Africa: Declaration of Public Health Emergency of Continental Security

1. What is the current situation of the Mpox outbreak in Africa?

17,541 Mpox cases, including 517 deaths, have been reported in 12 African countries in 2024:
1 in Southern Africa: South Africa
3 in East Africa: Kenya, Rwanda, Uganda
5 in Central Africa: DRC, Burundi, CAR, Congo Brazzaville, Cameroon
3 in West Africa: Nigeria, Ivory Coast, Liberia.
This represents a 160% increase by end of July, compared to the same period the previous year, 2023.
The DRC has reported the highest number of cases, accounting for 96% and 97% of deaths.

2. Why declare it a Public Health Emergency of Continental Security?

The declaration of Mpox as a Public Health Emergency of Continental Security by Africa CDC is a strategic decision to strengthen the collective and coordinated response to the outbreak across the continent.

This will enable the mobilization of necessary resources, strengthen regional coordination, raise awareness, and ensure a rapid and effective response to control the spread of the disease and protect public health across Africa.

3. Key reasons for the Africa CDC declaring Mpox as a public health Emergency of Continental Security include:

The rapid expansion of Mpox beyond non-endemic countries and regions reported cases for the first time. This swift geographic spread necessitates an urgent and coordinated response to prevent uncontrolled transmission.
The rapid increase in cases in several African countries indicates a growing emergency that could overwhelm fragile health systems. This is also reflected in the continuously rising death toll.
Mpox has a significant impact on health systems. Its spread could burden stressed health systems dealing with other epidemics or pandemics (such as COVID-19). The declaration will help secure the necessary resources to prevent a reduction in the capacity of these systems to respond effectively to other health emergencies.
The declaration will help combat stigma and misinformation by facilitating clear and consistent communication across the continent. It can also encourage people to report cases and seek medical care without fear of discrimination.
Declaring a health emergency will encourage countries to be more transparent and report cases more quickly, which is essential for an effective response.
The declaration will mobilize financial, technical, and logistical resources across the continent and beyond. This will include accelerating the supply of vaccines, medicines, and protective equipment.
The declaration will attract greater attention from the international community and foster collaboration with global partners, including the WHO, to obtain additional and coordinated support.
The declaration can also facilitate the implementation of border control measures and population movement restrictions to limit cross-border virus spread.
The declaration aims not only to protect African populations but also to prevent the global spread of Mpox by containing the outbreak before it becomes a global health crisis.
By declaring Mpox an emergency, Africa CDC can better prepare the continent to face this outbreak and other emerging threats by building sustainable resilience in health systems.

4. What will change for the population with this declaration as a public health emergency?

This notification will change many things from now on:

Africa CDC will coordinate the continental response and work with all partners to support countries to contain the outbreak. Member States will be required to share information quickly and transparently.
The declaration obliges Member States to notify Africa CDC of any health measures implemented in response to the emergency. Africa CDC will disseminate information to all Member States, improving overall awareness of the situation.
Africa CDC can issue temporary recommendations aimed at preventing or reducing the international spread of the disease and avoiding unnecessary interference with international traffic and trade.
The declaration of a PHECS often leads to increased funding and resources from international organizations, governments, and donors. This will include financial support, medical supplies, and the deployment of health personnel in affected areas.
Countries must strengthen their surveillance and reporting systems to detect and respond effectively to emergencies. There will be improved data collection and reporting to the CDC in Africa to monitor the situation better and adjust response strategies.
Africa CDC will communicate the risks and appropriate measures to the public and advise on reducing exposure and spread. This may include hygiene guidelines, travel advisories, and public health measures.
The declaration will accelerate the research and development of diagnostics, treatments, and vaccines. Collaborative efforts will be established to speed up clinical trials and regulatory approvals.
The declaration of PHEIC promotes international solidarity and encourages countries to support each other by sharing knowledge, resource allocation, and joint initiatives.

5. How can this resurgence in East and Central Africa be explained?

The lack of resources and control measures in Africa largely explains this resurgence. When the WHO declared Mpox a Public Health Emergency of International Concern from June 2022 to May 2023, Western countries received vaccines, medicines, and measures to strengthen their health systems. As a result, they significantly reduced the number of cases, and the international health emergency was lifted. Meanwhile, cases continued to increase in Africa because Africa did not receive such assistance. This indifference from the international community was also observed during the COVID-19 period.

