The World Health Organization (WHO) acted as expected this week and declared Mpox a Public Health Emergency of International Concern (PHEIC). So, a problem in a small number of African countries that has killed about the same number of people this year as die every four hours from tuberculosis has come to dominate international headlines. This is raising a lot of angst from some circles against the WHO.

While angst is warranted, it is mostly misdirected. The WHO and the IHR emergency committee they convened had little real power – they are simply following a script written by their sponsors. The African CDC, which declared an emergency a day earlier, is in a similar position. Mpox is a real disease and needs local and proportionate solutions. But the problem it is highlighting is much bigger than Mpox or the WHO, and understanding this is essential if we are to fix it.

Mpox, previously called Monkeypox, is caused by a virus thought to normally infect African rodents such as rats and squirrels. It fairly frequently passes to, and between, humans. In humans, its effects range from very mild illness to fever and muscle pains to severe illness with its characteristic skin rash, and sometimes death. Different variants, called 'clades,' produce slightly different symptoms. It is passed by close body contact including sexual activity, and the WHO declared a PHEIC two years ago for a clade that was mostly passed by men having sex with men.

The current outbreaks involve sexual transmission but also other close contact such as within households, expanding its potential for harm. Children are affected and suffer the most severe outcomes, perhaps due to issues of lower prior immunity and the effects of malnutrition and other illnesses.

Reality in DRC

The current PHEIC was mainly precipitated by the ongoing outbreak in the Democratic Republic of Congo (DRC), though there are known outbreaks in nearby countries covering a number of clades. About 500 people have died from Mpox in DRC this year, over 80% of them under 15 years of age. In that same period, about 40,000 people in DRC, mostly children under 5 years, died from malaria. The malaria deaths were mainly due to lack of access to very basic commodities like diagnostic tests, antimalarial drugs, and insecticidal bed nets, as malaria control is chronically underfunded globally. Malaria is nearly always preventable or treatable if sufficiently resourced.