In a historic move, on 13 August 2024 the Africa Centres for Disease Control and Prevention (Africa CDC) proclaimed its first Public Health Emergency of Continental Security (PHECS) over the Mpox Outbreak. This declaration signals a change towards more continental autonomy in handling health emergencies and represents a turning point in the governance of public health in Africa.
The African Union (AU) gave its CDC the power to declare a health emergency in 2022, during the COVID-19 pandemic. This new mandate has not been without controversy.
Concerns have been raised about potential overlaps with the WHO mandate, particularly regarding its authority to declare global health emergencies, underscoring the complex dynamics of global health governance and the evolving role of regional bodies in managing public health crises.
From the beginning of 2022 to the end of July 2024, there have been more than 37,000 cases and almost 1,500 deaths from mpox reported from 15 AU member states, mostly in the central African region, but with cases reported across the continent. The spread of the disease is accelerating and one of the variants circulating has the potential to evolve into an even more infectious and virulent form.
The significance of this declaration cannot be overstated. Existing global health governance instruments are known to be skewed in support of the Global North. The grossly inequitable response to the COVID-19 pandemic being the most recent but not isolated example of this. In 2022, WHO declared a Public Health Emergency of International Concern (PHEIC) for mpox only after cases surged in Global North countries, despite African nations having already reported higher case numbers and fatalities.
The WHO declaration facilitated the rollout of vaccines and accelerated clinical trials for novel treatments in the Global North, while African countries continued to struggle with limited access to these critical resources.
Even more concerning was the decision to declare the PHEIC over in May 2023 despite continuing high numbers of cases in Africa. On 14 August 2024, one day after the PHECS declaration, WHO once more declared mpox a PHEIC.
The consequences of failing to respond robustly to these declarations could be severe, potentially leading to the increased spread of new and more dangerous variants. The risk of a failure to act now is not just a risk to Africa, but to the rest of the world.
Mpox Outbreak: What next?
Africa CDC and WHO will be empowered to scale up the response to the outbreak, which has so far has been lacklustre with limited resource commitments: $1 million from WHO and $10.4 million from the AU. Meanwhile, the director-general of Africa CDC estimates that significantly larger sums will be required to control the Mpox outbreak.
The hope is there will be a rapid increase in access to resources – expert personnel, funds and medical products – diagnostics, therapeutics and vaccines. The PHECS declaration provides an opportunity for AU member states to show solidarity and a commitment to responding effectively by raising and releasing significantly more funds to support the coordinated response.
The PHECS and the new PHEIC both provide an opportunity to test the global response to health emergencies in the post-COVID-19 era, to show that lessons of equity have been learned. The response and support of the global community will also be a litmus test for the potential effectiveness of a future pandemic treaty.
So far, promised supplies have not been delivered and – at $200 per course – the vaccine remains beyond the reach of most African suppliers. Trials of mpox vaccines and therapeutics are being accelerated to bring them to market quicker and enabling regulatory frameworks are being developed to allow emergency licensing.
The declaration is also expected to charge the global and pharmaceutical industry to scale up manufacturing of existing products and to support a diversified manufacturing ecosystem to facilitate the scale-up. However, as the licenced manufacturers of the available vaccines and antivirals are not governed by the mandate of the declarations, the desired outcome will only follow if there is a global political response.
What could go wrong with The Mpox Outbreak?
One of the primary concerns is the possibility of an inadequate response from AU member states. Despite the urgency of the Mpox outbreak, the AU and its members tend to be short on delivery when it comes to global health security. The continental response to the COVID-19 pandemic was an exception.
The lacklustre support is further exacerbated by the deep economic downturn currently affecting many African countries, already strained by the disproportionate burden of debt repayment. Without substantial financial commitments and political will from member states, the declaration may struggle to translate into effective action on the ground.
Compounding this internal challenge is the potential failure of the global community to respond adequately. The post-COVID-19 era has seen an increase in replenishments of funds aimed at public health emergency preparedness, yet many of these initiatives have fallen short of their targets. This trend suggests a worrying ‘donor fatigue’ or shifting global priorities, which could severely limit international support for the response.
Paradoxically, even if the international community does respond, their actions could have unintended negative consequences. Fearing the spread of mpox to their own populations, some countries might implement measures that hinder rather than help the African response, such as travel bans, restrictions on the export of essential medical products, and increased hoarding of already scarce medical countermeasures by wealthy nations.
Such actions, reminiscent of the inequities seen during the COVID-19 pandemic, would severely hamper the public health response in Africa, potentially prolonging and expanding the Mpox outbreak globally.
Perhaps the most concerning scenario is one where, despite an influx of resources following the declaration, the outbreak is not brought under control rapidly. The affected regions are also grappling with multiple complex health and socioeconomic crises, compounded by wars and civil unrest.
These multifaceted challenges make effective disease surveillance and containment of a person-to-person transmitted disease extremely difficult, even with adequate resources. While the Africa CDC declaration may shine a light on these systemic challenges, it cannot solve them in the short term.
An underwhelming response to either declaration could have far-reaching consequences beyond this specific Mpox outbreak. It risks undermining the credibility of the entire PHECS and PHEIC processes, potentially casting doubt their effectiveness for mobilizing continental and global resources.
Moreover, if the declaration fails to produce tangible results, it could adversely affect the credibility of Africa CDC itself, potentially weakening its position as a leading public health agency on the continent. In fact, a failure in response will have significant consequences for the entire global health community.
But the PHECS declaration is a bold and commendable move. It addresses the need to define and respond to events that are significant on the continent even when they do not meet WHO criteria for a global emergency.
It also presents an opportunity for WHO and its emergency committee to consider why an additional instrument is required for Africa and why it did not act until after the PHECS. WHO must consider what changes it can make to ensure that its processes meet the needs of the African continent.
The question now is what the global response to the Mpox outbreak will look like. Will the international community rise to the occasion and demonstrate a commitment to equitable global health security? The answer to this question will shape the future of global health governance and determine our collective ability to respond effectively to continental and global health threats.
This post was originally published on Chatham House. Read original post here.
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