Asmaa El Safty‏‏

The monkeypox virus has become a significant challenge for many countries, especially after the World Health Organization (WHO) declared it a global health emergency. This declaration followed the virus's spread to several neighboring and non-neighboring countries of the Democratic Republic of Congo, currently the virus's epicenter. Additionally, the African Union's health authority has classified monkeypox as a public health emergency due to its widespread outbreak in several African nations, raising concerns that the world may face a new pandemic in 2024, reminiscent of the COVID-19 scenario.Threat IndicatorsThe monkeypox virus has undergone several critical developments that now pose a global threat, which can be outlined as follows:1- Ongoing Spread in African Countries: Monkeypox, now also known as "Mpox," was first discovered in 1985 when it spread in a research colony of monkeys in Denmark. However, the first case of animal-to-human transmission was recorded in 1970 when symptoms appeared in a nine-month-old infant. The disease's spread among humans was initially limited to the Democratic Republic of Congo and some neighboring African countries; for example, Nigeria recorded hundreds of cases in 2007.In May 2022, countries outside Africa began reporting monkeypox cases. By July of that year, the WHO declared the outbreak a global health emergency—the highest medical alert the WHO can issue—for the first time. In just one year, over ten countries recorded nearly 90,000 cases of monkeypox and more than 150 deaths. Despite this, the WHO lifted the global emergency status for dealing with the virus in May 2023, no longer viewing it as an international health emergency, even though it continues to spread in some countries, albeit at meager rates.2- Widening Geographic Spread: The monkeypox virus is no longer confined to a few African countries, it has become more geographically widespread. Infection rates in the Democratic Republic of Congo and several other countries around the world began to rise again in early 2024. A WHO report from June 2024 documented 175 cases across North, Central, and South America, as well as 100 cases in Europe and only 11 in Southeast Asia. The virus has spread more extensively among individuals within the Democratic Republic of Congo (the virus's epicenter), with local reports in May 2024 recording 7,851 cases of monkeypox and 384 deaths.3- Increased Warnings from International Organizations: Recently, international organizations have been issuing more frequent warnings about the dangers of the virus. These developments prompted the African Union's health authority to classify the virus as a public health emergency on August 13, 2024. The authority warned of the virus's spread throughout the African continent, including densely populated areas, rather than being limited to remote and rural regions as it was before.The WHO quickly joined the list of institutions warning of the virus's spread. On August 14, 2024, for the second time in its history, the WHO declared monkeypox a global health emergency. A day after the WHO's announcement, Sweden reported a case of the disease, marking the first confirmed case outside Central and East Africa in 2024.4- The Risk of Genetic Mutations: The WHO has recorded two main variants responsible for the spread of monkeypox. The first variant, "Clade I," has spread widely in the Democratic Republic of Congo and is considered more severe and deadly than the second variant, "Clade II," which spread to over 100 countries in 2022, leading to the first emergency declaration related to the virus. However, health authorities have confirmed that a development linked to the first variant—dubbed "Clade Ib"—is mainly responsible for the recent infections. The first case of this variant was recorded in the Democratic Republic of Congo in April 2024, and confirmed cases have also been reported in Uganda, Burundi, Rwanda, and Kenya. The variant has even been linked to the case recorded in Sweden in August 2024.Future ChallengesDespite many countries raising their health alert levels to deal with the virus, some experts downplay its severity, asserting that the COVID-19 experience will not be repeated with the current virus. Generally, whether monkeypox turns into a global pandemic like COVID-19 depends on several key factors:1- Continued Spread Beyond Traditional African Hotspots: Many experts view the declaration of emergency status by international and local health authorities as a reflection of deep concerns among scientists that the monkeypox outbreak could evolve into a pandemic that spreads rapidly across Africa and beyond, becoming a new global health disaster similar to the COVID-19 pandemic.2- Difficulty Predicting the Virus's Genetic Evolution: Although monkeypox has been on the global radar for some time, much remains unknown about how the virus spreads and why it suddenly appeared worldwide in 2022, receded in 2023, and is now resurging. Additionally, the virus has undergone genetic mutations and developments. While most genetic mutations have little to no impact, some have made the virus more deadly and contagious. When geneticists compared the 2022 monkeypox genome to a sample collected in 2017, they found about 40 genetic mutations had occurred. Some researchers suggest these mutations may have enhanced the virus's ability to spread from person to person.3- Rate of Virus Spread: The speed at which the virus spreads is a critical factor in determining whether it could become a global pandemic similar to COVID-19. According to a report by Asharq Al-Awsat, monkeypox spreads much more slowly than COVID-19. Shortly after COVID-19 was identified in China, case numbers surged from several hundred to several thousand in just one week in January 2020, increasing more than tenfold. By March 2020, when the WHO declared COVID-19 a pandemic, there were more than 126,000 cases and 4,600 deaths—just three months after the virus was first identified. In contrast, it took from 2022 to reach nearly 100,000 monkeypox cases worldwide, according to the WHO.4- Health Systems' Capacity to Handle the Virus: Global health systems have significantly weakened, especially under the pressures imposed by the COVID-19 pandemic, in addition to crises related to healthcare worker shortages and general declines in health funding. These problems are particularly pronounced in several African countries, the current epicenter of the virus. Acknowledging this deficit, the African Union announced $10.4 million in funds to respond to monkeypox, and the WHO pledged $1.45 million in emergency funds to combat the virus.5- Availability of Effective Vaccines: Some vaccines used to prevent smallpox also help combat monkeypox. For example, the "Jynneos" vaccine, manufactured by the Danish company Bavarian Nordic, was used in some monkeypox prevention campaigns in Europe and America after the virus was detected in 2022. Additionally, the "LC-16" vaccine, produced by the Japanese company KM Biologics, has been employed. However, the real challenge lies in the weak industrial infrastructure in the countries that are the current epicenter of the virus's spread, such as the Democratic Republic of Congo, and these countries' lack of millions of dollars needed to import such drugs from abroad.6- The extent of Support from Developed Countries to African Nations: As mentioned earlier, African countries struggling with the virus face enormous challenges in addressing it. For example, the Democratic Republic of Congo's Health Minister Roger Kamba stated that his country needs 3.5 million doses of monkeypox vaccines to stop the virus's spread, stressing the importance of asking the international community to step up and provide assistance, as well as deliver the resources needed to access these vaccines. In this regard, some European countries and the United States have initiated technical and financial support for the response to the monkeypox outbreak in Africa. In the second week of August, the U.S. Agency for International Development (USAID) announced it would allocate $10 million in funds to support the monkeypox response in the Democratic Republic of Congo.In conclusion, these troubling developments surrounding the monkeypox virus underscore that global health will always be a source of concern, ruling out the possibility that the international community can ignore it in favor of addressing other, more pressing global issues, such as the conflict in the Middle East, the Russia-Ukraine war, and the competition between the United States and China.

How to Address the Potential Monkeypox Pandemic?