Mpox: What it is, and why India needs to be careful

This week, the World Health Organisation (WHO) declared the latest Mpox outbreak in Africa an international health emergency, but available funding to address the crisis remains insufficient.

Mpox, formerly known as monkey pox, is a viral infection that causes fever, headache, muscle aches, back pain, and swollen lymph nodes, accompanied by pox-like rashes. While historically confined to rural Africa, mpox has gained global attention as recent research has focused on the virus' rapid evolution and spread, driven by human-to-human transmission.

India previously reported cases of the less severe clade II during the 2022 outbreak. With global travel links, there is concern that clade Ib may spread further.

In response to the WHO's declaration, Tamil Nadu’s directorate of public health has issued guidelines for health officers to remain vigilant, particularly for travellers from affected regions. The state has implemented thermal screening and monitoring for arrivals from Congo and neighbouring countries.

The latest Mpox case in India was reported in March, originating from Kerala, according to news agency PTI citing health ministry sources. Since 2022, India has recorded 30 laboratory-confirmed cases of this viral infection. 

What is Mpox?

Mpox, formerly known as monkey pox, is an infectious disease caused by the monkey pox virus, a member of the genus Orthopoxvirus. There are two main clades of the virus: clade I and clade II. The recent global outbreak in 2022-23 was primarily caused by clade IIb.

The disease can lead to painful rashes, swollen lymph nodes, and fever. Common symptoms include a skin rash or mucosal lesions that last 2 to 4 weeks, along with fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes. While most people recover fully, some may experience severe illness.

Mpox spreads through physical contact with infected individuals, animals, or contaminated materials. Transmission routes include:

- Direct contact with infected persons, through touch, kissing, or sexual activity

- Handling or consuming infected animals

- Contact with contaminated materials, such as sheets, clothes, or needles

- Transmission from pregnant women to their unborn babies

Treatment primarily involves supportive care. Vaccines and therapeutics developed for small pox, and approved in some countries, can also be used for mpox under certain circumstances.

WHO declares emergency

WHO has declared mpox an international “public health emergency” amid reports of a new, more deadly variant. Pakistan and Sweden have reported early cases of this new strain.

In Pakistan, a 34-year-old man who recently returned from Saudi Arabia tested positive for mpox, marking the country's first case of the year. Since April 2023, Pakistan has reported 11 cases, including one fatality.

Sweden has confirmed its first case of mpox in Stockholm, which is the first instance of the new deadly variant being diagnosed outside Africa. The outbreak is driven by clade Ib of the mpox virus, which is predominantly transmitted through sexual contact. This variant has been detected in Burundi, Kenya, Rwanda, and Uganda — countries that previously had not reported mpox cases.

WHO director-general Dr Tedros Adhanom Ghebreyesus has voiced concerns about the spread of this new clade. “The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighbouring countries are very worrying,” he said. “It’s clear that a coordinated international response is needed to stop these outbreaks and save lives”.

WHO has recommended two vaccines for mpox and has triggered an emergency use listing to expedite vaccine access for lower-income countries. Gavi and UNICEF are working to procure and distribute these vaccines, with WHO coordinating efforts to ensure equitable access.

Crisis in Congo

The latest outbreak is centred in the Democratic Republic of Congo, a nation beset by decades of conflict, severe poverty, and malnutrition. At least 450 people died during an initial outbreak in the DRC and the disease has since spread to areas of central and east Africa.

With approximately 42 lakh internally displaced people living in overcrowded camps, controlling the spread of mpox is particularly challenging. The Congolese government reports about 15,700 suspected cases and 550 deaths this year. The country requires 35 lakh vaccine doses, with public health minister Roger Kamba estimating the cost in the hundreds of millions of dollars. Kamba has called for international assistance, stressing that the $100 (Rs 8,387) per dose vaccine price is unaffordable for many. 

Funding shortages

Efforts to control mpox in the DRC and neighbouring countries will require significant resources for surveillance, public health education, and vaccination campaigns.

WHO has allocated $1.45 million from its emergency fund, and the African Union has approved $10.4 million from Covid relief funds for the Africa Centres for Disease Control and Prevention (Africa CDC). The vaccine alliance Gavi could provide up to $500 million from its new emergency fund for vaccinations. However, this is far below the $4 billion estimated by Africa CDC director-general Jean Kaseya as necessary to effectively combat the outbreak.

Javier Guzman, director of global health policy at the Centre for Global Development, highlighted the critical gap in financing. “The big gap I can clearly see here where we will repeat the mistakes of the past is not having a surge financing mechanism,” said Guzman. He noted that while Gavi’s potential funding is significant, it is “far from adequate”.

Global Funding Challenges

Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, underscored the broader issue of inadequate funding for various deadly diseases. “There are massive gaps in financing diseases that are already killing a lot more people,” Sands said. He suggested that repurposing existing funds for disease prevention could be an effective way to address the mpox outbreak.