An epidemic of mpox in the eastern Democratic Republic of Congo (DRC), is spreading quickly, particularly among young children. At least 20,000 people are known to be infected in the country, and more than 600 people have died, more than two thirds of them children. Cases have begun to appear in neighbouring countries Burundi, Kenya, Rwanda and Uganda.

Mpox is a serious, at times fatal, virus. The world knows how to prevent it. There are effective vaccines stockpiled in many western countries. Yet, after an earlier global epidemic in 2022 was largely brought under control in Europe and North America, the ongoing battle to protect people in Africa from mpox was ignored.

In this episode of The Conversation Weekly podcast, we ask a virologist and a paediatrician why Africa’s mpox crisis was so neglected – and what needs to happen now to save lives, particularly children’s.

Wolfgang Preiser is the head of medical virology at the University of Stellenbosch in South Africa. In a compelling article for The Conversation, he argued that the current mpox epidemic is yet another example of how infectious diseases, often perceived as someone else’s problem in mainly poor, developing countries, can suddenly pose unexpected global threats.

This is a virus which we thought was circulating naturally in small mammals in rainforest areas of Africa. But it’s just another very worrying reminder that these viruses are good for nasty surprises.

The mpox virus was discovered in captive monkeys in 1958, and the first human case of mpox was detected in an infant in 1970 in the DRC, but there was little human-to-human transmission.

I think we all became complacent. Yes, there were the occasional reports in the World Health Organization’s (WHO) weekly report about monkeypox, as it was still called up to last year. Cases in a village somewhere and some contacts and they were investigated, but there’s still a lot we don’t know about this virus.

A small outbreak in the US in 2003, caused by the import of infected rodents that spread to pet dogs, caused a global wake-up call. And then in 2022 an outbreak that had begun in Nigeria a few years earlier turned into a global epidemic, causing over 99,000 laboratory-confirmed cases in 116 countries. It spread particularly in communities of men who have sex with men.

In May 2023, the WHO announced this outbreak was no longer a public health emergency of international concern. “I was stunned,” says Nadia Sam-Agudu, a professor of paediatric infectious diseases at the University of Minnesota in the US, who also has affiliations with Nigeria’s Institute of Human Virology and the University of Cape Coast in Ghana. Transmission was still happening on the African continent, and not long after, a new strain of mpox began to emerge in the DRC.

In African countries we lost ground because this pandemic was declared over in 2023. And we are seeing the effects of that declaration, right now, because we have outbreaks really out of control.

In August 2024, a day after the African Centres for Disease Control (CDC) labelled the current epidemic a public health emergency of continental security, the WHO said mpox was once again a public health emergency of international concern.

Children at high risk

Previous mpox outbreaks in Africa have hit children particularly hard. As a zoonotic disease, it’s commonly passed from animals to humans – often young boys who go out hunting for small rodents in forests where the virus is endemic.

But even in the current outbreak in the DRC, driven by human-to-human transmission, young children are also particularly vulnerable to getting a severe form of the disease, and to complications from the infections. Current data suggests that 58% of the cases in the current epidemic in the DRC are children under the age of 15.

The African CDC said that 10m vaccine doses are needed by 2025 to bring the current epidemic in Africa under control . Some donations have begun to arrive in the DRC, but not of vaccines approved in children. One vaccine, Jynneos, made by the pharmaceutical company Bavarian Nordic is not yet approved in under 18s, although trials are planned in children aged two to 12. Another Japanese vaccine called LC16, has been given to children in Japan, but has not yet received global approval.

Sam-Agudu says this is part of a larger problem where approving vaccines for children and vulnerable adults, such as pregnant women, hasn’t been seen as a priority.

On account of their vulnerability they are pushed aside, but then it’s because of their vulnerability that they continue to have disproportionate effects and consequences of these diseases.

Listen to the conversations with Nadia Sam-Agudu and Wolfgang Preiser on The Conversation Weekly podcast, which also includes an introduction from Nadine Dreyer, health and medicine editor at The Conversation Africa, based in Johannesburg.

A transcript of this episode is available on Apple Podcasts.

This episode of The Conversation Weekly was written and produced by Mend Mariwany with assistance from Katie Flood. Sound design was by Michelle Macklem, and our theme music is by Neeta Sarl. Gemma Ware is the executive producer.

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