How This Mpox Outbreak Is Different, According To Experts

The World Health Organization declared the last mpox global emergency over in May 2023. And just over a year later, here we are again.

Since the start of 2024, a deadlier, more transmissible strain of the virus has killed about 575 people in the Democratic Republic of Congo and infected 30 times more. New cases have recently appeared in Europe and Asia. In August, the WHO declared a new mpox global health emergency. 

Bloomberg's Ashleigh Furlong joins host Sarah Holder to explain why the latest outbreak could have been avoided - and what it will cost to beat it.

Here is a lightly edited transcript of the conversation:

Sarah Holder: Mozart had it. So did Beethoven, George Washington and Abraham Lincoln. For nearly 3,000 years, smallpox wreaked havoc, killing a third of people who were infected, and severely disfiguring many others.

Archive: Because it is here that most of the fatal cases of smallpox have occurred...

Holder: Even though a vaccine - the world's first vaccine! - was created in 1796 - it took hundreds of years to figure out how to get it to enough people.

Archive: The focus, of course, is on Bradford, where tens of thousands of people have waited their turn for vaccination.

Holder: A concentrated effort to vaccinate the world against smallpox started in 1959. Two decades later, it had mostly succeeded.

Archive: In October, the Somalia smallpox eradication program recorded the last case in Merca town. And it seems to me that this was the last known case of smallpox in the world.

Holder: By 1980, health officials announced that smallpox was officially eradicated. And with that came the end of the vaccination push that had led to one of the greatest achievements in public health history. But that achievement also had some unintended consequences.

Ashleigh Furlong: We had the smallpox vaccines and that actually also protected against mpox. When we eradicated smallpox, stopped giving people smallpox vaccines, that's when we started to see mpox cases rise in certain countries in Africa.

Holder: Ashleigh Furlong is a health reporter for Bloomberg. She says that mpox has been infecting humans in West and Central Africa with increasing frequency since it was first reported in a nine-month-old boy in the Democratic Republic of Congo in 1970.

Furlong: It's been spreading in Africa for decades. It's called endemic at the moment because it's sort of constantly there. It's not sporadic.

Holder: Allowing that spread - and not instituting a comprehensive vaccine program - has allowed the mpox virus to mutate. Now, a dangerous new strain has been detected in at least six African countries - and the world is watching.

Archive: The World Health Organization declares an Mpox outbreak in Africa a global health emergency, as it seeks to contain the potentially deadly virus.

Holder: Vaccinations are part of the key to getting this outbreak under control. But things are different today from when the world beat smallpox. And public health experts are saying that the worst part about mpox being back on the map is that it was entirely avoidable.

Archive: This is something that should concern us all.

Holder: Today on the show: missed warnings, $100 vaccines and red tape - why the latest mpox outbreak didn't have to happen like this - and what it will now cost to beat it. I'm Sarah Holder and this is the Big Take from Bloomberg News.

Furlong: So the epicentre of where we're seeing the spread is in the Democratic Republic of the Congo. We're seeing it in neighbouring countries as well. And then we're seeing a couple of cases in European countries. We saw one in Sweden and then we also saw one outside of Africa in Thailand.

Holder: Bloomberg's Ashleigh Furlong says the epicentre of this current mpox outbreak is in the country where the virus was first spotted: Congo. And one thing that's notable about this particular outbreak is how mpox is spreading.

Furlong: So what we've been seeing at the moment is that it's being transmitted often through sexual contact. But it could be through, you know, just touching a friend or, you know, sharing bed sheets with someone who has been infected by the virus.

Holder: And what does a mpox case look like? What does it do to the body?

Furlong: A lot of the symptoms are kind of like any old virus that you might get and could be confused with another virus. But I think what is quite significant about mpox are these lesions that you get, sort of small sores, kind of like chicken pox. And we've seen a few cases where actually they thought it could be mpox, but it turned out to be chickenpox. So I think that the little round lesions that you see on people with mpox - that's sort of a strong attribute of mpox - but otherwise, it can cause people to sort of feel unwell, tired, things that you might get with another kind of virus.

Holder: Historically, mpox has shown a limited ability to spread. The virus has mostly been transmitted from animals to humans - like from eating bush meat - and amongst humans in very close proximity, like those who live in the same household or share the same bed sheets. But that's changed with this latest outbreak, which began in December with the emergence of a new strain, called clade Ib.

Furlong: Now what we're seeing is sort of a change in transmission and it's spreading from human to human in these long chains of transmission. And that's what's got scientists really quite worried.

Holder: Can it be fatal?

Furlong: It can.

Holder: The key thing to know about this outbreak is that it's different from the one that happened in 2022. That year saw the first-ever global outbreak of the virus. And fresh off the heels of the COVID-19 crisis, the US and western Europe acted fast.

Furlong: We saw vaccines rolled out to at-risk communities, which at that time was mainly men who have sex with men, and we were seeing the transmission within those communities. There was a lot of public health messaging as well around safe sex practices, about how mpox is transmitted, how to stop it being transmitted.

Holder: That messaging and those resources seemed to work in some places, particularly in the US, which had stockpiled vaccines.

Furlong: The US has always been really worried about a smallpox outbreak, potentially. And this vaccine is effective against smallpox. So that's why they had those contracts and why they had those stockpiles.

