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A Nigerian professor who alerted the world to the re-emergence of mpox in his home country has warned that experts are working “blind” on the viral disease’s latest surge in Africa because of a lack of adequate surveillance systems.
Dimie Ogoina, chair of the World Health Organization’s emergency committee of independent experts on mpox, said case numbers in an outbreak that has officially infected more than 17,000 people were likely to be underestimates because of a shortage of rapid diagnostic tests and inadequate data collection.
“We’re under-reporting cases because our surveillance system is not active enough,” Ogoina told the Financial Times. “Now that we have a new mpox [type] . . . it is time for us to rethink our surveillance system and make it more proactive,” he said.
The WHO last week triggered a second public health emergency for mpox in barely two years, a sign of growing alarm over the spread of the viral disease’s more infectious clade 1 types in Africa. Ogoina, who alerted the world to Nigeria’s first mpox case for decades in 2017, said the situation was “unprecedented” in Democratic Republic of Congo, the epicentre of the current outbreak.
He hopes the WHO declaration will encourage its partner bodies and countries to direct more resources to the health body’s “response plan”. WHO director-general Tedros Adhanom Ghebreyesus said on Friday the plan needed $135mn in funding over the next six months.
Ogoina said there was too much reliance on “evidence from the global north. [But] genetics and responses in immune systems are different”, adding: “If we don’t know our gaps [in health coverage] and our contexts, natural history, transmission dynamics, we’re working blind.”
A professor of medicine and infectious diseases at Nigeria’s Niger Delta University, Ogoina was honoured by Time magazine as one of the world’s 100 most influential people in 2023 for his research on mpox, formerly known as monkeypox.
The current outbreak began last year in the DRC and has spread to about a dozen African countries and been diagnosed in visitors to several European and Asian countries.
More than 17,000 confirmed or suspected cases and more than 500 deaths have been reported this year from 13 African Union member-states, according to the Africa Centres for Disease Control and Prevention. The caseload in the DRC accounted for 96 per cent of the continent’s total.
Mpox can cause fever, skin lesions and sometimes death. It can be more severe among patients with uncontrolled HIV and is transmitted through contact with infected people or animals, or contaminated materials.
Ogoina, who argues that global public health stakeholders should have invested more resources in managing the disease long before it reached the west in 2022, outlined several differences in the latest upsurge.
“The classical mpox presents with generalised rash all over the body but with the new mpox there are patients with three or four rashes on the genital area or groin area. This mpox may start as a genital or groin rash.”
As the more transmissible clade types circulate, patients are presenting with symptoms in DRC’s neighbours such as Rwanda, Uganda and Burundi and further afield in Kenya, countries that had never reported mpox cases.
This clade 1b type, discovered last September, was rapidly spreading among adults in the DRC, Ogoina said, including heterosexual people with “high-risk sexual behaviours and a history of contact with female sex workers”, whereas the “classical clade 1” variant was known to infect mostly children under 15.
The new variant also produced false negatives in tests, he said, meaning health workers could think a patient does not have mpox then they do.
“We are uncertain about so many things and that’s what makes it so dangerous,” Ogoina said of the new variant. “There is potential for it to cause serious disease [and] to spread in the population.”
Governments and health bodies are stepping up vaccine procurement efforts. Africa-CDC has said 10mn doses are needed to control the outbreak.
On Friday, Brussels called on EU governments to donate more mpox vaccines to Africa. EU health commissioner Stella Kyriakides requested that health ministers across the bloc signal their “intention to donate mpox vaccines and therapeutics and the volumes available for donation” by the end of August.
The EU has said it will send 215,000 vaccines made by Denmark’s Bavarian Nordic and bought through its joint procurement scheme to Africa-CDC by early September.
Ogoina said vaccines would be “beneficial” but trials would need to be conducted in Africa to test their efficacy and how long they offered protection.
“We need to invest in understanding these vaccines in the African setting,” he said.
Additional reporting by Michael Peel in London and Alice Hancock in Brussels
