Can MPOX cause a pandemic? Here’s what experts say

The World Health Organization (WHO) declared on Wednesday (14) the current outbreak of mpox in Africa as a global public health emergency . The announcement was made at a meeting of the emergency committee amid concerns that a more deadly strain of the virus, called clade 1B, could spread to other regions of the world.

In July, the WHO included the MPOX virus in the updated list of microorganisms with the potential to cause new pandemics. document was issued at the 2024 Global Pandemic Preparedness Summit, which took place that month in Rio de Janeiro.

The report aims to create broadly applicable knowledge, tools and countermeasures that can be rapidly adapted to emerging pandemic threats. In addition, the strategy also aims to accelerate surveillance and research to understand how pathogens transmit disease and infect humans, and how the immune system responds to them.

Despite this, the declaration of mpox as a global public health emergency does not mean that the outbreak is becoming a pandemic . However, the alert serves to emphasize the high risk of a disease spreading to other countries through international propagation, in addition to alerting to the need for a coordinated international response to contain this disease.

“The WHO’s biggest fear is that clade 1 will leave the Democratic Republic of Congo and spread throughout the world, which is what happened with clade 2 in 2022,” explains infectious disease specialist Álvaro Costa, who has Mpox as the central theme of his doctoral research, in an article previously published in CNN .

“At that time, all the cases of mpox were concentrated in Africa, and the cases in other regions were imported from people traveling there, and suddenly we had an outbreak. The pressure now is to prevent a global outbreak with this other variant,” adds the expert.

Clade 1 and clade 2 are different groups of viruses that, despite having genetic similarities, are not identical. According to the Centers for Disease Control and Prevention (CDC), clade 1 causes more severe disease and is more lethal compared to clade 2.

Clade 1 is endemic in the Democratic Republic of the Congo and is responsible for the current outbreak. In September 2023, cases related to subvariant 1B were also reported in the country and adjacent regions. Clade 2 was responsible for the global outbreak that began in 2022, according to the CDC. In Brazil, the current cases are related to the circulation of clade 2.

Could MPOX become a pandemic? What do experts think?

Clade 1B, in addition to being more lethal, appears to have greater transmissibility, according to infectologist Raquel Stucchi, professor at the State University of Campinas (Unicamp) and consultant for the Brazilian Society of Infectious Diseases (SBI). Precisely because of this characteristic, the specialist believes that It is possible that mpox could cause a new pandemic .

“We know that, nowadays, there is no longer any infectious disease that is concentrated in a single place with all the movement of people [de um país para o outro]”, explains the infectologist to CNN . “So, it is possible that it will reach other countries on several continents, especially since it is more transmissible,” he says.

To Giliane Trindade, professor of microbiology at the Institute of Biological Sciences of the Federal University of Minas Gerais (UFMG), also there is a chance that the new variant will spread to other regions of the world besides Africa.

“We live in a globalized world, and what we are seeing in the Democratic Republic of Congo is that it is a highly transmissible variant. There is community transmission and it is not under control. This is always a risk when associated with the factor of globalization,” says the professor, in an article previously published in CNN .

According to Hélio Bacha, an infectious disease specialist at Hospital Israelita Albert Einstein, because variant 1B of the mpox virus is more transmissible, the WHO’s concern about declaring a global public health emergency is pertinent and real. “The importance of having this declaration is that we have effective medicines and vaccines against this disease, but not in sufficient quantities to deal with a pandemic condition,” he told CNN .

What should be done to contain a new pandemic

Stucchi states that, among the main measures to contain outbreaks and a new pandemic caused by mpox, is the vaccination of the population, with greater equality in access to the vaccine. “Unfortunately, it seems that we have not learned — as a society, public managers and the population — from the Covid-19 pandemic about equity. We should have already vaccinated the population of Africa, because it has always been a population more affected by the disease [mpox] and this is where there is the highest mortality rate”, says the specialist.

It is also necessary to make appropriate treatment available and start it early in patients at greater risk of developing severe cases of mpox infection, according to the infectologist.

“We need to have a multilateral policy of responsibility, involving several countries, to confront this disease. The possibility of confronting this disease individually without the support and financial contribution of a global policy represents a very high risk of having a very serious public health problem,” adds Bacha.

After declaring mpox a global public health emergency, WHO signed the Emergency Use Listing process for both mpox vaccines and developed a regional response plan requiring $15 million, with $1.45 million already released from the WHO Contingency Fund for Emergencies.

In Brazil, the Ministry of Health announced that, starting this Thursday (15), it will install a Health Emergency Operations Center (COE) to coordinate response actions to mpox.

“Since the previous PHEIC for Mpox, declared by the WHO in July 2022 and ended in May 2023, surveillance for the disease has remained a priority for the Ministry of Health, which has been closely monitoring the global situation and the information shared by the WHO and other institutions. The ministry has already started updating the recommendations and the contingency plan for the disease in Brazil,” the ministry states in press release.

MPOX cases in the world

According to the CDC, the current outbreak of mpox in the Democratic Republic of the Congo is more widespread than any previous outbreak in the region and the fatality rate is higher. This year alone, the Democratic Republic of the Congo has recorded 15,600 cases of mpox and 537 deaths. This number is already higher than the 2022 outbreak, caused by clade 2: despite the 85,000 cases recorded, there were only 120 deaths. Worldwide, the WHO has recorded 99,176 confirmed cases of mpox in 116 countries from January 2022 to June 2024.

In Brazil, 709 cases of mpox have been registered so far. On Wednesday (14), the Minister of Health, Nísia Trindade, stated that there is no reason for “alarm”, but rather for “alert” in relation to the mpox virus.

“At the moment, there is no record of major concern, but several measures can be taken, such as warnings for travelers and a series of actions that should be taken in situations like this,” said the minister.

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