Editorial: Outmanoeuvre mpox

In a world that had just about managed to shake off the dust of the coronavirus pandemic, and preoccupied itself with other ‘business as usual’ phenomena such as wars, inflation, climate change, poverty, price rise, and other realities, the news regarding the outbreak of mpox in certain parts of Africa seems to have raised a spectre of doubt among the weary populace. Although mpox is technically not the answer to the dread-laden question of ‘what next?’, which followed the phase-out of COVID-19 globally, the World Health Organisation declared the virus outbreak a public health emergency of international concern, following a sudden spike in cases being recorded in some African regions.

The global health agency has reported over 15,600 mpox cases and over 500 deaths worldwide this year. The outbreak has affected 116 nations, with more than 96 per cent of all cases and deaths being reported in Congo, whose healthcare system crippled by poor infrastructure, has struggled for decades to contain disease outbreaks. Among the cases reported in June this year, Americas accounted for 19%, while 11% were reported in Europe. Last week Sweden announced the first mpox case outside Africa of the clade I variant (mostly found in central and east Africa); the clade II variant linked to more cases in west Africa.

It might be recalled that around 30 mpox cases have been detected in India since 2022. The most recent case in the country was reported in March this year. The Union Health ministry is cognizant of the fact that authorities in neighbouring Pakistan had zeroed in on a suspected case of mpox in Pakistan-occupied Kashmir this week, which took the number of people affected by the virus to four in the country. New Delhi has now issued advisories highlighting that scrutiny at airports and seaports, especially at international entry points will increase. The government has also declared three hospitals as nodal centres for the isolation, management and treatment of patients.

The contagion is being seen by many healthcare experts as yet another instance of how infectious diseases perceived to be ‘someone else’s problem’, mainly affecting the underserved, or citizens in developing countries, suddenly begins posing unforeseen global threats. There are quite a few examples of ‘neglected’ diseases which include the West Nile, Zika and Chikungunya viruses. What seems unconscionable is that the global mpox outbreak of 2022-23 had occurred in spite of repeated calls from African researchers seeking increased global investments in diagnostic, therapeutic and infection prevention tools for mpox.

The previous outbreak had brought to the fore global inequities in matters such as resource allocation and access to vaccines, diagnostics and treatments. These were made available in many industrialised nations, which helped curb the international outbreak. However, these interventions were largely lacking in most parts of Africa. This time around, analysts peg that as against 10 million doses required to control the contagion in Africa, only 0.21 million doses might be available for immediate supply. With regard to India, we are fresh from the learnings of the pandemic (vis-a-vis protocols of disease surveillance and contract tracing). We are also equipped with muscle memory of the containment of Zika and Nipah viruses in Kerala. A Pune-based biotech giant is now working on developing a vaccine for mpox in a year’s time. So, it might not be boastful to say that India is well-poised to lead a coordinated, global response to the public health challenge.