West and Central Africa Remain Critical Frontlines in the Ongoing Mpox Response
While the global health community can collectively breathe a sigh of relief with the World Health Organization’s (WHO) declaration that mpox is no longer a Public Health Emergency of International Concern (PHEIC), this designation does not signal an end to the virus’s threat. Instead, it marks a crucial shift in focus, emphasizing the ongoing, localized challenges and the critical need for sustained support, particularly in regions where the virus has historically endemic or frequently resurfaces. West and Central Africa, in particular, continue to be critical frontlines in the global effort to contain mpox, facing unique vulnerabilities and demanding a nuanced, long-term strategy.
Understanding the Evolving Mpox Landscape
The recent declaration by the WHO, announced in May 2023, acknowledged significant progress in controlling the widespread outbreak of mpox that began in 2022. This progress is largely attributed to enhanced surveillance, improved diagnostic capabilities, and the rollout of vaccination campaigns in affected countries. However, the WHO’s own statements underscore that the virus continues to circulate. Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, emphasized that “the threat is far from over,” highlighting that the virus has demonstrated resilience and can re-emerge in new contexts.
For West and Central Africa, this ongoing threat is a familiar one. Mpox has been endemic in these regions for decades, with sporadic outbreaks occurring regularly. The 2022 global surge brought renewed international attention to the virus, but the underlying challenges in these areas—including limited healthcare infrastructure, mobile populations, and often resource-constrained public health systems—persist. The International Organization for Migration (IOM), for instance, has been actively expanding its support in these regions, recognizing that border areas remain particularly vulnerable to mpox transmission and require continuous monitoring and intervention.
Specific Vulnerabilities in West and Central Africa
Several factors contribute to the heightened risk in West and Central Africa:
- Endemicity and Sporadic Outbreaks: Mpox is a zoonotic disease, meaning it can spread from animals to humans. In these regions, close contact with infected animals, such as rodents, is a known pathway for transmission. This ongoing enzootic circulation creates a constant reservoir for potential human outbreaks.
- Cross-Border Movement: The porous nature of many borders in West and Central Africa, coupled with significant population movements for trade, migration, and other purposes, facilitates the rapid spread of infectious diseases. Mpox can easily travel with individuals across these boundaries, making containment efforts complex.
- Limited Surveillance and Reporting: While improving, surveillance systems in some areas may still face challenges in early detection and rapid reporting of suspected mpox cases. This can lead to delayed responses, allowing the virus to spread further before effective interventions can be implemented.
- Healthcare Infrastructure Gaps: Access to quality healthcare, diagnostic testing, and treatment can be inconsistent across these regions. This can make it difficult for individuals to seek care, receive timely diagnosis, and for public health authorities to effectively track and manage outbreaks.
The Role of International Organizations and Local Efforts
Organizations like the IOM are playing a vital role by strengthening public health capacities at border crossings and in surrounding communities. Their work often involves training health workers, providing essential medical supplies, and raising awareness about mpox prevention and early symptom recognition among mobile populations. This localized approach is crucial, as it addresses the specific needs and contexts of these vulnerable areas.
The WHO’s own advisory bodies, such as the Strategic Advisory Group of Experts on Immunization (SAGE), have provided guidance on vaccine use, recommending a targeted approach for high-risk groups and during outbreaks. However, equitable access to these vaccines and treatments remains a significant consideration for many African nations.
Tradeoffs and Challenges in Long-Term Containment
The shift from an international emergency to sustained, localized control presents several tradeoffs and challenges:
- Resource Allocation: With the PHEIC status lifted, there is a risk that international funding and political attention may wane. Sustaining resources for mpox surveillance, prevention, and response in endemic regions will be critical but potentially difficult in a competitive global health landscape.
- Balancing Public Health Messaging: Communicating the ongoing risk of mpox without causing undue alarm is a delicate balance. Public awareness campaigns need to be continuous and tailored to specific communities, emphasizing practical prevention measures rather than solely focusing on the emergency.
- Addressing Stigma: Like many infectious diseases, mpox can be accompanied by social stigma, which can deter individuals from seeking testing or care. Efforts to combat stigma through education and community engagement are essential for effective public health responses.
Looking Ahead: What to Watch For
Moving forward, several factors will be key to monitoring the continued threat of mpox:
- Sustained Surveillance Data: Continued, robust surveillance data from West and Central Africa will be essential to detect any resurgence or emergence of new clusters.
- Effectiveness of Localized Interventions: The success of initiatives by organizations like the IOM in strengthening border health and community resilience will be a critical indicator.
- Vaccine and Treatment Access: Ongoing efforts to ensure equitable access to vaccines and antiviral treatments for those at risk in endemic regions will be paramount.
- Research into Mpox Transmission Dynamics: Further research into the animal reservoirs and human-animal interface in these regions could provide vital insights for long-term prevention strategies.
Practical Advice and Cautions
While the global emergency has passed, individuals, especially in or traveling to affected regions, should remain aware of mpox. Key precautions include:
- Practicing good hand hygiene.
- Avoiding close, skin-to-skin contact with individuals who have a rash that resembles mpox.
- Being aware of potential animal contacts in endemic areas.
- Seeking medical attention if experiencing symptoms consistent with mpox, such as fever, swollen lymph nodes, and a rash.
Public health authorities are urged to maintain and enhance their surveillance capabilities and to continue implementing targeted prevention and response strategies tailored to the specific risks in West and Central Africa.
Key Takeaways
- Mpox remains a significant public health threat, particularly in endemic regions like West and Central Africa, despite no longer being a PHEIC.
- Border areas and regions with high population mobility are particularly vulnerable to mpox transmission.
- Sustained international support and localized public health interventions are crucial for ongoing containment efforts.
- Challenges include resource allocation, effective public health messaging, and combating stigma.
- Continued surveillance, equitable access to medical countermeasures, and community engagement are vital for long-term control.
Call to Action
Continued investment in public health infrastructure, surveillance systems, and community-based interventions in West and Central Africa is essential. International partners and national governments must maintain their commitment to supporting these critical regions in their ongoing efforts to combat mpox and other infectious disease threats.
References
- World Health Organization (WHO) – Mpox and health emergencies: what you need to know (Provides context on the WHO’s decision and the ongoing threat)
- International Organization for Migration (IOM) – IOM strengthens mpox preparedness and response across West and Central Africa (Details IOM’s specific work and focus on border areas)