Strengthening Africa's response to Mpox (monkeypox): insights from historical outbreaks and the present global spread

Abstract

Mpox, formerly known as Monkeypox, is a viral zoonotic disease endemic to Central and West Africa that has posed significant public health challenges since its identification in 1970. Despite decades of experience in managing outbreaks, the 2022-2024 Mpox outbreaks exposed substantial gaps in global preparedness and response, leading the World Health Organization (WHO) to declare a Public Health Emergency of International Concern (PHEIC) in 2022. The resurgence of cases in Europe in 2022 and the more recent emergence of the virulent clade Ⅰb in the Democratic Republic of the Congo (DRC) in 2024 have highlighted a critical need for improved proactive and response strategies to curb the epidemic. This narrative review examines the historical and recent epidemiology of Mpox in Africa and explores the factors that have limited effective management. These include objective influences such as viral mutations, zoonotic transmission patterns, and environmental changes like deforestation, as well as subjective factors, including delayed responses, limited vaccine availability, cessation of smallpox vaccinations, and inequitable access to healthcare. In particular, the review emphasizes the ongoing disparities in global health equity, as wealthier nations have been able to secure vaccines and therapeutics quickly, while endemic regions in Africa continue to struggle with limited resources. The review also discusses how socio-economic and cultural factors, combined with weak public health infrastructure and inadequate surveillance systems, perpetuate cycles of outbreak in vulnerable populations. Furthermore, the emergence of clade Ⅰb in 2024, with its higher virulence and mortality rates among children, particularly in rural areas, underscores the urgency of addressing the evolving epidemiological landscape of Mpox. In response to these challenges, this review recommends strengthening healthcare infrastructure, enhancing surveillance systems, ensuring equitable access to vaccines and treatments, and integrating environmental management into public health strategies. Global collaboration remains essential to provide African countries with the resources and support needed to manage and prevent future outbreaks effectively. Without these measures, the world risks a prolonged public health crisis with far-reaching consequences for both Africa and the global community.

Keywords: Emerging infectious diseases; Mpox; Outbreak management; Surveillance systems; Zoonotic diseases.

Fig. 1

Timeline of Mpox from discovery till recent outbreaks. Abbreviation: DRC: the Democratic Republic of the Congo; WHO, World Health Organization.

Fig. 2

Map of Africa highlighting the cases, mortality, and clades associated with the 2024 Mpox outbreak from January 1st to October 6th based on WHO data [6]. Abbreviation: DRC: the Democratic Republic of the Congo; WHO, World Health Organization. Note: the map was designed by the authors and data captured in the map is adapted from the cited source.

Fig. 3

Global Mpox cases among WHO regions from January 2022 to August 2024 [6,7]. Abbreviation: WHO, World Health Organization. Blue bars represent the total Mpox cases from Jan 2022 to Aug 2024; orange line graph represent the total number of cases in Aug 2024 in different WHO regions.

Fig. 4

Phylogeny of all Mpox virus (MPXV) clades. (adapted from WHO, 2024; Available at https://worldhealthorg.shinyapps.io/mpx_global/).