Holder: But Ashleigh says in Congo and other African countries, where mpox is endemic, the response was different.

Furlong: In many African countries, mpox cases continue to appear and vaccines never arrived there. Public health messaging around stopping mpox- there might've been that messaging, but there's obviously many other priorities when you're a country, like the DRC, like Congo, where measles kills way more people than mpox does. So there's obviously different priorities that governments have when handling health crises.

Holder: Another factor governments have to contend with is the price of the mpox vaccine.

Holder: How much do those shots cost?

Furlong: So there's several vaccine developers who have mpox vaccines, and the one that is approved in the US and in Europe is from Bavarian Nordic. And we don't have an exact price because the company hasn't actually revealed how much they're charging for their shot. But the Africa CDC estimates that it's about $100 a dose. You need two doses to be fully vaccinated against the virus. So that's quite pricey. Vaccines are normally quite cheap.

Holder: In mid-2020, the US government was able to buy COVID-19 vaccines for about $20 a dose. So I asked Ashleigh what makes the mpox vaccine five times as expensive. She said there was one main reason.

Furlong: There's not a huge market for them. You know, mpox we might see - there's obviously quite a few cases, and there's currently a global health emergency around it - but it's still quite small. So if you're a vaccine developer figuring out how to price your vaccine, you need to make considerations about, you know, you're only producing maybe several million doses of this vaccine. So you need to still make a profit. And that's what Bavarian Nordic has said, basically, is that to be viable they have to charge the price that they have set, and they don't have that much flexibility. You know, when you're distributing a measles vaccine, for example - most childhood immunization campaigns will include a measles vaccine - so that's a massive, massive market compared to the mpox vaccines.

Holder: While fewer people might have needed an mpox vaccine, Ashleigh's sources told her that making sure the vaccine was available to the people who did need it could have changed the course of this current outbreak.

Furlong: When I spoke to scientists last week, they were really saying that if vaccines had gotten to the DRC, for example, to Congo in January, we wouldn't be in the situation.

Holder: But this is the situation we're in. So what will it take to get the outbreak under control - and what's at stake if the world fails to act. That's next.

Holder: The Africa Centres for Disease Control and Prevention reported Sunday that mpox has killed 575 people in the Democratic Republic of Congo since the start of this year - and it's infected 30 times more. And new cases are now being found in Asia and in Europe. I asked Bloomberg's Ashleigh Furlong where efforts to combat the outbreak currently stand.

Holder: So are vaccines available now for the folks around the world who are at most risk?

Furlong: No. So, Congo doesn't have any doses at the moment, they said, for the next couple days, but there's no clear timeline yet.

Holder: How many vaccines are needed?

Furlong: The Africa CDC says that about 10 million are needed for the African continent. That's quite small. In the DRC and in Congo, the population is nearly a hundred million. So we're talking about a tiny amount of vaccines really that are needed potentially to control the outbreak. Obviously, we would have needed probably less if we were talking about this several months ago.

Holder: The US is planning to donate 50,000 doses, but it has millions more in its stockpiles. Germany will donate 100,000 doses of its 117,000-dose reserve. Almost none of these donations are expected to get to Congo until September at the earliest.

Furlong: That won't get us up to the 10 million, so the rest will probably need to be bought. And countries like Congo don't have the budgets to buy those vaccines. So, we're going to be looking at who's going to help pay for those. There's some money being pledged by several aid organizations and organizations that might administer and roll out these vaccines. But at the moment, it doesn't look like we have the full amount that's needed.

Holder: But Ashleigh says containing the outbreak is not just a matter of getting enough vaccines.

Furlong: Rolling it out is going to also require quite a lot of resources. Healthcare workers, campaigns about educating people about getting the vaccine - because just because you have a vaccine on the ground, as we saw during COVID doesn't mean people will want to take it. And also, in some of these communities, there might be quite a lot of stigma around mpox vaccines. There might be concern that, oh, if I get an mpox vaccine, everyone's going to know that I might be at risk of mpox through my sexual network or through my sexual contacts. So we're going to have to see how that plays out on the ground.

Holder: Given all these challenges, how likely is it that mpox will be contained?

Furlong: We are seeing quite a strong finally, you know, response from sort of the global players in a sense from the US, from countries like Germany, et cetera. So we are seeing that reaction. It might have been a little bit delayed. I think there's a sense that this is not going to be the next pandemic. And that there's a strong desire to stop the outbreak and we're seeing from the WHO, from the Africa CDC, a really strong message that this needs to be stopped now. I suppose it'll depend on when that point's reached where it's no longer a global threat, then what happens? Are we going to go back to what happened last year when the global threat ended, the world health organization said this is no longer a global emergency, and then things kind of went back to the status quo where, which basically meant nothing really happened to stop the spread of mpox?

Holder: So there's a risk that there could be a false sense of complacency, and that could snowball into a much bigger problem.

Furlong: Exactly. But I think that we've seen what that risk has done now. So hopefully some of those lessons might be learned. But this is a disease that, as we've spoken about, has been spreading for a very long time. But there's been a push to end measles for years and we still haven't reached that, and we're seeing more spread of measles in high-income countries as well. So, I think global health experts don't get their hopes up too much.

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)