MPOX Public Health Emergency – how is Frontline AIDS responding?

Mpox is an illness caused by the monkeypox virus, and WHO outlines that its symptoms typically include a rash or sores which can be mild or severe and can affect the face, hands, feet, groin, genitals, mouth and throat, anus, rectum, vagina, or the eyes.  Most cases resolve within a few weeks, but for some people, including those with advanced HIV infection, they can be severe and even fatal. Mpox is, therefore, an important concern for Frontline AIDS and our partners, particularly in countries affected by the public health emergency.

Countries and communities on the frontline

In 1970, Mpox was detected in humans in the DRC, having spread from animals. For several years, it has been seen as endemic in several countries in Central and West Africa, although vaccines exist to prevent it.

From person to person, Mpox is mainly transmitted through close contact and occasionally through objects or surfaces touched by someone who has Mpox.

In 2022, Mpox spread rapidly across several countries where it hadn’t been seen before, mainly via sexual contact and among men who have sex with men. In May 2023, WHO declared the public health emergency over after a sustained decline in global cases, but during the same period, cases escalated in the DRC due to a new strain of the Mpox virus called clade 1b. In 2024, cases have surged further and already exceeded last year’s total, with 15,600 people testing positive by mid-August, and 537 deaths.

Authorities have declared a new public health emergency after Clade 1b appeared in four countries neighbouring the DRC that had not previously reported Mpox. These include Burundi, which has a significant number of cases, and smaller numbers in Kenya, Rwanda, and Uganda. While studies are underway to determine its properties, evidence suggests that clade 1b is predominantly but not exclusively transmitted sexually and may be having a disproportionate impact on key populations, for example, sex workers.

Frontline AIDS response team

Following Africa CDC and WHO’s declarations of a public health emergency of international concern, Frontline AIDS has convened a response team which will bring partners together to share expertise on how communities and civil society organisations can best respond and to put in place any support needed.

Mpox poses a higher risk for babies and children, people who are pregnant and those with underlying immune deficiencies, including people with advanced HIV infection. There is also some evidence that Clade 1b is disproportionately impacting marginalised populations, for example, sex workers and people displaced by war and conflict.

It is vital that Mpox responses aim from the very outset to meet the needs of people living with HIV and those from marginalised communities and that community-led organisations are included in the planning and implementation of national responses, recognising that their expertise will be vital.

During pandemics, people who are already stigmatised and discriminated against can face a heightened risk of human rights violations from state actors and the wider community.  These risks are even greater in the current context of a well-resourced anti-rights movement that is organising against LGBTQ+ people and sexual and reproductive health and rights. Our response team will focus on partners based in countries impacted by or at risk of Clade 1b and on those working with key and marginalised populations.

Advocacy on Mpox, human rights and health justice

Through our global advocacy, we will work with communities most affected by Mpox to ensure their voices are heard in the global response. We will also encourage international donors to support Mpox responses that address the needs of people living with HIV and marginalised communities, recognising the vital role of community-led organisations in tackling Mpox and other health threats. Finally, ensuring that the countries and communities most at risk can access vaccines and tests for Mpox is a major challenge, as it has been for HIV, COVID-19 and many other pandemics. We will harness our access to global advocacy spaces, including the Pandemic Accord negotiations, to push for equitable access to health technologies as essential to ending the Mpox emergency and to pandemic prevention, preparedness and response more widely.

Find out more:

• MPOX: WHO Questions & Answers.
• WHO Director-General declares mpox outbreak a public health emergency of international concern.
• EPI-WIN webinar: Managing stigma and discrimination in health-care settings in public health emergencies such as monkeypox.
• Dr Nicaise Ndembi, Africa CDC Coordinator of the mpox response, presentation to Pandemic Action Network and Resilience Action Network Africa. You can also view the meeting recording.