MPOX is a Global Health Emergency

Why ramping up vaccine access can end the outbreak

On August 14th, the World Health Organization declared MPOX a "Public Health Emergency of International Concern." This is the highest level of alarm that the WHO can issue to confront a public health crisis, and it was triggered in response to a rapidly spreading outbreak in Central Africa.

As my guest, Dr. Eric Toner, explains, this MPOX outbreak is different from the one two years ago due to the fact that this new strain of the virus is both more deadly and more transmissible. Dr. Eric Toner is a senior scholar at the Johns Hopkins Center for Health Security. He explains the differences between the strains and what we know so far about how MPOX is spreading within Central Africa and, more recently, to other continents. We have a lengthy discussion about how to contain the outbreak, which includes deploying effective vaccines. However, the problem is that the supply is limited and controlled by just a handful of vaccine manufacturing companies.

The episode is freely available across podcast listening platforms. The full transcript is available immediately below the fold for paying subscribers.

Transcript edited for clarity

Mark Leon Goldberg: Eric, the last time we spoke was a couple years ago was the last time there was an Mpox outbreak. Could you just remind listeners what is Mpox and what makes this outbreak different from the previous one that you and I spoke about a couple years ago?

Dr. Eric Toner: Well, Mpox is the new name for monkeypox. It was changed sometime in the last few months because it was felt that somehow monkeypox wasn’t appropriate. So, it is the same general species of virus as the one that we’ve experienced previously, but it’s a different clade — that is, it’s a different strain.

Mark Leon Goldberg: Yeah. This term ‘clade’ is one that comes up frequently when referencing Mpox. Can you just explain what that is?

Dr. Eric Toner: It’s a subcategory of the virus. Like the difference between genus and species, there are several clades of Mpox, just like there are several clades of many other viruses. The virus that caused the outbreak that started in 2002 a couple years ago and caused disease in over 70 countries was clade 2. Clade 1 has been endemic in Central Africa, particularly in the Democratic Republic of Congo for decades. Typically, it caused relatively mild disease but more severe disease than the clade 2 that we experienced in the U.S. and that many other countries experienced a couple years ago.

But now there is a new clade, clade 1b, which first appeared back probably in September, so almost a year ago — was first recognized around the beginning of this year — and it has been spreading very rapidly through Central Africa. It appears to be somewhat more severe than the clade 1 that we’ve known for many years and it seems to have a somewhat different transmission dynamic. Although it looks like it probably started amongst miners in these terribly crowded, poorly ventilated mines in central Africa, but was then also spread was encouraged through the sex trade through sex workers. But it has been transmitted also to the families of miners and sex workers and others in the community, including children. So, a fair number of these cases are among children.

Mark Leon Goldberg: And so it spreads mostly through close physical contact, is that right?

Dr. Eric Toner: Yes. It requires close physical contact, usually intimate contact, which is why that is often spread through sexual contact, but can also be spread by the contact that mothers have with their children or other people can have who are just living in very close quarters. It has now spread from the DRC to at least 12 other Central African countries, some of which don’t border the DRC. So, presumably there’s transmission going on through several countries. And there have been solitary exported travel-related cases in Sweden, and as of today, in Thailand.

Mark Leon Goldberg: And so what makes this a public health emergency of international concern? The highest alarm that the WHO can summon has been triggered because of this outbreak.