As the world grapples with a new strain of mpox known as clade 1b, the response in the crucial first 100 days since the World Health Organization (WHO) raised the alarm has been marked by both progress and setbacks. While some positive steps have been taken, experts warn that the overall global reaction has been too slow, with significant gaps in testing and treatment that could hinder efforts to contain the outbreak.
Mpox Strain Spreads Globally
Over the past year, cases of mpox clade 1b began rising sharply across central Africa, prompting the WHO to declare the outbreak a public health emergency of international concern. In recent weeks, this strain has been detected in several countries, including the UK, US, Germany, Sweden, and India, underscoring the global nature of the threat.
According to a close source, the first 100 days of an outbreak are critical in determining its trajectory. Global leaders had previously agreed to the 100 Days Mission, committing to rolling out effective tests, treatments, and vaccines within 100 days of a pandemic threat being identified. However, as the world marks 100 days since the WHO declaration on mpox, questions remain about whether enough has been done to achieve this mission.
Winning Moments and Challenges
There have been some bright spots in the response, such as the Africa Centres for Disease Control (Africa CDC) sounding the continental alarm and demonstrating regional leadership. Accelerated regulatory approvals for vaccines and donation pledges from various countries have also been positive developments, made possible by vaccine development between outbreaks.
However, vaccines alone cannot end outbreaks, and despite ongoing vaccination campaigns, mpox continues to spread globally. Testing remains a significant challenge, with the true number of cases likely being masked by difficulties in accessing and administering tests.
At day zero, the only approved tests for mpox needed to be done in a laboratory, conditions that are unlikely to be accessible in remote areas.
– Close source
While Africa CDC aims to test 80% of suspected cases, as of this week, only 36% had been tested in the DRC. Laboratory results can take two to three days, allowing potential spread in the interim.
Urgent Need for Accessible Testing and Treatment
The WHO has authorized a test that can be done without a laboratory for emergency use in affected countries, delivering quicker results. Africa CDC has procured test kits to boost local capacity and support decentralization. However, at day 100, there is still no WHO-approved antigen-based rapid diagnostic test that can distinguish between mpox clades and be easily used in rural communities.
On the treatment front, some drugs used for other diseases are being explored for repurposing against mpox, with clinical trials underway. However, after 100 days, no therapeutic is available for the new variant. Lack of funding and political attention has hindered drug development for pandemic-prone diseases.
Call to Action
Experts stress that the longer mpox circulates, the higher the risk of new variants threatening the efficacy of existing tools. Leaders are urged to actively commit to equitable vaccine rollout, implement community-centered public health measures, accelerate access to promising point-of-care tests, speed up evaluation of repurposed treatments, and invest in new drug development.
Mpox is testing our resolve and our preparedness. Despite progress, the sad reality is that if we had learned and embedded the lessons from previous emergencies, we could have responded faster.
– Dr. Mona Nemer, chief science advisor of Canada
With the changing nature of pandemic risk and the recent outbreaks of H5N1 flu, dengue, and Marburg virus, it is clear that the work of pandemic preparedness must start well before day zero. The 100 Days Mission provides a framework, but it will take the efforts of all sectors and government levels to protect people in an interconnected world.
As the mpox outbreak continues to unfold, the world faces a critical test of its ability to mount a swift and effective response. While some progress has been made, much more needs to be done to close the gaps in testing, treatment, and equitable access. Only by learning from past missteps and redoubling efforts can we hope to contain this latest threat and build resilience against future pandemics.
