WHO declares global health emergency

The world's attention is now focused on another emerging health crisis. It has issued its highest level of alert for the viral disease - named Mpox which is rapidly spreading in parts of Africa.

Analyst Areesha Lodhi has pointed out that for the second time since 2022, Mpox has been declared a global health emergency as the virus is currently spreading rapidly across the African continent and risks entering other continents. The World Health Organisation (WHO) on August 14 has issued its highest level of alert for the viral disease, noting that more than 14,000 cases and 524 deaths in Africa this year have already exceeded last year's figures. Apparently, this announcement came a day after the Centre for Disease Control and Prevention (CDC) in Africa declared Mpox a public health emergency.

This unravelling scenario has led to queries from all over the world about various aspects pertaining to this viral disease and how this viral infection primarily affects humans and animals.

Health scientists have in this regard observed that it belongs to the group of viruses classified as "Orthopoxvirus genus" that generally cause pox-like disease, which includes a rash with raised bumps or blisters on the skin. The bumps are often filled with fluid or pus and can eventually crust over and might heal. Lymph nodes, bean-shaped glands that are part of the immune system, can also swell up as they try to fight the virus. Some of the places these are located include under each arm, and the sides and back of the neck.

It was originally named "monkeypox" when first identified in monkeys in 1958. In 1970, the first reported human case was a nine-month-old boy in the Democratic Republic of Congo. In 2022, the WHO recommended updating its name to "Mpox" to reduce stigma and association with monkeys, as the disease can also infect rodents and humans.

Mpox can transmit from one person to another through contact with infectious lesion material or fluid on the skin, in the mouth or on the genitals; this includes touching, close contact, and during sex. It may also spread by means of respiratory droplets produced by talking, coughing, or sneezing. During the 2022-2023 global outbreak of clade II, transmission between people also took place through sexual contact.

The Mpox virus is transmitted to humans through close contact with an infected animal or person. Animal-to-human transmission typically occurs through bites, scratches, or direct contact with the blood, body fluids, or wounds of an infected animal. Human-to-human transmission can also happen through direct contact with skin lesions, body fluids, or respiratory droplets of an infected person. The virus enters the body through broken skin, the respiratory tract, or mucous membranes, which include eyes, nose, and mouth.

In some cases, an infection may be deadly. Health experts from the WHO have pointed out that overall, an infection can last two to four weeks. It can take three to twenty-one days to develop symptoms after being exposed to the virus. However, a person can transmit the disease to others in one to four days before symptoms appear. Patients who are at high risk from the disease include children, pregnant women, the elderly and those who are immune compromised. For these patients hospital admission and careful monitoring of symptoms is recommended.

WHO Director-General Tedros Adhanom Ghebreyesus has underlined that there is concern for spread of the disease within Africa and beyond, after a meeting of the United Nations health agency's Emergency Committee. He also observed, "The Emergency Committee met and advised me that in its view, the situation constitutes a public health emergency of international concern. I have accepted that advice. This is something that should concern us all." "WHO is committed in the days and weeks ahead to coordinate the global response, working closely with each of the affected countries, and leveraging our on-the-ground presence, to prevent transmission, treat those infected, and save lives," Tedros added.

It needs to be remembered here that the Public Health Declaration of Immergency Concern (PHEIC) can accelerate research, funding and international public health measures and cooperation to contain a disease. It triggers emergency responses in countries worldwide under the legally binding International Health Regulations.

Health analysts are observing that such an emergency declaration from the WHO is meant to spur donor agencies and countries into action. Amita Gupta, Director of the Division of Infectious Diseases at the Johns Hopkins School of Medicine has in this context observed that "there is a real attempt right now to mobilise resources and that is why in part WHO called for the public health emergency now".

It may be noted here that the WHO declared Mpox a global health emergency in July 2022 as well, when the virus was first found to spread through sexual contact and was reported in more than 70 countries across the world. Once the cases declined, the WHO lifted the emergency in May 2023. This time the Africa CDC has reported that Mpox has now been detected in at least 13 African countries. It has also pointed out that compared with the same period last year, the cases are up 160 per cent and deaths have increased by 19 per cent. So far, more than 96 per cent of cases have been reported in Congo, where earlier this year scientists found a new form of the virus that causes milder symptoms and lesions on the genitals. That makes it harder to spot, meaning people might transmit it to others without knowing they are infected.

However, A. Gupta has also remarked that while the 2022 outbreak was driven by clade (or group) II of mpox, the current outbreak is being fuelled by clade I which can be more deadly. The media through AFP has now reported that till now, although cases of Mpox had not been seen outside Africa, it has now surfaced in Sweden as well as Pakistan. There has been outbreak in the countries in tropical Africa-- Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana, Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.

What is worrying many is the question as to whether there is any vaccine for fighting this disease. Unfortunately, some doctors have been pointing out that while mild cases can resolve cure on their own, there are very few treatments or vaccines specifically for Mpox.

However, public health officials are now pointing out that as of August 2024, there are currently 4 vaccines in use to prevent mpox, although supplies are limited. All were originally developed to combat smallpox. This includes (a) MVA-BN, marketed as Imvanex and has been approved for use against Mpox by the United States Food and Drug Administration ; (b) LC 16 from KMB Biologics of Japan and is licensed for use in Japan; (c) Orthopox Vac manufactured in Russia for use there; and (d) ACAM 2000 manufactured by Emergent Bio Solutions and available for use in the USA. Nevertheless, many have also drawn attention to the fact that the antiviral drug tecovirimat (TPOXX), originally for smallpox, is also under scrutiny as to whether it can successfully treat Mpox.

Ngashi Ngongo, the Chief of Staff of the regional health body has added that efforts are underway to reach an agreement with the EU's health task force and Mpox vaccine manufacturer Bavarian Nordic to provide an initial 215,000 doses of the inoculant to Africa. He has also said that they were still negotiating a deal for the continent to receive two million doses by the end of the year, and ten million by the end of 2025.

Ngongo has also made some other significant observations about the efforts that have been undertaken to ensure physical health safety. It has been underlined by Ngongo that "We are also planning to saturate the media, both television and the radio, to make sure that all those that have access to those media can also receive the message". This is being done because the concerned authorities need to "remember that 96 per cent of cases are in the DRC, and 60 per cent of those cases are among the young people below the age of 18. So, we're also using social media to ensure that the young people are also reached."

One needs to understand the significance of these proposed positive measures. It is incumbent on all of us throughout the world to actively participate in this exercise. This is particularly pertinent for all the countries in South Asia, South East Asia, USA, Canada, Brazil and China. One must not forget that the total population of these regions and China suffered immensely during the Covid pandemic. China has now informed that it will begin screening people and goods entering the country.

Time has come for us to work on greater surveillance. Monitoring will also be required by health officials. There also needs to be coordinated international response for making potential vaccines available.

Muhammad Zamir, a former Ambassador, is an analyst specialised in foreign affairs, right to information and good governance.

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