COVID, mpox, cholera: Is the world prepared for another pandemic?

The Hidden Cracks in Global Healthcare: A Pandemic Prone World

The world has been grappling with the aftermath of the COVID-19 pandemic, and it seems we haven't fully closed the chapter on it yet. The emergence of mpox (monkeypox) and ongoing cholera outbreaks are stark reminders that global health preparedness remains a significant concern. The World Health Organization (WHO) has sounded the alarm, highlighting that 4.5 billion people worldwide are without adequate access to essential healthcare services. This staggering figure underscores the vulnerability of our global health infrastructure, leaving us wondering if we are truly prepared for another pandemic.

The State of Global Healthcare

The WHO's recent declaration that mpox constitutes a public health emergency of international concern (PHEIC) has brought global attention to the issue. The rapid spread of a new clade of mpox in Central Africa, coupled with its detection in neighboring countries, has heightened fears of a potential epidemic. The situation is further complicated by the fact that many African nations lack the necessary resources to combat such outbreaks effectively. Vaccines and treatments, which were largely unavailable during the initial mpox outbreak in 2022, are still in short supply in these regions.

Moyeza, an epidemiologist at the University of California, Los Angeles, emphasizes the critical need for global coordination and resource allocation. "An infection anywhere is potentially an infection everywhere," she warns. "We've seen this idea come to bear many times. The neglect of mpox in Africa led to its global spread in 2022. We must act decisively to prevent history from repeating itself".

The Challenges of Mpox

Mpox, caused by the monkeypox virus, is a disease that has been endemic in central and western Africa for decades. However, the recent emergence of a new clade (Ib) has sparked widespread concern. This strain appears to be spreading mainly through sexual networks, which makes it particularly challenging to contain. The WHO has noted that the true number of cases is likely higher than reported, as many clinically compatible cases remain untested.

The rapid spread of mpox in Africa and its detection in countries like Burundi, Kenya, Rwanda, and Uganda are alarming indicators of a potential epidemic. In the Democratic Republic of the Congo (DRC), nearly 2,400 suspected infections and 56 deaths were reported in a single week in early August. These numbers are a stark reminder of the dire situation on the ground.

The Ongoing Cholera Crisis

While mpox dominates the headlines, another infectious disease continues to wreak havoc on communities around the world: cholera. This bacterial disease is often associated with poor sanitation and contaminated water sources, making it a significant threat in areas with limited healthcare infrastructure.

WHO's global strategies to combat cholera include the "Ending Cholera: A Global Roadmap to 2030" initiative. This comprehensive plan aims to reduce the spread of cholera by enhancing water, sanitation, and hygiene practices. Despite these efforts, cholera remains a major public health concern, particularly in regions like Yemen where it has caused tens of thousands of deaths over the past few years.

Lessons from COVID-19

The COVID-19 pandemic has provided valuable lessons for global health preparedness. Rapid access to vaccine financing has been identified as a critical factor in responding to health emergencies quickly. Gavi, the Vaccine Alliance, has played a crucial role in securing doses of mpox vaccines for rapid deployment. An agreement with Bavarian Nordic to procure 500,000 doses of mpox vaccines is an important milestone in the international response to mpox.

Gavi's commitment to building a stockpile of mpox vaccines underscores the importance of preparedness. The organization's efforts are bolstered by the World Economic Forum's (WEF) emphasis on leveraging global partnerships to address pandemics. The WEF's agenda highlights the need for robust international cooperation to ensure equitable access to healthcare resources, especially during emergencies.

The United States' Commitment to Mpox Response

The United States has also taken significant steps to address the global mpox outbreak. The Biden-Harris Administration has pledged $500 million and one million doses of mpox vaccine to support African countries in preventing and responding to the outbreak. This funding will be used to train frontline health workers, enhance disease surveillance, and improve laboratory diagnostic supplies and testing.

Can We Learn from Past Mistakes?

The world has experienced numerous public health crises in recent years. Each outbreak has highlighted the need for better preparedness, including enhanced surveillance systems, robust infrastructure, and equitable access to healthcare resources. However, despite these lessons, many challenges persist.

In Africa, where mpox is most prevalent, the lack of resources and infrastructure remains a significant barrier to effective containment. Vaccines and treatments continue to be in short supply, exacerbating the situation. The Africa Centers for Disease Control and Prevention (Africa CDC) is working tirelessly to address these issues, but more support is needed from the global community.

Dr. Matshidiso Moeti, WHO Regional Director for Africa, emphasizes the importance of coordinated international action. "Significant efforts are already underway in close collaboration with communities and governments," she states. "But we must scale up further through coordinated international action to support countries bring the outbreaks to an end".

The Path Forward

The world is at a critical juncture, with multiple pandemics looming on the horizon. The emergence of mpox and ongoing cholera outbreaks serve as stark reminders of our vulnerabilities. To address these challenges effectively, we must leverage global partnerships and commit to comprehensive preparedness initiatives.

1. Enhanced Surveillance: Strengthening surveillance systems globally is crucial for early detection of outbreaks. This can be achieved through enhanced collaboration between countries and the use of advanced technologies like genetic sequencing.

2. Resource Allocation: Ensuring equitable access to healthcare resources, including vaccines and treatments, is essential. Global partnerships like Gavi and the Pandemic Fund can play a significant role in securing and distributing these resources.

3. Capacity Building: Investing in local healthcare infrastructure, particularly in regions like Africa, is vital for long-term preparedness. This includes training frontline health workers and enhancing laboratory capacity.

4. International Coordination: A coordinated international response is critical for containing outbreaks quickly. The WHO's declaration of PHEIC status highlights the need for swift action and increased collaboration among nations.

In conclusion, while significant progress has been made in addressing global health crises, much work remains to be done. The ongoing mpox and cholera outbreaks underscore the need for sustained commitment to preparedness and resource allocation. The world must learn from past mistakes and work together to ensure that we are better equipped to face future pandemics.

References

• https://www.nature.com/articles/d41586-024-02607-y
• https://www.who.int/activities/preparing-and-preventing-epidemics-and-pandemics
• https://www.whitehouse.gov/briefing-room/statements-releases/2024/09/24/fact-sheet-the-united-states-commitment-to-address-the-global-mpox-outbreak/
• https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern
• https://www.weforum.org/agenda/2024/09/pandemic-healthcare-health-mpox-vaccine/