Mpox 2024: A Global Call to Action Amid Rising Health Inequities

Dear Editor,

As the global health community watches with growing concern, the resurgence of mpox in 2024 has laid bare the vulnerabilities in our public health systems, particularly in the Democratic Republic of Congo (DRC). ¹ The DRC, which has reported more than 14,000 cases and 511 deaths in 2024 alone, is now the epicenter of a crisis that threatens not just the African continent but the entire world. ² Disturbingly, 70% of these cases are in children under 18 years old, a demographic particularly vulnerable due to their lack of immunity from the smallpox vaccine, which was discontinued after smallpox was eradicated in 1980. ³ The variant driving this surge, clade Ib, is spreading primarily through sexual transmission—a mode of transmission previously unseen in the DRC. ² This evolution of the virus has made it more difficult to diagnose, with some diagnostic tests struggling to detect it due to genetic changes in the virus. Despite the variant being less fatal, with a mortality rate of just under 1%, the sheer volume of cases is overwhelming an already fragile health care system. ⁴

In response, the World Health Organization (WHO) and the Africa Centers for Disease Control and Prevention (Africa CDC) have taken unprecedented steps. The WHO has declared the outbreak a Public Health Emergency of International Concern, while the Africa CDC, for the first time in its history, has declared a continental emergency.^1,2 These declarations are not mere formalities; they signal a dire need for international cooperation and swift action to prevent the further spread of the virus. However, the challenges are immense. Vaccine availability is a critical issue. While the United States has pledged $10 million and 50,000 vaccine doses to help combat the outbreak, Africa CDC estimates that at least 10 million doses are needed.^5,6 The current vaccine supply is far from sufficient, and with each dose costing approximately $100, many African countries simply cannot afford the cost of widespread immunization.^2,3

The situation in the DRC is a stark reminder of the global inequities in public health preparedness. Children, who make up the majority of the cases, are particularly at risk due to factors such as malnutrition, which weakens their ability to fight off the virus. This outbreak is a haunting echo of past global health failures, where the most vulnerable populations are often the most neglected. The world must act decisively. The lessons from the COVID-19 pandemic are clear: we cannot afford to be reactive. We must be proactive, ensuring that resources, vaccines, and support reach those who need them most. The cost of inaction is too high—not just in lives lost but in the potential for this outbreak to spiral out of control, affecting millions more.

In 2024, the fight against mpox is more than a battle against a virus; it is a battle for global health equity and justice. The decisions we make now will shape the health and well-being of future generations. We must ensure that no region is left to fight alone, and that the global community stands united in addressing this crisis.