By Esther Claudette Gittens | Editorial Credit: Mia Studio / shuterstock.com

As the world continues to grapple with the challenges posed by emerging infectious diseases, Mpox serves as a reminder of the importance of global cooperation, scientific innovation, and equitable access to healthcare. By working together, the global community can prevent Mpox
from becoming the next global health crisis and ensure a safer, healthier future for all.

Mpox: A Comprehensive Analysis of Its Evolution, Global Scientific Response, Funding, and Potential Consequences

Mpox, historically known as monkeypox, has rapidly transitioned from being a relatively obscure zoonotic disease confined to specific regions in Africa to a global health concern with the potential to cause widespread outbreaks. This disease, caused by the monkeypox virus, a member of the Orthopoxvirus genus, is closely related to smallpox, a virus that was eradicated in 1980. However, unlike smallpox, Mpox has not been contained and is now evolving at an alarming rate, raising concerns among global health authorities, scientists, and governments.

The recent surge in Mpox cases, particularly outside its traditional endemic regions, has highlighted the need for an urgent and coordinated global response. African and international scientists are working tirelessly to understand the virus’s evolving nature, develop effective vaccines and treatments, and implement robust public health measures. However, the adequacy of funding, the role of the World Health Organization (WHO), and the potential consequences of an uncontrolled spread of Mpox remain critical areas of concern.

This analysis delves into the evolution of Mpox, examines how the scientific community is responding, evaluates the current state of funding for research and public health efforts, and considers the potential global consequences if the disease continues to spread without effective intervention. It also explores the WHO’s response to the crisis and its role in coordinating international efforts to combat Mpox.

1. What is Mpox?
1.1. Historical Background and Origins
Mpox was first identified in 1958 when outbreaks occurred in colonies of monkeys kept for research, leading to the name “monkeypox”. The first human case was recorded in 1970 in the Democratic Republic of the Congo (DRC), during a period when smallpox was being eradicated. The disease is caused by the monkeypox virus, which belongs to the Ortho poxvirus genus, the same family as the variola virus (which causes smallpox), cowpox virus, and vaccinia virus.

Mpox primarily affects wild animals, particularly rodents and primates, and is transmitted to humans through direct contact with the blood, bodily fluids, or skin lesions of infected animals. Human-to-human transmission can also occur, primarily through respiratory droplets, direct contact with infected bodily fluids, or contaminated materials. The virus can enter the body through broken skin, the respiratory tract, or mucous membranes (eyes, nose, or mouth).

1.2. Clinical Presentation and Symptoms
Mpox typically presents with symptoms similar to those of smallpox, although it is generally less severe. The incubation period (from infection to symptoms) is usually 7 to 14 days but can range from 5 to 21 days. The disease begins with a fever, headache, muscle aches, and exhaustion.

Within 1 to 3 days after the onset of fever, patients develop a rash that often starts on the face before spreading to other parts of the body. The rash progresses through several stages, from macules (flat lesions) to papules (raised lesions), vesicles (fluid-filled lesions), and pustules,
before finally scabbing over and falling off. Other symptoms may include lymphadenopathy (swollen lymph nodes), which is a distinguishing feature of Mpox compared to smallpox.

The severity of the disease can vary, with most cases being self-limiting and resolving within 2 to 4 weeks. However, severe cases can occur, particularly in children, pregnant women, and immunocompromised individuals, with complications including secondary infections, respiratory distress, and, in some cases, death.

1.3. Epidemiology and Geographic Distribution
Historically, Mpox was considered endemic to Central and West Africa, with the majority of cases reported in rural areas of the DRC, Nigeria, Cameroon, and the Central African Republic. The virus circulates primarily in animal reservoirs, with occasional spillover into human
populations. Human outbreaks were relatively rare and typically occurred in remote areas with limited access to healthcare, which contributed to the underreporting of cases.

However, in recent years, there has been a notable increase in Mpox cases outside of Africa, raising concerns about the virus’s potential to spread globally. Notable outbreaks have occurred in the United States, the United Kingdom, Israel, and several European countries, indicating that the virus may be adapting to human-to-human transmission more effectively than before.

