Editorial Note: The following PAN analysis is current as of Nov. 12, 2024, and based on mpox tracker data from: WHO (Updated Nov. 5, 2024), Africa CDC Mpox Briefing (Updated Nov. 5, 2024), IPPS (Updated Oct. 28, 2024), Africa CDC Mpox Dashboard (as of Week 42), Duke University (Updated Oct. 25, 2024), and Think Global Health (Updated Oct. 22, 2024).

PRIORITY RECOMMENDATIONS

• Continue to increase transparency and information-sharing on total mpox response funding and country-level allocation, as well as vaccine need, access, and delivery. Timely and aggregated information is needed on mpox response funding and allocation, along with vaccine needs and allocation to fuel transparency and accountability for donor governments, global institutions, and African countries. As coordinators of the continental and global response, Africa CDC and WHO must continue to take steps to proactively and publicly share mpox funding information. We welcome the recent launch of the Africa CDC dashboard as a needed tool for information-sharing, but critical information is still missing including: how funding is used and where, allocation decision processes, and why certain gaps remain. More information-sharing is also needed on mpox vaccine needs, as well as the composition and decision-making processes of the i-MCM-net mpox Access and Allocation Mechanism (AAM), especially to underscore allocation decisions and how up-to-date needs and epidemiological trends are fueling decision-making, grounded in equity. 

• Drive targeted, community-centered efforts for mpox vaccination and other interventions. More focus is needed to make sure interventions — from vaccines to infection prevention and control (IPC) — reach the most at-risk and vulnerable populations, including children. This will require purposeful and scaled-up efforts for community engagement with high-risk groups to co-design effective outreach strategies. Efforts must be taken to ensure campaigns are tailored to address specific concerns, counteract misinformation, and provide clear, accessible information on the risks, safety procedures, and vaccination benefits.

• Double down on non-vaccine interventions to curb the spread of mpox in vulnerable communities and high-risk settings. Focus and funding for the many other interventions that can help curb the spread of mpox at the community level, tailored to meet the needs of the most at-risk and vulnerable, is urgently needed. This includes additional community health workforce to enhance contact tracing; increased access to diagnostics; water, sanitation, and hygiene interventions; and scaled up efforts to work with communities to understand their needs and prevent the spread of infection.

SITUATION

2024 Outbreak

• 19 countries on the African continent reported 11,148 confirmed mpox cases as of Nov. 12.
• Four countries — Cameroon, Gabon, Guinea, and South Africa — have not reported confirmed cases in the last four weeks.
• Uganda continues to experience a rise in cases, with a total of 359 confirmed cases.
• Rwanda reported 20 new cases over the past week after four weeks with no new cases.
• 2,500 to 3,000 new mpox cases are reported weekly on the African continent.
• Overall, the continent has seen a 545% increase in confirmed mpox cases in 2024 compared to the whole of 2023. Confirmed cases in the Democratic Republic of the Congo (DRC) — the outbreak’s epicenter — have reached 8,662.
• Mpox has been closely linked to HIV infection, particularly in cases where HIV has been inadequately managed, with recent instances reported in Kenya and Uganda.

Response 

• The Africa CDC launched its mpox dashboard, which provides an overview of epidemiological status, programmatic response, resources (including tracking financial pledges/commitments and aligning funding with strategic pillars), and partnerships to drive the response. 
• The Africa CDC-led mpox Incident Management Support Team (IMST) allocated a budget of US$311,315,436 across multiple strategic pillars to address the outbreak. The budget’s largest portion, 24.2%, is allocated to Vaccination and Logistics, followed by Case Management at 17.9%, and IPC at 13.2%. Risk Communication and Community Engagement (RCCE) is allocated 12%. 
• The DRC received 85% of the 899,000 vaccine doses allocated to nine African countries through the mpox Access and Allocation Mechanism of i-MCM-Net, followed by Rwanda with 4% and Nigeria with 3%.
• A total of 975,700 vaccine doses have been allocated to the most affected countries through the i-MCM-Net in November and are expected to be delivered in December.
• The first round of the vaccination campaign in six DRC provinces ended on Oct. 30. Health workers achieved the highest vaccination coverage, surpassing the target at 158%, followed by sex workers at 37%. Transgender individuals and men who have sex with men (MSM) — both high-risk groups — have 10% and 9% vaccination coverage rates, respectively.

