Mpox declaration marks a key shift in global health
Mpox declaration marks a key shift in global health
Africa asked for more say in global health decisions after Covid. It now has that. The mpox declaration is a test of this new power.
Charles Ebikeme
Africa asked for more say in global health decisions after Covid. It now has that. The mpox declaration is a test of this new power. African leaders now have to own the solutions to African problems – but that comes with a risk of friction with global health players.
In the past two decades, the World Health Organisation has declared eight public health emergencies of international concern. Last week’s mpox declaration had a twist: the Africa Centres for Disease Control and Prevention (Africa CDC) officially declared it first. This is a major milestone for the regional body, which is pushing for a new public health order.
Africa CDC’s announcement “represents Africans recognising their own problem and taking steps to promptly address it,” said Professor Dimie Ogoina of the Niger Delta University Teaching Hospital. The infectious diseases physician was the first to describe sexual transmission of mpox in Nigeria in 2017.
“A global outbreak occurred in 2022 largely because the 2017-2019 outbreak in Nigeria was ignored by the global community,” he said.
The lessons were not learned and it is leading to the same outcome this year.
“We warned everyone about it,” Placide Mbala, an epidemiologist at the National Institute of Biomedical Research in the Democratic Republic of Congo told Science earlier this month.
The DRC declared a national outbreak in December 2022 and largely had it contained until late last year. Now, the outbreak has spread to Burundi, Kenya, Rwanda, and Uganda. In 2024, nearly 3,000 cases and 517 deaths have been confirmed in at least 12 African countries.
In the past few days, cases have been reported further ashore in Sweden, Thailand and Taiwan, with a new sexually transmissible strain driving the spread.
Africa CDC’s mpox emergency declaration came a day before the WHO’s and is the first chance to test if the power to declare a health emergency will make a real difference. African countries demanded that power in the wake of the Covid-19 crisis.
Optimists expect it will. “A mandate such as this allows the Africa CDC to accelerate the release of resources by African governments in response to an African public health emergency,” said Dr Ebere Okereke, the former chief executive of Africa Public Health Foundation.
Spring Gombe, a strategist who has advised international agencies on health policy, expects this allows for more nuanced responses by each country. “Heavily affected countries, like the DRC, will need, and will get, different solutions to those on the brink, like Burundi or Kenya or South Africa.”
But a more powerful mandate also places the Africa CDC on a collision path with global health policy movers, in particular the WHO.
In 2022, the UN agency was accused of lobbying against more autonomy for the African body. At an African Union meeting, about a dozen African health ministers appeared to regurgitate talking points from a document prepared by the WHO’s Africa office, to argue for reining in Africa CDC, Devex reported.
Friction between regional and global public health players, especially during an active emergency, would be consequential. Declaring a public health emergency is only ever one step. Routes of transmission need to be stopped, treatments developed, awareness raised – and all this needs coordinated actors and countries working together.
In the best of both worlds, a more autonomous and initiative-taking Africa CDC could lead African leaders to “take full ownership and show full commitment to addressing outbreaks on the continent without waiting for handouts from the global north,” said Ogoina.
But they will still need to try to do this without stepping too hard on the bigger toes, which mobilise most of the money needed to marshal a coordinated global response.