Mpox unlikely to be COVID-19 situation but must be nipped in the bud: WHO Europe team lead

- 'We can't be too complacent. We never quite know what these viruses will do,' says WHO Europe official

The announcement that a more deadly strain of mpox had been discovered in Sweden earlier this month was the first warning that the virus had spread outside of Africa, where it has caused a deadly outbreak in the Democratic Republic of Congo.

The World Health Organization (WHO) and Africa Centers for Disease Control and Prevention (Africa CDC) have declared mpox a public health emergency of international and continental concern, respectively.

As of Monday, the Africa CDC had recorded a total of 22,863 mpox cases – 3,641 confirmed and 19,222 suspected – and 622 deaths across 13 African Union member states this year, with DR Congo accounting for a vast majority of all cases and fatalities.

Cases have recently been confirmed in countries around the world, including Pakistan, Thailand, the Philippines, Australia and Sweden.

However, the WHO has stressed that the mpox virus strain, known as Clade 1, is “not the new COVID,” despite this being the second emergency alert relating to the virus from the global health agency in two years.

“What it means is that there's something that we need to nip in the bud as soon as possible. And that's really what it means, rather than meaning that we're in a COVID situation,” Dr. Marc-Alain Widdowson, who is leading the mpox response at WHO Europe, told Anadolu.

The outbreak requires a collaborative international effort to deal with it, but “I think it doesn't mean that we're in a COVID situation at all, or even likely to be,” he said.

While there are similarities between mpox and COVID-19, as both are zoonotic diseases, meaning they are transmitted from animals to humans, there are also major differences.

Largely a respiratory disease, COVID transmits mainly by droplets and air, and less via direct contact, while the mpox virus transmits mainly via direct skin to skin contact and less, if any, via droplets and air.

Just like COVID, the mpox disease manifests as a flu-like illness but also as swollen adenoids, and the hallmark of the disease, virus-containing rash-like blisters that can be very painful, Niklas Arnberg, a Swedish professor at the Department of Clinical Microbiology at Umea University, told Anadolu.

- 'We can't be safe until everyone's safe'

Widdowson warned that the world should brace itself for more pandemics in the future and that infectious diseases are a threat to human health which need to be understood as global issues.

“These are global problems, and we can't just look at our own back door or our own back garden and our own belly button, as it were, and see what's our problem without looking at this from a global perspective.”

He further pointed out that the world should not repeat past “mistakes” and that infectious diseases should be tackled by a global health community, “because we can't be safe until everyone's safe.”

Widdowson expressed concerns about the virus spreading in disadvantaged communities in certain countries in Africa, which according to him, is a reflection of “what may happen globally” if the focus is not on reducing the transmission in this part of the world.

“You know, we've already seen one case in Sweden as you know, and I think that the more cases that are in Africa, the more likely we are to see continued imported cases,” he said, adding that when the disease gets imported into Europe, there are several scenarios that could potentially happen.

“So scenario number one is what we are in now, and is that we have imported cases, but they are, in effect, isolated, detected quickly. Sweden did an excellent job in doing that. Scenario two is that we do see some limited transmission within the European context. And the third scenario is one that we really don't want to go to, which is more widespread communities' transmission. Again you know, we can't be too complacent. We never quite know what these viruses will do.”

- Global concern

Widdowson, who leads WHO Europe's High Threat Pathogens team, noted that Sweden detecting mpox Clade 1 has concerning global implications.

Some countries in Western Europe which have already experienced the less serious variant mpox Clade 2, circulating since 2022, have good systems to detect, diagnose and control the disease, he added.

Asked about how well Sweden and other countries are prepared against Clade 1, Widdowson said: “I think we are well prepared, but not perfectly prepared, or not very well. I think we can do better.”

He noted that the world must be better prepared to be able to respond with vaccines.

“We need to make sure that we have vaccines available for response to Clade 1 importations and also to strengthen our resilience against Clade 1 spreading through networks by making sure we vaccinate.”

While Arnberg said given what we know about the virus and its relatively poor ability to transmit between humans, he expects some more imported cases in Sweden and possibly few, if any cases of human-to-human transmission.

“But this also depends on the ability to limit the current outbreak in Africa. If we fail with that, this increases the ability of the virus to mutate and transmit faster. We really don't want that.”

- Insufficient knowledge and tools

In the last 14 years, the WHO has declared eight international public health emergencies all caused by viruses.

“This cannot be coincidences. I think it happens for several reasons. We are now eight billion people on the planet. We travel more than ever. We impoverish the biological diversity,” Arnberg pointed out.

According to him, global warming leads to virus-transmitting insects colonizing new areas.

Arnberg also pointed out that health care has insufficient knowledge and tools for treatment and prevention of known virus-caused diseases.

“The virology research area is too small with too few researchers in relation to the threats,” he added.

Currently, health care has antiviral treatments against less than 5% of all known viruses that cause disease in humans, said the professor.

“If we could develop more such treatments in a way similar to the treatments that we have against other pathogens, i.e. antibiotics, we would be in a much better position to manage future outbreaks and pandemics,” Arnberg added.