Other factors that explain this resurgence are:

In many parts of East and Central Africa, the human population lives close to wildlife, particularly in rural and forested areas. Frequent interactions between humans and animals (such as rodents and primates, natural reservoirs of the Mpox virus) increase the risk of zoonotic transmission. Handling infected meat or contact with animals carrying the virus can result in direct transmission of the virus to humans.
Massive deforestation in parts of East and Central Africa has disrupted the natural habitats of reservoir animals, forcing these animals closer to areas inhabited by humans. This increased proximity raises the chances of contact and transmission of the Mpox virus.
In many East and Central African countries, health systems lack the resources and capacity to monitor and detect Mpox outbreaks early. This often leads to a delayed response, allowing the virus to spread more widely before being contained.
Conflicts and political instability in some regions have caused mass population displacements, creating conditions conducive to the spread of Mpox. Refugee camps and forced displacements increase population density and close physical contact, facilitating the virus's transmission.
The stigma associated with Mpox, due to its visible and sometimes severe symptoms, may discourage individuals from getting tested or reporting cases, leading to underreporting. This underreporting prevents an adequate response and allows the virus to spread widely and unnoticed.
Misinformation and misconceptions about Mpox, including beliefs that the disease is not severe or does not affect specific communities, have also contributed to inadequate response and continued spread.
Although the Mpox virus is relatively stable, mutations may have occurred, increasing its transmissibility or altering its epidemiological behaviour. These mutations could partly explain the resurgence of the disease in certain regions.

6. This is the first time the Africa CDC has taken such a measure. Does that mean the epidemic could become uncontrollable?

Indeed, this is the first time the Africa CDC has used the mandate under Article 3, paragraph E of its Statute to declare Mpox a Public Health Emergency of Continental Security.

There is a real risk that the epidemic could become uncontrollable if appropriate measures are not taken. As outlined in question 3 above, these measures will help control this epidemic.

7. What measures has the center taken to control the spread of the disease?

To control the spread of Mpox, Africa CDC has implemented several strategic measures, drawing on its experience gained during the fight against other epidemics such as Ebola and COVID-19. Here are some of the primary measures:
Africa CDC is strengthening surveillance and detection of Mpox cases across Africa. This includes improving diagnostic capacities in national and regional laboratories and establishing a rapid notification system for suspected cases.
Africa CDC conducts intensive training for healthcare personnel in affected countries to prepare them to identify, isolate, and treat Mpox cases. Training programs have also been organized for epidemiologists and public health experts.
Africa CDC facilitates the sharing of critical information among African countries to ensure a harmonized and coordinated response to the epidemic. Regular meetings and communication platforms are in place to exchange data, strategies, and lessons learned.
Africa CDC supports awareness campaigns to inform the public about how to prevent Mpox infection. Africa CDC collaborates with health ministries, various partners, media, and community organizations to disseminate clear and accessible messages about the disease
Africa CDC works with regional and international partners to ensure the availability of essential medical supplies, including vaccines, personal protective equipment, diagnostic kits, and medicines.
In partnership with research institutions, Africa CDC supports research on vaccines and treatments for Mpox. Clinical trials and field studies are encouraged to understand the epidemic better and develop solutions adapted to the African context.
Case management protocols have been developed and disseminated to ensure that Mpox patients receive adequate care while minimizing the risk of transmission. The isolation of confirmed cases and monitoring of contacts have been vigorously promoted.

8. How is the center working with national governments to strengthen health systems and improve disease detection and response?

Africa CDC is clear that national-level coordination is done by the Ministries of Health and Africa CDC does continental-level coordination. Africa CDC supports affected countries and the continent in strengthening their health systems through training, reinforcing surveillance and laboratory systems, providing pharmaceutical and medical products, and enhancing communication and partnerships.

Africa CDC also works to mobilize the resources the continent needs for this vision.

Through the coordination of disease responses, the Africa CDC plays a central and essential role in ensuring the well-being of communities.

9. What are the centre's most significant challenges in combating monkeypox in Africa?

Africa CDC faces several significant challenges in its fight against Mpox in Africa, requiring a multidimensional response involving Africa CDC and African governments, international partners, and mobilizing local communities. The most significant challenges are:

Many health systems in Africa lack the resources to effectively respond to an outbreak like Mpox. This includes a shortage of infrastructure, trained personnel, and medical equipment, making it difficult to detect, isolate, and treat cases quickly.
Limited access to vaccines and specific treatments for Mpox is a significant obstacle. The available vaccines are in insufficient quantities, and their distribution is complicated by logistical management issues.
The lack of robust surveillance systems leads to underreporting of Mpox cases, hindering understanding of the actual extent of the outbreak, its epidemiology, and the development of effective response strategies.
Stigma and misinformation associated with Mpox hinder awareness and prevention efforts. Affected communities sometimes hesitate to report cases or seek care, exacerbating the spread.
In some regions of Africa, political instability and armed conflicts complicate efforts to combat Mpox. Massive population displacements and limited access to conflict zones increase the risk of the virus spreading.
Funding for the fight against Mpox is often insufficient relative to actual needs. Limited financial resources affect Africa CDC's ability to implement large-scale interventions, particularly regarding vaccination, research, and capacity building.