ANALYSIS

The Africa CDC Mpox Dashboard launch is a positive step toward information-sharing and transparency for the continental mpox response, as it provides some insights into resources available and their allocation. However, more information is still needed, including information on the decision-making process behind resource allocations, factors fueling funding gaps in high-need, high-burden areas, and how funding pledges are being converted into delivered commitments. This information is critical to continued resource mobilization, especially to support the greatest needs at this moment in time. 

Continued efforts to distribute mpox vaccine to affected countries is also good progress, and allocations from the i-MCM-Net AAM underscore the imperative to allocate vaccines to areas with the highest disease risks and burdens. As vaccinations continue to roll out, it remains critical to uphold focus on reaching key underserved and vulnerable populations. To ensure vaccination campaigns are most successful, barriers to vaccination — including community outreach, stigma, and mis-/dis-information — must continue to be prioritized. 

Growing evidence of the link between mpox and HIV infection brings new data to back up the deep connections between HIV-affected communities and susceptibility to emerging diseases, as well as the need for integrated health delivery approaches. It also underscores the need to take a holistic approach to reach all impacted communities, especially MSM, sex workers, and those with limited access to healthcare, who may be more at risk for both diseases and should be prioritized in mpox risk communications.

Editorial Note: The following PAN analysis is current as of Nov. 5, 2024, and based on mpox tracker data from: WHO (Updated Oct. 31, 2024), Africa CDC Mpox Briefing (Updated Oct. 31, 2024), IPPS (Updated Oct. 28, 2024), Duke University (Updated Oct. 25, 2024), and Think Global Health (Updated Oct. 22, 2024).

PRIORITY RECOMMENDATIONS

• Increase transparency and information-sharing on total mpox response funding and country-level allocation, as well as vaccine need, access, and delivery. More timely and aggregated information is needed on mpox response funding and allocation, along with vaccine needs versus donations to help drive accountability and action from donor governments, global institutions, and African countries. As coordinators of the continental and global response, Africa CDC and WHO must take steps to regularly and publicly share mpox funding information, including how it is used and where, allocation decision processes, and what gaps remain. They must also regularly share vaccine allocation information, including areas of greatest needs, where donations will go, decision processes, and what gaps and challenges hinder widespread vaccination to drive a more fulsome and equitable response.

• Targeted, community-centered efforts for mpox vaccination and other interventions. More focus is needed to make sure interventions — from vaccines to infection prevention and control (IPC) — reach the most at-risk and vulnerable populations, including children. This will require purposeful and scaled-up efforts for community engagement with high-risk groups to co-design effective outreach strategies. Efforts must be taken to ensure campaigns are tailored to address specific concerns, counteract misinformation, and provide clear, accessible information on the risks, safety procedures, and vaccination benefits.

• Double down on non-vaccine interventions to curb the spread of mpox in vulnerable communities and high-risk settings. Focus and funding for the many other interventions that can help curb the spread of mpox at the community level, tailored to meet the needs of the most at-risk and vulnerable, is urgently needed. This includes additional community health workforce to enhance contact tracing; increased access to diagnostics; water, sanitation, and hygiene interventions; and scaled up efforts to work with communities to understand their needs and prevent the spread of infection.

SITUATION

2024 Outbreak

• 19 countries on the African continent reported 10,772 confirmed mpox cases as of Nov. 5, including the first case reported in Mauritius on Oct. 26. 
• Five countries — Cameroon, Gabon, Guinea, Rwanda, and South Africa — have not reported confirmed cases in the last five weeks.
• Uganda continues to experience a rise in cases, with a total of 152 confirmed cases reported across 19 out of 146 districts to date.
• Overall, the continent has seen a 500% increase in confirmed mpox cases in 2024 compared to the whole of 2023. Confirmed cases in the Democratic Republic of the Congo (DRC) — the outbreak’s epicenter — have reached 8,585.

