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Description of the crisis
Many African countries are experiencing an introduction or upsurge of mpox (formerly known as monkeypox).
There has been a dramatic increase in cases in the Democratic Republic of the Congo (DRC), Burundi and now Uganda; and epidemics are re-emerging or growing in previously endemic countries. These developments, linked with an increased risk profile amongst the population due to poverty and strained access to health services, and almost non-existent supply of mpox related vaccines, led organisations such as the Africa Centres for Disease Control and Prevention and the World Health Organisation to declare this epidemic a public health emergency of continental and international concern. The IFRC joined these organisations in raising the alert through a statement and activated internal coordination mechanisms to enhance preparedness and scale-up response.
As of 20 November 2024, 21 countries have reported 13 735 confirmed cases, including 64 deaths in 2024.
Burundi, Nigeria and Uganda are the most affected countries after DRC. A new strain of the virus, called Clade 1b, is causing outbreaks in previously unaffected areas of DRC and has spread to countries that had not previously reported mpox. In endemic countries such as Nigeria, Central African Republic, Cameroon and Cote d’Ivoire, outbreaks are slowly expanding or have re-emerged. Meanwhile the 2022 global epidemic also continues and has expanded into South Africa. This makes it the first time that mpox cases and sustained transmission is reported concurrently in endemic and non-endemic countries and with multiple Clades (Clade 1a, 1b and 2) in different geographical areas.
The virus is endemic in West and Central Africa, however since 2022 there were outbreaks in countries outside of the endemic areas. In countries with a longer history of mpox, apparent wider population transmission is occurring compared to previous years, with unclear routes. Two different Clades exist: Clade 1 and 2. Clade 1, endemic to Central Africa, has historically been associated with more severe disease and higher mortality rate and has shown higher transmission rates compared to Clade 2. Clade 1a has been present in West and Central Africa for years, while Clade 1b was first identified in September 2023, in Eastern DRC where mpox is not endemic. The new Clade 1b has so far resulted in high caseloads among sex workers and the broader population, including children, and is rapidly spreading to East African countries.
The increasing concern over zoonotic diseases—viruses that spread from animals to humans—has a documented link to climate change and environmental degradation. Key factors contributing to this issue include rising temperatures, deforestation, land clearance, habitat loss, and pollution. The World Health Organization’s One Health initiative underscores how environmental changes are impacting wildlife, leading to more frequent interactions between animals and humans, which in turn accelerates the spread of zoonotic viruses.
Biodiversity decline, driven by ecosystem destruction, can further exacerbate the spread of diseases. Climate change is one driver of this deterioration, disrupting people’s livelihoods, contributing to deforestation and impacting the ecosystem around them. Encroachments on ecosystem boundaries (i.e. through hunting, mining, logging, and agriculture) increases the risk of spillover events of zoonotic diseases like mpox. Supporting a healthy ecosystem and community resilience is essential to reducing the risk for spillover events.
Due to the evolving nature of the new level of transmission of clade 1a and emerging clade 1b, there are many unknowns and uncertainty among communities impacted by the mpox epidemics. High levels of uncertainty about an emerging infectious disease can manifest as social anxieties or panic, particularly in areas where there is already stigma against a specific group. Acknowledging the unknowns, focusing on addressing issues of trust and concerns expressed by people will be essential for co-designing responses and actions that are inclusive and adaptable as evidence grows around the current mpox outbreaks.