continental Security, Mobilizing Resources Across the Continent. 2024 August 13.
[8] Pelley L. Growing mpox ‘crisis’ prompts Africa CDC to declare first-ever public health emergency. CBC News 2024 August 13.
[9] Cohen J. Africa intensifies battle against mpox as ‘alarming’ outbreaks continue. Science. 2024 Apr 26;384(6694):373-374.
[10] Cohen J. Deadlier strain of mpox spreads to multiple African countries. Science. 2024 Aug 9;385(6709):591
[11] CEPI (Press Release). New clinical trial will assess if mpox vaccination works after virus exposure. 2024 July 27.
[12] Petersen BW, Kabamba J, McCollum AM, et al. Vaccinating against monkeypox in the Democratic Republic of the Congo. Antiviral Res. 2019 Feb;162:171-177.
[13] European Commission (Press Release). European Commission coordinates procurement and donation of 215,000 vaccine doses from Bavarian Nordic to support Africa CDC in addressing the Mpox outbreak in affected countries in Africa. 2024 August 14.
[14] Mbrenga F, Nakouné E, Malaka C, et al. Tecovirimat for Monkeypox in Central African Republic under Expanded Access. N Engl J Med. 2022 Dec 15;387(24):2294-2295
[15] Bourner J, Redji Mbrenga FD, Malaka CN, et al. Expanded Access Programme for the use of tecovirimat for the treatment of monkeypox infection: A study protocol for an Expanded Access Programme. PLoS One. 2024 May 9;19(5):e0278957.