Response 

• Africa CDC reports that while several countries and international organizations have the funding they need to drive mpox response, several of the most high-burden countries do not.  Countries and organizations that are still short of funding needs include Burundi (at 60% of target), Africa CDC (31%), DRC (27%), Central African Republic (14%) and the International Organization for Migration (IOM) (7%).
• In Rwanda, the first vaccination campaign achieved 100% of its target. In DRC, vaccination coverage reached 103% of its target.
• Three DRC provinces that began vaccination efforts two weeks ago are progressing well with 46% coverage in Sankuru, 53.3% in Equateur, and 77.9% in Sud Ubangi.  
• A total of 898,000 MVA-BN doses have been allocated to 9 member states over the past week, with coordination between the WHO, Africa CDC, and Gavi, among others, via the mpox Access and Allocation Mechanism of the Interim Medical Countermeasures Network (i-MCM-Net).
• WHO added two additional diagnostic tests to its emergency use listing, including the Roche Molecular Systems cobas MPXV Qualitative Assay and the Cepheid Xpert Mpox Molecular Test. WHO is collaborating with manufacturers and regulatory authorities to fast-track approvals and improve access to these mpox diagnostics.
• Contact tracing remains challenging across the African continent, with an average of only 4 contacts listed per case (against the Africa CDC target of 20) and fewer than 9% of contacts under active follow-up.

ANALYSIS

Available funding may be challenging the mpox response, with reporting from Africa CDC that gaps exist across countries and organizations. It is important that donor countries and institutions who have pledged financial commitments deliver funds to fuel the response. It is similarly imperative that Africa CDC and WHO, as coordinators of the response, swiftly and publically share information on pledged funding, converted funding, and allocation and use of funds – including how decisions are made on funding allocation – to detail how funding is being used and why/where there are gaps. If significant funding gaps exist between countries, it is also imperative that Africa CDC and WHO work together to help channel funding to areas of highest need and disease burden and work to make sure capacity for mpox response is not reliant on donor preference or pre-existing partnerships and relationships. Similarly, it is promising to see the iMCM-net Mpox Access and Allocation Mechanism begin to deliver vaccine doses, but for transparency and accountability, it is critical that the platform quickly and publicly share information on how allocation decisions are being made, and by whom.

Mpox cases continue to grow across countries, including cases from travelers moving between countries and regions. Strengthening surveillance at points of entry is crucial to promptly identify and isolate potential mpox cases to prevent further spread. This requires implementing detailed screening protocols, training staff on case identification and response, and equipping entry points with adequate diagnostic tools.

Continued spread of mpox also highlights ongoing challenges in contact tracing, and underscores the need for attention and resources to close gaps and meet Africa CDC targets. More engagement continues to be needed at the community level, including  increasing the number of community health workers dedicated to contact tracing, and improved patient monitoring to uplevel outbreak management and help limit community transmission.

Editorial Note: The following PAN analysis is current as of Oct. 29, 2024, and based on mpox tracker data from: WHO (Updated Oct. 26, 2024), Africa CDC Mpox Briefing (Updated Oct. 24, 2024), IPPS (Updated Oct. 13, 2024), and Think Global Health (Updated Oct. 22, 2024)

PRIORITY RECOMMENDATIONS

1. Targeted, community-centered efforts for mpox vaccination and other interventions. More focus is needed to make sure interventions — from vaccines to infection prevention and control (IPC) — reach the most at-risk and vulnerable populations, including children. This will require purposeful and scaled-up efforts for community engagement with high-risk groups to co-design effective outreach strategies. Efforts must be taken to ensure campaigns are tailored to address specific concerns, counteract misinformation, and provide clear, accessible information on the risks, safety procedures, and vaccination benefits.
2. Double down on non-vaccine interventions to curb the spread of mpox in vulnerable communities and high-risk settings. Focus and funding for the many other interventions that can help curb the spread of mpox at the community level is urgently needed, tailored to meet the needs of the most at-risk and vulnerable. This includes increased access to diagnostics; water, sanitation, and hygiene interventions; and scaled up efforts to work with communities to understand their needs and prevent the spread of infection.
3. Increase transparency and information-sharing on total mpox response funding, and vaccine need, access, and delivery. All efforts must be taken to safely, responsibly, and equitably advance the approval and introduction of novel mpox countermeasures — especially sorely lacking diagnostics and therapeutics — and technologies designed for use in low-resource settings. This will require not only proactive communications on medical countermeasures in the pipeline and coordination to streamline Emergency Use Authorization/Emergency Use Licensing/Pre Qualification, but also proactive outreach to affected communities to build relationships, trust, and mutual understanding ahead of any rollout.