2. The Rapid Evolution of Mpox2.1. Genetic Evolution and Variants
The rapid evolution of Mpox has become a major focus of scientific research. Genetic sequencing of the virus from recent outbreaks has revealed mutations that may contribute to its increased transmissibility and virulence.

These genetic changes have raised concerns about the potential for the virus to evolve further, possibly leading to more severe disease or increased resistance to existing vaccines and treatments. One of the key findings from recent studies is the identification of two distinct clades (genetic lineages) of the Mpox virus: the West African clade and the Central African (Congo Basin) clade.

The Central African clade is associated with more severe disease and higher mortality rates, while the West African clade, which has been responsible for recent outbreaks outside of Africa is generally less virulent but still capable of causing significant illness. The evolution of these clades and the emergence of new variants underscore the need for ongoing genetic surveillance to monitor the virus’s evolution and to inform public health strategies.

2.2. Changes in Transmission Dynamics
Recent outbreaks of Mpox have shown that the virus’s transmission dynamics are changing. In the past, human-to-human transmission was relatively rare and typically occurred in households or healthcare settings where close contact with an infected person was more likely. However,
recent outbreaks suggest that the virus may be spreading more efficiently between humans, potentially through mechanisms that are not yet fully understood.

Factors contributing to these changes in transmission dynamics may include increased urbanization, which brings humans into closer contact with animal reservoirs, and changes in human behavior, such as increased travel and mobility. Additionally, the waning immunity to smallpox in the global population, following the cessation of routine smallpox vaccination after the disease’s eradication, may also be playing a role in the increased susceptibility to Mpox.

2.3. Increased Severity of Disease
While Mpox was traditionally considered a mild disease, recent outbreaks have shown that it can cause more severe illness than previously thought, particularly in vulnerable populations. Cases of severe Mpox have been reported among children, pregnant women, and individuals with weakened immune systems, such as those living with HIV/AIDS.

The increased severity of the disease has led to concerns that the virus may be evolving in ways that enhance its pathogenicity. This possibility highlights the need for further research to understand the factors contributing to the severity of Mpox and to develop targeted interventions to protect at-risk populations.

3. The Global Scientific Response to Mpox
3.1. African Scientists Leading the Charge
African scientists have played a crucial role in advancing our understanding of Mpox, given the disease’s long history on the continent. Researchers in countries like the DRC, Nigeria, and Cameroon have been at the forefront of efforts to characterize the virus, track its spread, and develop strategies for controlling outbreaks.

For example, during the 2017 Mpox outbreak in Nigeria, which marked the country’s first reported cases in nearly four decades, Nigerian scientists quickly mobilized to investigate the outbreak. They conducted field studies to identify the source of the infection, collected samples for genetic sequencing, and collaborated with international partners to develop diagnostic tools
and treatment protocols.

These efforts have been critical in informing the global response to subsequent Mpox outbreaks and have demonstrated the importance of local expertise and leadership in addressing emerging infectious diseases.

3.2. International Collaboration and Research Initiatives
The global scientific community has recognized the need for international collaboration in addressing Mpox. In response to the recent surge in cases, the WHO and other global health organizations have launched initiatives to coordinate research efforts, share data, and develop
strategies for controlling the disease.

One of the key areas of focus has been the development of vaccines and therapeutics. Although the smallpox vaccine provides some protection against Mpox, it is not widely available, especially in regions most affected by the disease. As a result, efforts have been made to develop Mpox-specific vaccines and antiviral treatments. The MVA-BN (Modified Vaccinia Ankara-Bavarian Nordic) vaccine, which has shown promise in preventing Mpox, is one such example.

In addition to vaccine development, researchers are also exploring the use of antiviral drugs, such as tecovirimat, which has been approved for the treatment of smallpox and is being investigated for its potential use against Mpox. Clinical trials are underway to assess the safety and efficacy of these treatments in Mpox patients.

