The Curious Case of Mpox in Africa: How Prepared Are We Really?

Africa is no stranger to infectious diseases, but when mpox (formerly known as monkeypox) decided to crash the party, it brought along new challenges and a few surprises. From its traditional haunt of rural forests to the bustling urban chaos of Kinshasa, this is a story of epidemiological evolution, neglected vaccination programs, and a pandemic playbook that Africa urgently needs to revise. Let’s take a deep dive—and hopefully, some humor will make it a bit more bearable—into what’s happening and how we can prepare better.

A Sneaky Virus on the Loose

Mpox is, frankly, making a name for itself. While it used to be the shy cousin of smallpox, lurking around in dense rainforests, it’s now enjoying the urban limelight in Kinshasa, the Democratic Republic of the Congo (DRC). The numbers are staggering—the DRC alone reported over 25,000 suspected cases this year, which accounts for 90% of Africa's total mpox cases. Imagine if your neighbor suddenly started occupying 90% of your yard! It’s clear that mpox is feeling quite at home in the DRC’s capital.

But what changed? Why did mpox pack its bags and move to the city? Well, first of all, Kinshasa's population density plays a huge role. With 17 million people packed into one of Africa’s largest cities, social distancing is as rare as a unicorn sighting. In urban areas like Kinshasa, the virus gets a free ride from one person to the next without even having to try.

Vaccination Gaps and New Tricks

Let’s take a walk down memory lane to the 1970s when mpox first appeared in the DRC. Back then, smallpox vaccination was still a thing, and guess what? It also provided cross-protection against mpox. But after smallpox was eradicated, we decided to retire the vaccines and, like an unfinished Netflix series, left a cliffhanger for viruses like mpox. With four decades of unvaccinated individuals, adults are now more susceptible than ever. The DRC, unfortunately, has become a glaring case study of what happens when vaccination programs take a back seat.

Adding to the complexity, we’re seeing a shift in transmission dynamics. Mpox isn’t just sticking to its old habits of spreading via animals or contaminated surfaces. Nope, it’s joined the 21st century by also spreading through sexual contact. The clade Ib variant, notorious for its urban exploits, has been detected in Kinshasa and is making itself quite comfortable within social and sexual networks. It’s almost like mpox decided to reinvent itself for a more “modern audience.”

The Healthcare Struggle: Playing Catch-Up Across the Region

Mpox's spread hasn't been limited to the DRC alone; neighboring countries such as Rwanda, Tanzania, Kenya, and Burundi have also reported cases, and the virus has even extended further abroad. The healthcare systems across these countries, much like the DRC, are struggling to keep up with the demands posed by this outbreak. This regional spread of mpox serves as a crucial test case in pandemic preparedness, especially as we still grapple with the lingering effects of COVID-19.

Now, picture this: you have healthcare systems across multiple countries already stretched thin, and on top of that, you throw in 25,000 suspected mpox cases in the DRC alone. The healthcare infrastructure in these countries is facing a massive uphill battle. The diagnostic capacity is, to put it bluntly, not great—only about 20% of suspected cases are confirmed due to limited resources and overlapping symptoms with diseases like chickenpox. It’s as if healthcare workers are trying to find a needle in a haystack, except there are thousands of haystacks, and the needles keep moving.

To make matters worse, the contact tracing efforts across the region are woefully insufficient. You know that game where you try to follow a piece of string through a maze? Now imagine that half the string is missing. That’s what contact tracing looks like in Kinshasa and the surrounding countries. Without enough data on who’s been in contact with whom, containing the spread becomes an almost impossible challenge.

The Bigger Picture: Preparing for Pandemics

This mpox crisis highlights the need for greater regional and global coordination. Organizations like Africa CDC (Africa Centres for Disease Control and Prevention) play a pivotal role in leading public health efforts across the continent. Africa CDC's initiatives, such as developing unified pandemic response strategies and building local healthcare capacity, are essential for improving Africa's preparedness.

However, pandemics like mpox and COVID-19 remind us that health crises are not just regional problems—they are global threats. A virus knows no borders, and neither should our response. The World Health Organization (WHO) and other international bodies must continue supporting Africa's health systems, not only because it's the right thing to do, but because it also protects global health. Collaborative efforts, shared resources, and knowledge exchange are crucial for preventing outbreaks from becoming pandemics that affect everyone.

Leaving Africa to fend for itself while others assume safety is a dangerous misconception. The interconnectedness of today's world means that what affects one region ultimately impacts us all. Global solidarity and investment in robust health systems are the only sustainable ways to tackle pandemics effectively.

This mpox crisis is a clear reminder that pandemic preparedness in Africa needs to level up, and fast. We’ve learned some hard lessons from COVID-19, but it seems like the same mistakes are repeating themselves. Limited diagnostics, inadequate surveillance, and underfunded healthcare systems have turned mpox from a minor annoyance into a significant threat.

What’s needed now is a comprehensive approach that addresses these gaps. Here’s a short wish list for better pandemic preparedness in Africa:

1. Revive Vaccination Programs: Vaccines work. Period. The smallpox vaccine provided some immunity against mpox, and investing in targeted vaccination campaigns could help prevent future outbreaks.

2. Improve Diagnostic Capabilities: Currently, confirming only 20% of suspected cases isn’t cutting it. Strengthening lab infrastructure and training healthcare workers to quickly identify and report mpox cases should be a top priority.

3. Effective Surveillance and Contact Tracing: Imagine trying to fight a fire without knowing where it’s spreading. Investing in digital tools for surveillance and improving contact tracing protocols will help us contain outbreaks before they spread uncontrollably.

4. Community Engagement: Public awareness campaigns, especially in densely populated cities like Kinshasa, could make a world of difference. People need to know how mpox spreads and what they can do to protect themselves.

5. Integrate Sexual Health in Outbreak Response: Given the increasing role of sexual transmission in mpox spread, educating people on sexual health and incorporating sexual health services into the outbreak response can help curb new cases.

Africa Can (and Should) Do Better

To effectively combat pandemics, it's crucial that all stakeholders in the health and research ecosystem step up, beyond relying solely on government systems. Africa CDC, alongside research institutions like KEMRI (Kenya Medical Research Institute), MRCs (Medical Research Councils) across Africa, national disease surveillance centers, and regional universities, all have a significant role to play. Institutions such as APHRC (African Population and Health Research Center) should be proactive in leading research, public awareness campaigns, and evidence-based policy formulation.

These institutions need to leverage their expertise, engage in rigorous surveillance, contribute to diagnostics, and develop actionable insights to improve health outcomes. Collaborative efforts among research bodies, academia, and public health organizations are key to building a more resilient health system. Africa cannot afford to leave the heavy lifting to governments alone; the combined power of these institutions can pave the way for a robust and sustainable pandemic response framework.

The reality is that pandemics are not going anywhere, but Africa can be ready. It’s about more than just throwing resources at the problem; it’s about building systems that are resilient enough to handle the next big outbreak. Mpox has shown us the cracks in our current strategy, but it’s also given us a chance to fix them.

And hey, if a virus like mpox can reinvent itself for the urban crowd, then Africa can surely reinvent how it tackles pandemics. It’s time to stop playing catch-up and start leading the way in public health preparedness. After all, when it comes to pandemics, being ahead of the curve is the only safe place to be.