SITUATION

2024 Outbreak

• 18 countries on the African continent have reported 9,320 confirmed mpox cases as of Oct. 29. Children under 15 account for 38.1% of the confirmed cases. 
• Four countries — Cameroon, Gabon, Guinea, and South Africa — have not reported confirmed cases in the last six weeks and are considered to have transitioned into the mpox outbreak’s control phase.
• Uganda reported its first mpox death on Oct. 23 and is now ranked third among African countries with the highest confirmed case counts, surpassing Nigeria.
• In total, the continent has seen a 400% increase in confirmed mpox cases in 2024 compared to the whole of 2023. Confirmed cases in the Democratic Republic of the Congo (DRC) — the outbreak’s epicenter — have reached 7,534.
• There is a coinciding increase in mpox and measles cases among the under 15-age group in the DRC.

Response 

• Only 5.3% of the 5.39 million vaccine doses pledged have arrived in Africa to-date. 
• Three DRC provinces — Nord Kivu, Sud Kivu, and Tshopo — have been vaccinating for three weeks, achieving or even exceeding initial coverage rate targets with 138.5%, 109.3%, and 91.7%, respectively.
• DRC’s capital city, Kinshasa, is scheduled to begin vaccinations on Nov. 8.
• Vaccination efforts have started in DRC prisons and internally displaced persons (IDP) camps.
• There are no vaccines approved for children under 12 available on the African continent to date.
• The average weekly testing rate across the African continent has risen by 37% over the past three weeks.
• Seven sets of sequencing equipment and maintenance support have been provided to Burundi, Ethiopia, Kenya, Mauritania, Sierra Leone, and Zimbabwe through the Africa CDC.
• 7,000 Gene Xpert machines and cartridges from the Africa CDC and WHO have been distributed to Burundi, Cameroon, Central African Republic, Congo, Côte d’Ivoire, DRC, Kenya, Liberia, Rwanda, and Zambia, along with 11,000 qPCR tests.

ANALYSIS

The mpox response in Africa is showing some signs of progress with four countries reporting no new confirmed cases for several weeks and given new access to equipment and testing. The increase in average testing rates per week across the continent highlights increased capacities in and commitment to surveillance. However, despite advancements, there is still an urgent need for increased infection, prevention, and control interventions. 

The rise in mpox cases in Uganda is concerning and highlights the need for enhanced surveillance, preventive actions, and prompt interventions to control the outbreak within the country. Regional and global partners must strengthen efforts to partner with Uganda to help bolster capacities in disease prevention, control, and response to address this surge.

The vaccine campaign in DRC is showing promising results, especially the extension to high-risk settings like prisons and IDP camps to reach vulnerable populations often overlooked in outbreak responses. However, vaccines are just one part of an effective and equitable response. IPC and water, sanitation, and hygiene (WASH) measures remain critical to curb transmission, particularly in settings where crowding and sanitation issues heighten infection risk. 

Concurrent infections of mpox and measles in children under 15 in North and South Kivu present a serious public health concern that requires attention and study to investigate potential shared sources of infection. Strengthening IPC measures in hospitals is essential to prevent facility-based transmissions, which could be exacerbating both outbreaks. This also highlights the urgent need to expedite the approval of safe vaccines for children under 12 to help ensure that this vulnerable group is adequately protected against mpox.

Editorial Note: The following PAN analysis is current as of Oct. 22, 2024, and based on mpox tracker data from: WHO (Updated Oct. 17, 2024), Africa CDC mpox briefing (Updated Oct. 17, 2024), IPPS (Updated Oct. 13, 2024), and Think Global Health (Updated Oct. 8, 2024)

