In the summer of 2022, the US was confronted with the last thing it needed after two years of Covid-19: another public health emergency. For the first time ever, mpox, then commonly called monkeypox, was spreading widely in developed countries.
At the height of that outbreak, the US was reporting nearly 500 new daily cases of the virus, which can cause severely painful rashes and, in a small percentage of cases, death. But developed nations quickly stamped out the outbreak with effective testing and vaccines. In May 2023, the World Health Organization declared the global mpox emergency over.
But around the same time, the first known sexual transmission of a deadlier version of mpox was beginning in the Democratic Republic of Congo (DRC), where the virus circulates regularly but usually through less transmissible means, such as animal bites or eating contaminated food.
Over the last year, the DRC, a country of more than 110 million people in central Africa, registered more than 12,500 suspected mpox cases and 581 suspected mpox deaths — both all-time highs. The culprit was mpox clade I, which has a higher fatality rate than the clade IIb that circulated in the US and other places around the world in 2022. Before April 2023, sexual transmission of clade I had never been documented; now, mpox has been detected in parts of the DRC where it has never been seen before. The World Health Organization is warning again about the possibility of worldwide spread.
An existing mpox vaccine, which is widely available in the US, could stop transmission of this strain — but it is nowhere to be found in the DRC. Bavarian Nordic, the manufacturer, has blamed bureaucratic hurdles for the failure to provide doses to the DRC and other African nations. The vaccine has not technically been approved by local regulators, and the company says it wants assurances about liability before selling or donating vaccines there.
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