10. How does the center raise awareness among at-risk populations and promote effective prevention practices?

Africa CDC implements several strategies to raise awareness among at-risk populations and promote effective prevention practices against Mpox:

Africa CDC develops prevention messages tailored to the cultural and linguistic contexts of the affected regions. These messages are designed to be clear, accessible, and easily understood, using local languages and simple visual images.
Africa CDC uses traditional and digital media (radio, television, newspapers, social media, and digital platforms) for awareness campaigns to reach a broad audience, including remote areas. Commercials and educational videos are produced to inform populations about Mpox symptoms, modes of transmission, and prevention measures, such as hand hygiene and avoiding contact with potentially infected animals.
Africa CDC collaborates with traditional leaders, community leaders, and religious authorities to disseminate prevention messages. These leaders, who are respected and influential within their communities, play a crucial role in raising awareness and adopting preventive practices.
Africa CDC organizes training for community actors to provide them with the necessary information to address their communities' questions and concerns and to dispel myths and misconceptions about Mpox.
Africa CDC organizes discussion groups, workshops, and community forums to allow local populations to ask questions, share concerns, and obtain reliable information about Mpox and its prevention.
Africa CDC promotes and works with community relay networks trained to raise household awareness and distribute information materials on Mpox prevention while encouraging preventive behaviors at the individual and family levels.
Africa CDC collaborates with NGOs and civil society organizations with on-the-ground presence and expertise to conduct targeted awareness activities in at-risk areas. These partnerships help establish health education programs in schools, markets, and other gathering places to inform at-risk populations about the disease and measures to protect themselves.
Africa CDC actively promotes hygiene practices such as frequent handwashing with soap and water, as well as the use of disinfectants. Campaigns are also conducted to raise awareness about the importance of waste management and sanitation in preventing Mpox transmission.

11. How does the center plan to adapt its strategy to respond to the evolving outbreak and new challenges that may arise?

Africa CDC plans to adapt its strategy to respond to the evolving Mpox situation and potential new challenges by focusing on several key areas:

Africa CDC is working to improve surveillance systems to detect Mpox cases more quickly and accurately. This includes expanding the use of digital technologies for real-time case tracking.
Africa CDC plans to strengthen national and regional laboratories to enable faster and more accurate testing and genomic analysis of the virus to monitor its evolution.
Africa CDC is working to strengthen vaccine production capacities in Africa in partnership with local and international manufacturers. This aims to ensure increased availability of vaccines against Mpox.
Africa CDC is implementing strategies to ensure equitable vaccine distribution, particularly in rural areas and vulnerable populations.
In the field of communication, Africa CDC plans to strengthen its communication campaigns to combat misinformation and stigma associated with Mpox, using communication channels adapted to local contexts. Africa CDC will intensify engagement with community leaders and local organizations to promote preventive behaviors and facilitate access to health services.
In the area of partnership and collaboration, Africa CDC plans to improve coordination mechanisms among African countries for a more coherent and harmonized response. This includes setting up regional platforms to share resources, information, and best practices. Africa CDC continues to collaborate with international agencies, NGOs, and bilateral partners to mobilize resources and share knowledge about Mpox.
As part of its adaptive response strategies, Africa CDC is developing contingency plans to address potential virus mutations or a resurgence of the epidemic. These plans include rapid response scenarios for unforeseen situations. Africa CDC is also implementing monitoring and evaluation systems to adjust its strategies based on results and emerging challenges.
Africa CDC has launched several initiatives to strengthen research and development (R&D) in response to Mpox, aiming to better understand the disease, develop diagnostic tools, treatments, and vaccines, and increase the resilience of health systems to this threat.
Africa CDC is partnering with renowned research institutes in Africa and globally to conduct studies on Mpox. This includes collaboration with universities, public health institutes, and international organizations like WHO.
Africa CDC has also established research networks to facilitate the exchange of data, knowledge, and resources related to Mpox.
Africa CDC actively supports Mpox research by mobilizing financial resources from governments, international financial institutions, and private donors. These funds are intended to finance research projects on diagnostics, vaccines, treatments, and Mpox epidemiology.

12. Do you plan to have a vaccine?

Yes, Africa CDC plans to step up its efforts to make a vaccine against Mpox available and accessible on the African continent, in particular through :

Africa CDC is collaborating with global vaccine manufacturers to accelerate the development and production of vaccines against Mpox tailored to the African context. Africa CDC supports research initiatives to develop new vaccines or improve existing ones, taking into account the viral strains present in Africa.
Africa CDC is also working with partners to develop local vaccine production capacity on the continent through technology transfer. This aims to reduce import dependence and ensure a more reliable and rapid supply.
Africa CDC envisions coordinating vaccine pooled procurement for African countries to negotiate better prices and ensure equitable distribution, particularly in the most affected or vulnerable areas. Africa CDC is developing strategies to identify and prioritize vaccinating at-risk populations, such as healthcare workers, communities living in outbreak areas, and individuals with comorbidities.

Read the original article on Africa CDC.

Africa: Declaration of Public Health Emergency of Continental Security

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