PRIORITY RECOMMENDATIONS

1. Targeted, community-centered efforts for mpox vaccination and other interventions. More focus is needed to make sure interventions — from vaccines to IPC — reach the most at-risk and vulnerable populations. This will require purposeful and scaled-up efforts for community engagement with high-risk groups to co-design effective outreach strategies. Efforts must be taken to ensure campaigns are tailored to address specific concerns, counteract misinformation, and provide clear, accessible information on the risks, safety procedures, and vaccination benefits. 
2. Double down on non-vaccine interventions to curb the spread of mpox in vulnerable communities and high-risk settings. Focus and funding for the many other interventions that can help curb the spread of mpox at the community level is urgently needed. This includes increased access to diagnostics; water, sanitation, and hygiene interventions; and scaled up efforts to work with communities to understand their needs and prevent the spread of infection.
3. Increase transparency and information-sharing on total mpox response funding, and vaccine need, access, and delivery. All efforts must be taken to safely, responsibly, and equitably advance the approval and introduction of novel mpox countermeasures — especially sorely lacking diagnostics and therapeutics — and technologies designed for use in low-resource settings. This will require not only proactive communications on medical countermeasures in the pipeline and coordination to streamline Emergency Use Authorization/Emergency Use Licensing/Pre Qualification, but also proactive outreach to affected communities to build relationships, trust, and mutual understanding ahead of any rollout.

SITUATION

2024 Outbreak

• 18 countries in Africa have reported mpox cases as of Oct. 22, including the first case reported in Zimbabwe on Oct 12.
• Kenya recorded its first mpox related death on Oct. 14, and there have been a total of 1,100 confirmed deaths in Africa since the beginning of the year. 
• In total, the continent has seen a 380% increase in confirmed cases of mpox in 2024 compared to the whole of 2023. Confirmed cases in the Democratic Republic of the Congo (DRC) — the outbreak’s epicenter — have reached 6,962.
• Two Ugandan prisons reported mpox cases, the first prisons to do so during this outbreak.

Response 

• Vaccination campaigns in Rwanda and the DRC are ongoing. 
• 20,897 people have been vaccinated in three DRC provinces, with an overall coverage of 31%. The vaccination rates are 63% in Sud Kivu, 72% in Nord Kivu, and 91% in Tshopo.
• Health workers in the DRC have the highest vaccination coverage in the country, representing 27% of the total vaccinated population, followed by sex workers at 14%. Men who have sex with men (MSM), a high-risk group, has a vaccination coverage of 1%.
• 500 people have been vaccinated in Rwanda as of Oct. 12. 

ANALYSIS

The continued uptick of mpox cases highlights that strengthening mpox prevention and control strategies across the African continent remains urgent. Resources and interventions must be unlocked to help more effectively limit the spread of mpox, especially in vulnerable communities. Expanding community outreach and raising public awareness are essential interventions that need to be scaled.

Vaccine campaigns in DRC and Rwanda are off to promising starts, however, the efforts to-date reveal notable disparities in vaccine uptake among high-risk populations. Vaccination rates among MSM and sex workers are especially low, signaling the range of barriers these groups face in accessing vaccines and other interventions, including stigma, misinformation, and legal challenges. While many of these barriers have been known, the data underscores the need to double down on targeted strategies to reach the most at-risk populations, wherever they are and however they present, to meaningfully control the outbreak. 

The recent detection of mpox in overcrowded environments — like prisons — also highlights the critical need to enhance non-vaccine mpox interventions, such as bolstered WASH infrastructure, effective infection prevention and control (IPC), and improved capacities for the rapid identification and isolation of cases. These environments often lack essential resources, which fosters optimal conditions for a virus to spread. 

Editorial Note: The following PAN analysis is current as of Oct. 16, 2024 and based on mpox tracker data from WHO (Updated Oct. 13, 2024), Think Global Health (Updated Oct. 8, 2024), and IPPS (Updated Sept. 27, 2024).