3.3. Advances in Diagnostics and Surveillance
Accurate and timely diagnosis is essential for controlling the spread of Mpox. African and international scientists have made significant strides in developing and deploying diagnostic tools that can detect Mpox quickly and accurately. These tools include polymerase chain reaction
(PCR) tests, which can identify the virus’s genetic material, and serological tests, which detect antibodies against the virus. Enhanced surveillance is also critical for detecting and responding to Mpox outbreaks. Countries in Africa, with support from international organizations, have been working to strengthen their surveillance systems, often leveraging technology such as mobile health platforms and data analytics to improve the detection and tracking of cases. The integration of these diagnostic and surveillance tools into public health systems has been a key factor in the early detection of Mpox outbreaks and the implementation of timely interventions to prevent further spread.

4. Funding for Mpox Research and Public Health Responses
4.1. The Current Funding Landscape

Adequate funding is essential for effective research, vaccine development, public health responses, and global coordination in combating Mpox. However, funding for Mpox has historically been limited, particularly in Africa, where the disease is most prevalent. In recent years, there has been an increase in funding from international donors, governments, and global health organizations. The WHO, the Centers for Disease Control and Prevention (CDC), and the Bill & Melinda Gates Foundation have provided financial and technical support for Mpox research and public health initiatives. However, the funding remains insufficient given the scale of the threat. The COVID-19 pandemic has further strained global health resources, with many governments and organizations prioritizing funding for COVID-19 research and response efforts. This shift in
focus has led to concerns that funding for other infectious diseases, including Mpox, may be neglected.

4.2. Challenges in Securing Sustainable Funding

One of the main challenges in securing sustainable funding for Mpox research and response efforts is the competition for resources with other global health priorities, such as COVID-19, HIV/AIDS, and malaria. Donor fatigue and shifting political priorities also pose significant barriers. Additionally, the perception of Mpox as a “neglected” tropical disease that primarily affects low-income countries has contributed to the lack of sustained funding. This perception undermines the urgency of addressing Mpox, despite its potential to spread globally. There is also the challenge of ensuring that funding reaches the areas where it is most needed. In many African countries, weak health systems, limited infrastructure, and bureaucratic inefficiencies can hinder the effective allocation and utilization of funds for Mpox research and response efforts.

4.3. The Role of Governments and International Organizations

Governments and international organizations play a crucial role in providing funding and resources for Mpox research and response efforts. African governments, in particular, have been called upon to increase their investment in health systems and disease surveillance to better respond to outbreaks.

International organizations, such as the WHO, the World Bank, and the African Union, have been instrumental in mobilizing resources and coordinating global efforts to combat Mpox. These organizations have also advocated for increased funding from high-income countries to support research, vaccine development, and public health interventions in Africa.

The WHO has launched several initiatives to address the funding gap for Mpox, including the establishment of emergency funding mechanisms and the creation of partnerships with private sector organizations and philanthropic foundations. These efforts aim to ensure that adequate resources are available to support the global response to Mpox and to prevent future outbreaks.

5. Consequences of Unchecked Spread of Mpox

5.1. Public Health Implications for Africa

If Mpox continues to spread without effective control measures, the public health implications for Africa could be severe. The virus’s ability to cause outbreaks in both urban and rural settings, coupled with the limited access to healthcare and vaccines in many African countries, could lead to widespread illness and death.

Mpox could also exacerbate existing health disparities in Africa, as marginalized communities are often the most affected by infectious diseases. The strain on already fragile healthcare systems could further undermine efforts to control other diseases, such as malaria, tuberculosis, and HIV/AIDS.

The unchecked spread of Mpox could also lead to the emergence of new variants that are more transmissible or virulent, potentially leading to more severe outbreaks and higher mortality rates. This scenario underscores the importance of early detection, rapid response, and sustained investment in public health infrastructure to prevent the spread of the virus.

5.2. Global Health Risks

The global health risks associated with the unchecked spread of Mpox are significant. As demonstrated by the COVID-19 pandemic, infectious diseases can quickly spread across borders, leading to global health crises. Mpox, with its potential for human-to-human transmission and evolving epidemiology, could follow a similar trajectory if not contained.

