WHO has once again declared mpox a global health emergency. This time the emergency is centered in a dozen African countries where there are still no vaccines. The New York Times (US) reports, “The outbreak has spread through 13 countries in Africa, including a few that had never reported mpox cases before. On Tuesday, the Africa Centers for Disease Control and Prevention declared a ‘public health emergency of continental security,’ the first time the organization has taken that step since the African Union granted it the power to do so last year. ‘It’s in the interests of the countries, of the continent and of the world to get our arms around this and stop transmission as soon as we can,’ said Dr. Nicole Lurie, the executive director for preparedness and response at the Coalition for Epidemic Preparedness Innovations…”
 
Lawrence Gostin and colleagues write in an opinion in The New York Times (US), “Africa CDC has estimated that it needs 10 million doses to stop the current outbreak. But as was the case with the Covid vaccines, mpox vaccines are in the hands of the world’s richest countries and companies.” Commitments from the EU and the US should bring 250,000 vaccines to the region. “But this still leaves Africa nowhere near the 10 million doses needed… Urgent, coordinated action is needed now—especially the equitable sharing of vaccines. Covid-19 and too many health emergencies before that have taught us that complacency and delayed action pose a threat to all of us.”
 
If You Are in a Hurry

• Read a detailed background on the origins of the 2022 mpox outbreak in Science.
• Read a call from Fedayo MO Adetifa and Madhukar Pai in BMJ for a global response to mpox in Africa.
• Read about how game theory could help break the impasse on vaccine access in pandemic treaty negations in Think Global Health.
• Read CIDRAP on a new report on antimicrobial resistance in Africa.
• Read The New York Times on rising concerns about avian flu in the US.
• Read Euro News on calls for a humanitarian pause in Gaza to allow for polio vaccinations.

More on the Mpox Emergency
Fedayo MO Adetifa and Madhukar Pai write in a BMJ (UK) opinion, “Whenever outbreaks have appeared to be limited to Africa, we have seen the world do little and take action only when high income nations are directly affected. Until Ebola affected people in the US and Europe, it barely registered as a problem for leaders and funders in the Global North, and this was replayed in 2022 when mpox clade IIb was declared a PHEIC. Once these diseases affected people in rich nations, millions of dollars were poured into finding cures and vaccines. We simply cannot do this again with the ongoing mpox crisis in Africa… the latest mpox crisis is another reminder that the world desperately needs a strong pandemic accord with equity and accountability. Otherwise, history shows that repeated failures of equity are the norm in global health, not the exception.”
 
Reuters (UK) reports, “A World Health Organization official stressed on Tuesday that mpox, regardless of whether it is the new or old strain, is not the new COVID, as authorities know how to control its spread. ‘We can and must tackle mpox together,’ said Hans Kluge, WHO regional director for Europe, in a UN media briefing. ‘So will we choose to put the systems in place to control and eliminate mpox globally? Or we will enter another cycle of panic and neglect? How we respond now and in the years to come will prove a critical test for Europe and the world,’ he added.”
 
Bloomberg (US) quotes Tulio De Oliveira, director of Stellenbosch University’s Centre for Epidemic Response and Innovation: “I don’t think the world has learned that it didn’t make sense to stop the World Health Organization emergency last year. If we had learned, we would have focused on stopping the outbreak.”
 
Science (US) looked at a 2017 outbreak of mpox in Nigeria and the link to the earlier 2022 mpox global health emergency. “Powerful genomic studies have now pinpointed when the virus jumped from animals to humans and how it slowly spread across the country. But other questions are more difficult to answer. Why did the Nigerian outbreak fail to trigger international alarms? Why didn’t sexual transmission—never documented before 2017—receive more attention? And could this outbreak have been stopped before it went global?... And the new clade I variant from the DRC is banging on the world’s door. There’s far less fog this time: Scientists have warned of the threat for several months, and African countries have been on high alert… [Africa CDC Director-General Jean] Kaseya criticized the world at large for not offering Africa more support during the first mpox PHEIC, in 2022 and 2023. ‘When this declaration ended, cases in Africa continued to increase, and today, we are facing the consequence of not having appropriate assistance,’ he said. ‘If we don’t deal with mpox as we need to do, we can be surprised.’”
 
The East African (Kenya) reports, “Kenya is one of five African countries set to receive 50,000 doses of the Mpox vaccine as part of an international effort to prevent the transmission of the disease… Other countries receiving doses are the Democratic Republic of Congo (DRC), Burundi, Rwanda and Uganda.”
 
Nature (UK) reports, “The drug tecovirimat did not accelerate recovery for people in a clinical trial in the Democratic Republic of the Congo (DRC) who were infected with a concerning type of monkeypox virus, according to the US National Institutes of Health (NIH). The viral type, called clade I, has been spreading across Africa and is thought to be more lethal than the one that caused a global mpox outbreak that began in 2022, known as clade II.
 
Financing Pandemic Preparedness
Africa CDC’s Nicaise Ndembi and colleagues write in BMC Globalization and Health (UK), “As we are in the season with enormous emerging and reemerging public health threats, it is imperative to place mechanisms that ensure equity, and effective and sustainable financing for PPPR [pandemic prevention, preparedness, and response]. Lessons learned from the continental and global financing initiatives, particularly during the COVID-19 pandemic, must be translated as we prepare for the next pandemic. Therefore, we call upon the global health community and decision-makers to focus on the harmonization of financing efforts for PPPR, make regional financing mechanisms central to global PPPR financing efforts, and ensure the inclusivity of international finance governance systems. This can be realized through provisions that can be included in the Pandemic Agreement.”
 
