Understanding Mpox: Challenges, Solutions and Amref’s Response
Mpox was first discovered in 1958 in a Belgian lab investigating zoonotic diseases, and the first case in humans was diagnosed over 40 years ago in the Democratic Republic of Congo (DRC).
Since 2022, when the World Health Organisation (WHO) first declared mpox a Public Health Emergency of International Concern (PHEIC), mpox cases have increased across 15 African countries.
As of August 2024:
Amref public health experts, Boniface Hlabano (Programme Manager, Global Health Security Unit) and Mary Mathenge (Directorate of Populations Health and Environment, Amref Kenya), recently discussed with Amref supporters the current state of the Mpox crisis, the challenges it poses, and how Amref is working to raise awareness and curb the outbreak's spread.
Watch the discussion here
Watch hereWhat is mpox and how does it spread?
Mpox, previously known as Monkeypox, was discovered in the 1950s, and has been circulating among humans since the 1970s. It is zoonotic—meaning it hibernates in animals—but its mutations, called ‘Clades’, are now transmitted from human to human through social and sexual networks.
It is primarily transmitted through the respiratory tract, but it can also be transmitted through lesions (broken skin), mucus membranes, and other bodily secretions including blood, urine, saliva, semen, vaginal secretions and breastmilk. Clades 1a and b can also be transmitted through contact with infected fabric like clothing and bedlinen.
The virus is self-limited, meaning it resolves in 2-4 weeks in most cases, with clinical care focussing mostly on pain management and hydration. The fatality rate is around 2.7%, with most of those deaths from mpox in people already with co-morbidities – particularly HIV or tuberculosis (TB). Pregnant women and children under the age of 15 are also at risk.
How do we then control the spread?
Here, the COVID-19 lessons on basic personal hygiene and enhanced hygiene for health settings are key. Avoiding contact with infected people and animals is critical—and isolating those infected if it is practically possible. If not, then strictly avoiding sharing bedding, towels and utensils is vital, as is ensuring that all food—particularly meat—is very well-cooked. There is also some evidence that adding ash to bath/cleaning water can neutralise the virus in settings where access to water and sanitation are limited.
For healthworkers and caregivers, wearing good personal protective equipment (PPE) is critical. They will also be first in line for the vaccines when they are delivered.
But we must remember that in the areas where we are working, and where the majority of mpox cases are, total isolation is just not practically possible. In Goma, DRC for instance, running water is a luxury. Therefore using PPE and prioritising healthworkers for vaccination are the best prevention measures.
Community-based disease surveillance is one of the weakest areas in our health systems on the continent. Amref has built a model, tested and expanded it, on using community-based capacity for surveillance.
What are the other challenges to curbing the spread of mpox?
African health systems have generally limited or weak disease surveillance. This means that the systems are not in place to track suspected cases of a disease, to get a diagnosis, and to manage them properly in a health facility.
For example, in July 2024 we had a figure of 12,500 suspected cases in Africa. This is of course a conservative estimate—we suspect that the real case numbers are more like 100,000 in Africa alone. Of those 12,500 suspected cases, only 9% went to be tested and confirmed.
Stigma and fear of discrimination are driving people away from diagnosis. There is a high level of mistrust among communities, as people know if they are diagnosed with mpox they and their families are quarantined. This means loss of livelihoods as well as isolation compounding mental health issues.
Testing is currently done with the PCR tests we are familiar with from COVID-19. The turnaround time on the test is 5-8 hours. This means that although in Kenya testing is currently free of charge, there is a long waiting list of cases waiting for confirmation.
Across affected countries, the testing supply chain is under pressure. In DRC it takes an average of 2 days for a sample to get from the community to a testing facility. This means samples are often compromised. In Ethiopia, with a population of 123m people, there are just 14 labs with the capacity to process mpox samples for testing in the whole country.
Misinformation is also spreading on social media platforms, which drives more stigma and discrimination. Social networks are incredibly important across the affected countries, and stigma is destroying those networks.
How is Amref helping to tackle these challenges?
This outbreak of mpox is a milestone in public health coordination between Africa CDC and the WHO. It is the first time these agencies have coordinated a joint response plan. Amref analysed the plan’s requests for support and is now working across six strategic areas of support in cooperation with Africa CDC, WHO and partners on the ground:
1. Community engagement and public awareness
This is also known as risk communication and engagement. We are training community health workers (CHWs) with the skills they need to tackle mpox myths and misinformation, to undertake case contact tracing and link people to the health system. We are also working in this way with influential community and religious leaders. This is particularly important to ensure communities have the right information and awareness of mpox vaccines, so we see better uptake of the vaccines once they are available.
2. Community-based disease surveillance
We know this is one of the weakest areas in African health systems. Amref has tested and scaled community-based disease surveillance models over the decades. Our active indicator-based community disease surveillance training means that CHWs are able to detect presumed cases very early, and alert the formal health system to do quick investigation, testing and confirmation.
3. Laboratory capacity strengthening
Amref is participating in African Union and WHO working groups to support training of lab experts in 12 countries. Training focusses on interpretation of mpox test results, as well as sample collection and management. We have our own Amref labs in Kenya and we are looking at ways to raise funds to strengthen our own lab and diagnostics capacity for mpox testing.
5. PPE for infection prevention and control
Amref is providing masks, aprons, and sanitisers to frontline health workers in mpox hotspots and throughout programmes in affected countries, so that work can continue amid the outbreak.
6. Advocacy for vaccines
The first consignment of vaccines has arrived in the DRC. Similar consignments have arrived in other affected countries through donations from global stockpiles and through multilateral bodies. Amref is assisting Ministries of Health to put together vaccination plans. In addition, we are participating in a programme on integrated immunisation across 22 countries. We are now adapting the existing programmatic plans to ensure mpox vaccination is integrated.
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