International health emergency due to the resurgence of mpox in the world.

The recent declaration of "international public health emergency" by the World Health Organization (WHO) has alerted the global community to the resurgence of mpox, previously known as monkeypox. This virus, which has claimed the lives of over 500 people in the Democratic Republic of the Congo and has surpassed 17,500 cases in twelve African countries since the beginning of 2024, has found fertile ground for its spread in an increasingly connected world. The situation is exacerbated by the confirmation of cases in Europe and Pakistan, underscoring the urgency of an international response. Mpox is a zoonotic virus, meaning it can be transmitted from animals to humans. Its endemic origin in Central and West Africa poses a serious public health challenge, as the virus is found in a variety of mammals, including rodents and primates. Clinical manifestations of the disease include rashes, fever, muscle pain, and fatigue, which can appear up to 21 days after exposure. Although mpox is generally not considered deadly, the new variant responsible for the current outbreak has an alarming case fatality rate estimated between 3% and 4%. WHO Director-General Tedros Adhanom Ghebreyesus has expressed concern about the potential for further spread and has urged the international community to respond in a coordinated manner. However, this declaration raises questions about the effectiveness of current control and treatment measures. Although there are antivirals and vaccines that can be used against mpox, availability is limited. The global stockpile of smallpox vaccines, which also offers cross-protection against mpox, is insufficient to address the current crisis. Containment and treatment strategies have been a topic of debate. The WHO has recommended avoiding casual encounters and sexual relations in areas affected by the virus and has emphasized that individuals with compromised immune systems are at higher risk of severe forms of the disease. This highlights the vulnerability of certain groups, including children and people with pre-existing health conditions, who may face fatal outcomes if they contract the illness. Despite the severity of the situation, the WHO has not deemed it necessary to implement mass vaccination as was done during the COVID-19 pandemic. This has led to criticism from experts warning about the ineffectiveness of current control measures. The lack of sufficient vaccines has prioritized vaccination for close contacts of infected individuals and high-risk groups, which may not be enough to stem the spread of the virus. The African Centers for Disease Control and Prevention has estimated that at least 10 million vaccine doses are needed to halt the current crisis. However, WHO’s stockpiles rarely exceed 2.6 million doses, raising serious doubts about the capacity to respond to an expanding outbreak. The vaccine shortage is further exacerbated by European authorities recommending that travelers to Africa get vaccinated, which could further limit the availability of doses for those already at risk. In this context, the scientific community faces a significant challenge: to increase resources and research capabilities to better understand mpox and its variants. With the emergence of "secondary infections" in some individuals, it is clear that there is still a great deal of uncertainty regarding the duration of immunity following an initial infection. These gaps in epidemiological knowledge hinder predictions about future outbreaks and strategies to contain them. Despite its cautious stance, the WHO has made an urgent call for international cooperation. History has shown that pathogens do not respect borders and that a country’s isolated response may be insufficient. It is imperative for countries to work together, sharing resources, research, and, fundamentally, vaccines, to reduce the risk of future outbreaks. The situation with mpox highlights the fragility of global health systems and the need to be prepared for unexpected public health events. The international community must learn from past experiences with COVID-19 and act swiftly and decisively to contain the spread of this disease. Only through a collective and coordinated effort can this new challenge be effectively met and the health of millions worldwide protected.