The Africa Centres for Disease Control and Prevention (Africa CDC) has recently issued an urgent update on the escalating Mpox outbreak across the continent. The outbreak, which began in early 2023, has now spread to 16 African Union (AU) Member States, with alarming increases in case numbers and fatalities. This report outlines the critical situation and Africa CDC’s response to the ongoing crisis.

The Mpox outbreak in Africa has escalated significantly in recent months, prompting urgent responses from the Africa Centres for Disease Control and Prevention (Africa CDC) and other stakeholders. From January 1 to August 23, 2024, the continent has reported a total of 21,466 cases and 591 deaths, with a case fatality rate of 2.9%. This represents a sharp increase compared to the previous year, reflecting a troubling trend in the spread and impact of the disease across the region. As of mid-August 2024, Mpox has been identified in 13 African Union (AU) member states, with new cases emerging in countries previously unaffected, such as Gabon, Sierra Leone, and Malawi.

As of August 23, 2024, Africa has recorded 21,466 Mpox cases, with 3,350 confirmed and 18,116 suspected, resulting in 591 deaths and a case fatality rate (CFR) of 2.9%. This represents a sharp rise from the previous year, with cases increasing by 160% since 2023. The rapid spread and high CFR are raising significant concerns about the outbreak’s impact on public health.

The epidemic has seen new cases emerging in countries previously unaffected by Mpox, such as Gabon, Sierra Leone, and Malawi. The situation is exacerbated by surveillance, testing, and diagnostics limitations, which have led to underreporting and inadequate response measures.

In response to the outbreak, the Director General of Africa CDC, Dr. Jean Kaseya, declared Mpox a Public Health Emergency of Continental Security (PHECS) on August 13, 2024, following the Emergency Consultative Group (ECG) recommendation. This decision was supported by the Pandemic Prevention and Preparedness Response (PPPR) Commission, the Advisory Technical Council (ATC), and the Governing Board (GB) of Africa CDC. The World Health Organization (WHO) followed suit on August 14, 2024, declaring Mpox a Public Health Emergency of International Concern (PHEIC).

The decision to elevate Mpox to a PHECS was based on several factors: the rapid increase in cases, a high case fatality rate, limited diagnostic capabilities, and the need for enhanced coordination of response efforts. The ECG highlighted several critical issues, including inadequate surveillance, limited vaccine access, and the need for a more integrated response plan.

In response to the crisis, Africa CDC convened an Emergency Consultative Group (ECG) comprising 20 senior African and international experts. The ECG’s review highlighted several critical issues:

• Epidemiological Limitations: The current case and death figures are likely underestimates due to limited surveillance and reporting mechanisms.
• Increasing Cases: A rapid surge in Mpox cases has been observed, with the outbreak spreading to new regions.
• High Case Fatality Rate: The CFR of 3-4% is particularly concerning, especially given the link with HIV, which complicates the situation in Africa.
• Vaccine Challenges: Limited vaccine access and unclear efficacy data raise concerns about effective vaccine deployment.
• Diagnostic Limitations: Access to diagnostic tools remains insufficient, impeding accurate detection and response.

The ECG has recommended that the Director General of Africa CDC declare a Public Health Emergency of Continental Security (PHECS), a decision that was supported by various continental bodies, including the Pandemic Prevention and Preparedness Response (PPPR) Commission and the Advisory Technical Council (ATC). On August 13, 2024, the Africa CDC officially declared Mpox as a PHECS, and the World Health Organization (WHO) followed suit on August 14, 2024, declaring Mpox a Public Health Emergency of International Concern (PHEIC).

Africa CDC’s Strategic Response

In response to the PHECS declaration, Africa CDC has mobilized a comprehensive strategy:

1. Coordination and Support: Africa CDC has coordinated with AU Member States, WHO, and other partners to enhance response efforts. This includes deploying staff, improving surveillance, and strengthening case detection capabilities.
2. Vaccine Distribution: Partnerships have been established with entities like the European Commission’s Health Emergency Preparedness and Response Authority (HERA) to provide 215,000 vaccine doses. Further partnerships are anticipated.
3. Training and Awareness: Extensive training programs for healthcare workers and public awareness campaigns are being conducted to improve knowledge and response to Mpox.
4. Diagnostic and Research Support: Efforts are underway to upgrade diagnostic facilities and support research initiatives tailored to the African context.

To address the Mpox outbreak effectively, continued efforts are needed to improve surveillance, enhance diagnostic capabilities, and ensure equitable vaccine distribution. The Africa CDC, AU Member States, and international partners must maintain a unified approach to manage the outbreak and mitigate its impact. Future steps include regular strategic meetings with health ministers, ongoing public awareness campaigns, and bolstering community engagement to support preventive measures.

The situation remains fluid, and the response must adapt as new data and challenges emerge. The commitment of African leaders and international partners will be crucial in navigating this health crisis and safeguarding the continent’s health security.

Several challenges remain, including:

• Resource Limitations: Many African countries struggle with insufficient domestic resources to combat the outbreak effectively.
• Vaccine Approval: Only three countries have approved Mpox vaccines, with others needing to expedite their approval processes.
• Communication Gaps: There is a need for improved communication and awareness to encourage vaccine uptake and preventive measures.
• Cross-Border Spread: The virus spreads across borders, posing a risk to previously unaffected areas.

Africa CDC plans to hold regular meetings with Ministers of Health to discuss strategies and provide updates. An African Taskforce for Mpox Coordination will be established to enhance preparedness and response capacities across the continent.

Dr. Njeri Karanja, Epidemiologist at Kenya Medical Research Institute (KEMRI):
“The Mpox outbreak’s rapid spread across Africa underscores the urgent need for enhanced surveillance and diagnostics. Our current testing capabilities are limited, and we often encounter delays in case confirmation. This exacerbates the challenge of managing the outbreak effectively.”

Dr. Samuel Asare, Public Health Expert with the Ghana Health Service:
“The declaration of Mpox as a Public Health Emergency of Continental Security is a crucial step in mobilizing resources and coordinating efforts. However, the success of this response will heavily depend on how well we address the vaccine distribution challenges and enhance public awareness.”

Dr. Amina Zubair, Director of Africa CDC’s Emergency Operations Centre:
“We are working closely with AU Member States and international partners to ensure a coordinated response. This includes deploying epidemiologists, improving surveillance systems, and establishing a continental strategy for Mpox. We focus on integrating efforts across the continent and ensuring that all affected areas receive the support they need.”

The Mpox outbreak presents a significant public health challenge for Africa. The Africa CDC’s comprehensive response and coordination efforts are crucial in addressing the crisis. Continued international support and collaboration will be essential in managing and overcoming this outbreak.

For more information, the Africa CDC remains available for consultations and support as the continent navigates this urgent health emergency.