The spread of Mpox to non-endemic regions could strain healthcare systems, disrupt economies, and lead to widespread panic. The lack of widespread immunity in the global population, particularly among younger generations who have not been vaccinated against smallpox, could result in higher transmission rates and more severe outbreaks.

In addition to the direct health impacts, the spread of Mpox could also have broader implications for global health security. The emergence of new infectious diseases poses a constant threat to global stability, and the unchecked spread of Mpox could undermine efforts to strengthen global health systems and preparedness.

5.3. Economic and Social Consequences

The economic and social consequences of a global Mpox outbreak could be profound. Disruptions to trade, travel, and commerce could lead to economic downturns, particularly in countries heavily reliant on tourism and international trade. In addition, the social impact of widespread illness and death could lead to increased social unrest, displacement, and weakened governance.

In Africa, where many countries are already grappling with economic challenges, the spread of Mpox could exacerbate poverty, food insecurity, and political instability. The economic burden of responding to repeated outbreaks, coupled with the potential loss of productivity due to illness, could set back development efforts by decades.

The spread of Mpox could also have long-term social consequences, particularly if the virus disproportionately affects vulnerable populations. The loss of life, social disruption, and economic hardship resulting from a widespread outbreak could have lasting effects on communities and countries, further exacerbating existing inequalities and challenges.

6. The Role of the World Health Organization (WHO) in Responding to Mpox

6.1. WHO’s Role in Coordinating the Global Response

The WHO has been at the forefront of the global response to Mpox, providing leadership, technical guidance, and coordination to countries and regions affected by the virus. The organization has played a critical role in raising awareness about the disease, mobilizing resources, and coordinating international efforts to prevent and control outbreaks.

One of the key components of the WHO’s response to Mpox has been the development of the Research and Development (R&D) Blueprint for Mpox. This initiative brings together scientists, public health experts, and policymakers to accelerate the development of vaccines, therapeutics, and diagnostic tools for Mpox. The R&D Blueprint also facilitates the sharing of data and research findings, enabling a coordinated and evidence-based approach to controlling the disease.

The WHO has also worked closely with countries to strengthen their capacity to detect and respond to Mpox outbreaks. This includes providing technical support for surveillance, diagnostics, and case management, as well as helping countries develop and implement national Mpox preparedness plans.

6.2. WHO’s Efforts to Secure Funding and Resources

Securing adequate funding and resources for the global response to Mpox has been a top priority for the WHO. The organization has launched several initiatives to address the funding gap, including the establishment of emergency funding mechanisms and the creation of partnerships with private sector organizations and philanthropic foundations.

The WHO has also advocated for increased funding from high-income countries to support research, vaccine development, and public health interventions in low- and middle-income countries. This includes efforts to ensure that vaccines and treatments are accessible to those most in need, particularly in regions where Mpox is endemic.

In addition to securing funding, the WHO has worked to ensure that resources are allocated where they are most needed. This includes providing technical assistance to countries to help them prioritize their Mpox response efforts and ensure that resources are used effectively.

6.3. WHO’s Role in Public Communication and Advocacy

Effective public communication and advocacy are critical components of the WHO’s response to Mpox. The organization has worked to raise awareness about the disease, educate the public about the risks, and provide clear and accurate information about prevention and treatment.

The WHO has also engaged in advocacy efforts to ensure that Mpox remains a priority on the global health agenda. This includes working with governments, international organizations, and civil society to highlight the importance of addressing Mpox and to mobilize political and financial support for the global response.

In addition to its public communication efforts, the WHO has worked to combat misinformation and stigma associated with Mpox. This includes providing accurate information about the disease, addressing misconceptions, and promoting understanding and empathy for those affected by Mpox.

7. Strategies for Controlling Mpox and Preventing Future Outbreaks

7.1. Strengthening Health Systems and Surveillance

To effectively control Mpox and prevent future outbreaks, there is a need to strengthen health systems and surveillance in both endemic and non-endemic regions. This includes improving access to healthcare, enhancing disease surveillance, and building the capacity of healthcare workers to respond to outbreaks.

