On August 15, Sweden reported a case of a new strain of mpox known as clade 1b. It marked the first time the more deadly strain of mpox, formerly known as monkeypox, was found in Europe and outside of the African continent.
According to Sweden’s public health agency, the person who contracted the virus had just returned from a trip to an unidentified African nation where there has been a major outbreak of the new mpox strain.
Just two days earlier, the African Union’s public health agency had declared mpox a “public health emergency of continental security,” while the World Health Organization designated the outbreak of the virus in the Democratic Republic of Congo and several neighbouring countries a “public health emergency of international concern” the following day.
It was the second time in just two years that the WHO labelled an mpox outbreak with such a designation, one that allows the UN agency to issue guidance to countries on measures they should adopt to strategically tackle the explosion in cases. So far in 2024, there have been more than 20,000 reported mpox cases and 582 deaths in Africa.
A more severe strain
The fast spread of the new mpox strain from central African countries to other parts of the world has public health experts concerned due to its higher severity compared to the previously dominant clade 2b, and its adaptability to humans. It also seems to be associated with higher death rates and a greater likelihood of severe symptoms.
Public health officials have warned that the new strain should be seen and treated as an emergency, not only for the African continent, but for the globe.
“Mpox was once considered an isolated threat in Africa, but its changing nature, particularly with clade 1b, requires a global response, with Europe playing a crucial role,” David Heymann, a professor in infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, tells The Parliament.
“The best thing to do in Europe and elsewhere is to provide vaccines for different strategies and determine which might be important to stop transmission based on the epidemiology,” Heymann says. Until the mid-1990s, he notes, experts thought mpox was exclusively transmitted from animals to humans, while today it is also known to spread through person-to-person contact.
According to the WHO, common symptoms of the new strain include skin rashes, fever, headaches, muscle aches, back pain, low energy and swollen lymph nodes. Children, pregnant people and those with weak immune systems are at higher risk for serious illness and death from the virus.
Access to vaccines
Mpox vaccines are effective at protecting individuals from contracting the viral disease.
But, as the Covid-19 pandemic demonstrated, ensuring equitable access to vaccines and treatments can be a major challenge. During the 2022 mpox outbreak, wealthier countries like those in Europe were similarly able to secure vaccines and treatments more quickly than less affluent regions.
That's why the WHO has stressed the importance of global equity in the fight against mpox and called on EU countries “to support efforts to ensure that vaccines are available to all who need them, regardless of geographic location.”
On Monday, the WHO launched its Strategic Preparedness and Response Plan, which will run from this September through February of next year. The aim of the six-month plan is to support global efforts to significantly lower transmissions of the new, more dangerous type of mpox by scaling up WHO staff in the hardest-hit countries and boosting surveillance, prevention and response strategies.
In response, EU Health Commissioner Stella Kyriakides last week called on European countries to support the African public health response, with the European Commission itself procuring and donating 215,000 vaccine doses. Germany has since pledged to donate 100,000 doses of the mpox vaccine to Africa, while France committed to donating an additional 100,000 doses. Austria has said it would support the WHO effort, but did not disclose how many vaccines it aims to contribute.
But some EU countries have taken a wait-and-see approach before committing to donations. “Before deciding on a donation, I will wait to see how the situation develops and make sure the strategic stockpile in Netherlands is at a sufficiently high level,” Fleur Agema (PVV), the Dutch health minister, wrote in a letter to local lawmakers last week.
Heymann of the London School of Hygiene and Tropical Medicine emphasises that vaccine distribution should be accompanied by proper evaluation and local adaptation. “In Europe, making sure that when they use a vaccine, they do an evaluation to see whether or not that vaccine was effective in stopping transmission is crucial,” he says.
He also warns against a one-size-fits-all approach, particularly when supporting African nations. “It’s important to listen to what countries want and what countries say, rather than just say, 'you need this,'” he adds, advocating for a more collaborative and tailored approach to international health interventions.
Impact on the EU
Although the European Centre for Disease Prevention and Control predicts that the impact of clade 1b on the bloc will be low, EU countries have started to put preventative measures in place to ensure that healthcare workers across the bloc are able to manage a potential surge in cases. Researchers have also stressed the importance of continued so-called genomic surveillance to monitor the virus’ evolution and track the emergence of potentially more dangerous variants.
When mpox was first declared a public health emergency by the WHO in 2022, the EU was able to reduce cases as a result of its disease management experience and through coordinated public health efforts impacted segments of the population.
"Two years ago, we controlled mpox in Europe thanks to the direct engagement with the most affected communities of men who have sex with men," Dr. Hans Henri P. Kluge, WHO regional director for Europe, said in a statement last week. "Learning from our success, we urged governments and health authorities to sustain those measures – to help eliminate mpox from Europe," he added.
Meanwhile, Heymann also highlights the role of local scientists and experts, particularly in Africa, where the disease has a strong foothold. “It’s important that we continue to work with African countries,” he says. “So that they can use their excellent scientists to understand the epidemiology of mpox and develop the best strategies for vaccination with support from the North if they request it.”