Mpox: The Anxiety Virus

A LITTLE OVER FOUR YEARS after the World Health Organization (WHO) turned the world’s attention to a then new virus, Covid-19, by classifying its outbreak in China as a ‘public health emergency of inter­national concern’, the organisation has now made the same declaration for a new outbreak—caused by the mpox virus—in Africa. Covid-19 had already begun spreading rapidly by the time of that declaration, and in less than month-and-a-half later, WHO elevated its status to a pandemic. By compari­son, mpox is not entirely new. It had led to a surge in 2022 too and was termed a public health emergency even then. But this ongoing outbreak has got health officials the world over a little more worried.

Mpox is a virus that is endemic to central and western Africa. It made its first big leap outside Africa in 2022, when a particular version of it—Clade II (each clade is classified as a genetically and clinically distinct group of  viruses)—spread to around 116 countries, affecting nearly 100,000 people in all. But that outbreak spread mostly among gay and bisexual men, and it is said, behavioural changes, along with vaccination, led to the outbreak being contained.

This outbreak is a lot more different. It is being mostly spread by a different variant—Clade I—which experts say is causing more severe illness and has a much higher mortality rate. The death rate of the current outbreak, according to reports, is 3 per cent, significantly higher than the 0.2 per cent observed during the 2022 outbreak. In the Democratic Republic of Congo, where the outbreak is most severe and more than 15,600 cases and 537 deaths have been reported, most infections were occurring from the consumption of contaminated meat or being in close contact with infected animals. Scientists have since detected a new subtype within Clade I, termed Clade Ib, which spreads from person to person, often through sexual contact, and also through other physical and face-to-face contact, via contaminated bedding or other items. Infection usually brings on flu-like symptoms like fever, chills and aches, and is typically followed by a rash that is often mistaken for measles or chickenpox. Like Covid-19, it is toughest on people with compromised immune systems.

There is however quite a bit we still do not understand about this virus, the biggest mystery being why children make up such a high percentage of the infected. Initially, sex workers made up a high proportion of those infected, which is unsurprising since mpox has been found to spread through sexual contact. However, reports estimate that children under 15 now account for more than 70 per cent of the cases and 85 per cent of the deaths in Congo. Some experts think this might have to do with the high rates of malnourishment and poor immune systems among children.

At its epicentre in Congo, which has been assailed with internal conflict, the outbreak has been difficult to control, and it is said to be rapidly spreading through its crowded refugee camps. It has since spread to over a dozen countries, including for the first time in East Africa. Last week, a case was also reported in Sweden, in an individual who had travelled to Africa. India so far has had no cases. It did record several cases back in 2022, including one death, and the government, it is believed, is closely tracking arrivals from Congo and Central Africa. Given the interconnectedness of global travel, the infection is likely to spread more widely outside Africa.

This outbreak, however, does reveal how inequitable and broken our global public health response remains. During the Covid-19 pandemic, richer countries hoarded vaccines, even though a more equitable distribution would have not just been the moral thing to do, but also one that benefited the developed world, since viruses, unchecked, can mutate and spread. Something similar has occurred here too. Vaccines were used to control mpox spread in the US and Europe back in 2022, but were hardly supplied to Africa, where the virus continued to remain and mutate.

Most experts believe mpox is unlikely to cause a pandemic, since it does not spread through the air. But if we want to make sure it or some other future virus does not snowball into the next Covid-19, we have to ensure there is more equitable access to vaccines and drugs for all.

About The Author

Lhendup G Bhutia

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