In Africa, where health systems are often under-resourced, international support will be critical in providing the necessary infrastructure, training, and resources. Investment in technology, such as mobile health platforms and data analytics, can also play a crucial role in improving surveillance and response efforts.

Enhanced surveillance systems can help detect outbreaks early, monitor the spread of the virus, and implement timely interventions to prevent further transmission. This includes the use of real-time data collection, geographic information systems (GIS), and predictive modeling to track the virus and identify high-risk areas.

7.2. Enhancing Vaccine Development and Distribution

The development and distribution of vaccines will be crucial in preventing the spread of Mpox. While the smallpox vaccine offers some protection against Mpox, there is a need for Mpox-specific vaccines that can be produced and distributed at scale.

Efforts should focus on accelerating the development of new vaccines, ensuring equitable access to existing vaccines, and addressing logistical challenges related to vaccine distribution.

International cooperation will be essential in ensuring that vaccines reach the most vulnerable populations, particularly in low-income countries. In addition to vaccine development, it is important to ensure that vaccination strategies are tailored to the needs of different populations. This includes prioritizing high-risk groups, such as healthcare workers, close contacts of confirmed cases, and individuals in areas with ongoing transmission.

7.3. Promoting Global Cooperation and Coordination

Global cooperation and coordination will be key in controlling the spread of Mpox and preventing future outbreaks. This includes sharing data and research findings, coordinating public health responses, and ensuring that resources are allocated where they are needed most.

International organizations, such as the WHO, must continue to play a leading role in coordinating global efforts, while also advocating for increased funding and political commitment to combat Mpox.

Regional organizations, such as the African Union, can also play a vital role in coordinating efforts within Africa and mobilizing resources. Collaboration between countries is essential in addressing the cross-border spread of Mpox and ensuring that all countries have the capacity to respond to outbreaks. This includes sharing best practices, providing technical assistance, and supporting capacity-building efforts in low- and middle-income countries.

7.4. Addressing Socioeconomic Determinants of Health

Addressing the socioeconomic determinants of health, such as poverty, education, and access to clean water, will be essential in preventing the spread of Mpox and other infectious diseases. Efforts should focus on improving living conditions, reducing health disparities, and strengthening community resilience to health crises.

In Africa, where many communities face significant socioeconomic challenges, addressing these determinants will be critical in preventing the spread of Mpox and other infectious diseases. International support, coupled with strong political commitment from African governments, will be essential in addressing these challenges.

In addition to addressing the root causes of health disparities, it is important to ensure that public health interventions are inclusive and equitable. This includes engaging communities in the design and implementation of public health programs, addressing barriers to access, and promoting health literacy and education.

8. Conclusion

Mpox is rapidly evolving from a relatively obscure zoonotic disease into a global health threat with the potential to cause widespread outbreaks. The rapid evolution of the virus, changes in transmission dynamics, and increased severity of the disease underscore the urgency of a coordinated and well-funded global response.

African and international scientists have made significant strides in understanding the virus, developing vaccines and treatments, and improving diagnostics and surveillance. However, much work remains to be done, particularly in securing sustainable funding, strengthening health systems, and ensuring equitable access to healthcare.

The WHO has played a critical role in coordinating the global response to Mpox, providing leadership, technical guidance, and resources to countries affected by the virus. However, the potential consequences of an unchecked spread of Mpox, both in Africa and globally, are significant. These include severe public health impacts, economic and social disruption, and the risk of new variants emerging that could further complicate efforts to control the disease.

As the world continues to grapple with the challenges posed by emerging infectious diseases, Mpox serves as a reminder of the importance of global cooperation, scientific innovation, and equitable access to healthcare. By working together, the global community can prevent Mpox from becoming the next global health crisis and ensure a safer, healthier future for all.

  Emerging Diseases, Epidemiology, Global Cooperation, Global Health, Health Funding, Infectious Diseases, monkeypox, Mpox, public health, Scientific Research, Vaccine Development, WHO