Game Theory and Vaccine Access
Think Global Health (US) reports on a potential way to break the impasse on vaccine access in the pandemic accord negotiations. “This stark divide between HICs and LMICs on PABS [pathogen access and benefit sharing] might seem unbridgeable, but a third way forward is possible. Pandemic accord negotiators could reward vaccine makers that participate in a voluntary PABS Program that commits the companies to provide a portion of all real-time production of their vaccines to LMICs at low or no cost—in exchange for the promise of enhanced access to pathogen data and opportunities to accelerate vaccine testing by collaborating with researchers in the countries where the pathogen first emerged. Vaccine manufacturers that participate would benefit themselves and their home countries by being able to bring their vaccines to market more quickly.”

Focus on Antimicrobial Resistance
CIDRAP (US) reports, “Amid a burgeoning mpox crisis, African health officials are drawing attention to the growing burden of antimicrobial resistance (AMR) on the continent and have laid out a roadmap for addressing the problem. An African Union report found, “that AMR was responsible for 255,000 deaths in Africa in 2019—more than 20% of the global total—and that sub-Saharan Africa experienced the highest AMR burden of any region in the world, with 27.3 deaths per 100,000 people. Lack of antibiotics and diagnostics, overuse of antibiotics in people and food animals, suboptimal vaccination rates, significant gaps in AMR surveillance, and limited knowledge of AMR are some of the factors contributing to the problem, the report said. But officials said the issue is compounded by additional challenges, including lack of access to clean and safe water sources, inadequate infection prevention measures in hospital, and a shortage of funding and political will.” Read the report.
 
The Guardian (UK) reports, “People who have grappled with drug-resistant infections say their stories are too often hidden behind statistics on the scale of the problem. “We want the world to not only think of us as numbers affected by AMR but also to see us as daughters, sisters, brothers, and sons and hear our plea for change,” they said in a recent Lancet commentary calling for meaningful patient engagement. In September, the UN will hold a high-level meeting on AMR during its general assembly in New York to address the threats posed to global health, food security and development.
 
Avian Flu Concerns Mount
The New York Times (US) reports, “Without a sharp pivot in state and federal policies, the bird flu virus that has bedeviled American farms is likely to find a firm foothold among dairy cattle, scientists are warning. And that means bird flu may soon pose a permanent threat to other animals and to people… ‘The idea that we would have a flu pandemic anytime soon, I think the weight of that politically, economically, in terms of all of our mental health, is just too much to bear at the moment,’ said Dr. Van Kerkhove of the WHO. ‘Everyone’s tired from Covid, everyone’s tired from mpox, everyone’s tired from climate change and war and all that,’ she added. ‘But right now, we don’t get to be tired.’”
 
Global Impact of Long COVID
The New York Times (US) reports, “About 400 million people worldwide have been afflicted with long Covid, according to a new report by scientists and other researchers who have studied the condition. The team estimated that the economic cost—from factors like health care services and patients unable to return to work—is about $1 trillion worldwide each year, or about 1 percent of the global economy. The report… in the journal Nature Medicine, is an effort to summarize the knowledge about and effects of long Covid across the globe four years after it first emerged. It also aims to ‘provide a road map for policy and research priorities,’ said one author, Dr. Ziyad Al-Aly…” Read the report.
 
US CDC Says COVID is Endemic
NPR (US) reports, “US health officials now say COVID-19 is an endemic disease. That means it's here to stay—circulating regularly like the flu. Even though that changes how public health officials think about managing the virus, they say it doesn't mean being less cautious or vigilant during surges, like the current one this summer. COVID still poses significant risks for older individuals and those with underlying conditions—and anyone who gets COVID is at risk of developing long COVID.”
 
Politics and Public Health: Mask Bans
An opinion in STAT (US) argues that a recently enacted mask ban in a New York county endangers people who wear masks for medical reasons. “The legislation in Nassau County and elsewhere primarily targets people who wear masks to hide their identity while committing crimes or during public protests… But people like me, who wear masks for health reasons, are disproportionally affected by these bans even when they include medical exemptions. That’s because although the Nassau mask ban contains provisions for people who mask for medical reasons, it is up to the police to determine whether someone has a medical reason for masking if they are out in public. This means that enforcing the ban is subjective and will disproportionally impact Black people and people of color, who are more likely to be stopped by police and are also more likely to wear masks to prevent Covid. This is in part because Black and Latinx Americans are more cautious in their approach to the pandemic, reflecting the higher hospitalization and death rates in these communities.”
 
Polio in Gaza
Euro News (France) reports, “Aid groups and international organisations are calling for a humanitarian pause in fighting in Gaza to allow for a mass polio vaccination campaign. One case of polio has been confirmed in Gaza with others suspected, and the virus was detected in wastewater in six samples in July. ‘I am appealing to all parties to provide concrete assurances right away guaranteeing humanitarian pauses for the campaign,’ said UN Secretary-General Antonio Guterres last week… To avert a widespread outbreak, more than 1.6 million oral doses of polio vaccine are set to be delivered to Gaza, and aid groups are preparing to vaccinate more than 600,000 children in the coming weeks.”
 
In an online CSIS event discussing the outbreak UNICEF’s Jean Gough says, “I want to reiterate the critical importance that all parties are ensuring that this campaign can be rolled out in a safe, unimpeded manner; the absolute need to have safe access to distribute the vaccine to more than 640,000 children below the age of 10 wherever they are in Gaza. The best way to make this happen is to ensure the campaign is taking place during humanitarian ceasefires, or the so-called days of tranquility, or a temporary pause in fighting. If this is not implemented, it could have disastrous consequences for children not only in Gaza, but for the region.”