PRIORITY RECOMMENDATIONS

• Increase transparency and information-sharing on total mpox response funding, and vaccine need, access, and delivery.  More timely and aggregated information is needed on mpox response funding and vaccine needs vs. donations to help drive accountability and action from donor governments, global institutions, and African countries. As coordinators of the continental and global response, Africa CDC and WHO must take steps to regularly and publicly share how mpox funding is being used and where, and what funding gaps remain. They must also regularly share information on where vaccines are most needed, where donations will go, how vaccine allocation decisions are made, and what gaps or challenges are hindering widespread vaccination to drive a more fulsome and equitable response.
• Double down on non-vaccine interventions to curb the spread of mpox in vulnerable communities. Focus and funding for the many other interventions that can help curb the spread of mpox at the community level is urgently needed. This includes increased access to diagnostics; water, sanitation, and hygiene interventions; and scaled up efforts to work with communities to understand their needs and prevent the spread of infection.
• Commitment and action to streamline novel countermeasure approval and introduction. All efforts must be taken to safely, responsibly, and equitably advance the approval and introduction of novel mpox countermeasures — especially sorely lacking diagnostics and therapeutics — and technologies designed for use in low-resource settings. This will require not only proactive communications on medical countermeasures in the pipeline and coordination to streamline Emergency Use Authorization/Emergency Use Licensing/Pre Qualification, but also proactive outreach to affected communities to build relationships, trust, and mutual understanding ahead of any rollout.

SITUATION

2024 Outbreak

• Mpox cases are increasing across the African continent, including within Zambia and Ghana where first cases were detected last week.
• The majority of cases — 60% of all cases — have been reported among men.
• Children under five years old continue to represent a significantly affected age group, especially in the Democratic Republic of the Congo (DRC) where they account for 28.1% of cases.
• The DRC remains the outbreak’s epicenter; confirmed cases have reached 6,169 with 25 deaths and 31,350 suspected cases.
• Burundi and Nigeria, the countries with the next highest infection levels, have not reported any deaths.

Response

• Only 5.23% of the 5.39 million vaccine doses pledged have arrived in Africa to-date.
• Vaccination campaigns started in Rwanda and the DRC, targeting frontline health workers, mpox patient’s close contacts, sex workers, and immunocompromised individuals.
• The DRC vaccination campaign is focused on 11 of the most affected zones in Equateur, North Kivu, Sankuru, South Kivu, Sud-Ubangi, and Tshopo provinces.
• The MVA-BN vaccine remains the only vaccine approved by the WHO for mpox. On Oct. 8, 2024, WHO granted prequalification for extending the vaccine’s use from individuals 18 and up to also include those aged 12 to 17 years.
• No therapeutics have received WHO approval, though clinical trials for the drug tecovirimat are currently in progress.
• Mpox testing remains challenging due to cost and access to PCR tests. The Emergency Use Listing (EUL) for the Alinity m MPXV assay (Oct. 3) is an encouraging step toward expanding diagnostic capacity and access. As of Oct. 10, WHO is in the process of reviewing four requests for diagnostic manufacturing approvals related to mpox​.

ANALYSIS

Mpox continues to spread in Africa highlighting that despite increased response coordination efforts the outbreak remains uncontained. Reported deaths are relatively low, suggesting more mild infections, but continued challenges accessing diagnostics may mask true case counts. Action is still needed to help detect and prevent mpox spread in communities, requiring up-leveled efforts to increase availability and use of diagnostics, support enhanced sanitation and hygiene practices, and bolster communications efforts that work with communities most at risk of infection.

Progress to advance new mpox countermeasures, while promising, remains slow and highlights the challenges of developing, testing, and approving new countermeasures during an active emergency. Continued efforts to advance emergency use authorities for new diagnostics, therapeutics, and vaccines are vital to get tools to all people who need them most efficiently, as is proactive community engagement to work with communities on best strategies for introducing novel tools for widespread uptake.

The total number of pledged vaccine donations remains a positive signal that high-income countries are paying attention to the mpox emergency. However, pledged donations are still far below the need outlined by Africa CDC, and delivery timelines are unclear. This situation reflects several ongoing and complex challenges: countries with vaccine stockpiles are uncertain about future disease trajectory and want to maintain capacity for possible domestic needs; continued uncertainty on how and where to deliver mpox vaccines, where vaccines are most needed, and who is managing allocation decisions and delivery logistics; and possible differences of opinion on total vaccine doses needed to contain the current mpox emergency in central Africa. All these challenges reaffirm that vaccine donation is not the best way to ensure an accessible, equitable, and timely response, and not the mechanism the world should rely on for public health emergencies. The global community must simultaneously solve the mpox vaccine access challenge for the current emergency — including increased and more transparent vaccine donations — and develop better systems for timely access to affordable vaccines and other countermeasures for the future.