Again, fear grips Nigerians as Monkeypox resurfaces

With the Africa Centres for Disease Control and Prevention (Africa CDC) declaring the stubborn Monkeypox as a health emergency, BENJAMIN SAMSON speaks with experts, stakeholders on its implications amid the continent’s weak health care systems.

The Africa Centres for Disease Control and Prevention (Africa CDC) last week declared the ongoing Mpox (formerly known as Monkeypox) outbreak a Public Health Emergency of Continental Security (PHECS), marking the first of such declaration by the agency since its inception in 2017.

This declaration, under Article 3, Paragraph F of the Africa CDC Statutes, empowers the organisation to lead and coordinate responses to significant health emergencies. 

A public health expert, Dr. Joshua Olufemi, in an interview with this reporter said the statute mandates Africa CDC to, “Coordinate and support Member States in health emergency responses, particularly those declared PHECS or Public Health Emergency of International Concern (PHEIC), as well as health promotion and disease prevention through health systems strengthening, addressing communicable and non-communicable diseases, environmental health, and neglected tropical diseases.

“The declaration will enable the mobilisation of resources across affected countries, unlocking essential funding, strengthening Risk Communication and Community Engagement (RCCE), boosting surveillance and laboratory testing efforts, and enhancing human resource capacities to respond effectively to Mpox through a one health approach.”

Africa CDC Director General Dr. Jean Kaseya emphasised the urgency of swift and decisive action: “Today, we declare this PHECS to mobilise our institutions, our collective will, and our resources to act—swiftly and decisively. This empowers us to forge new partnerships, strengthen our health systems, educate our communities, and deliver life-saving interventions where they are needed most. There is no need for travel restrictions at this time.”

According to the Africa CDC, the declaration of emergency over the outbreak of Mpox has become compelling because about 38, 465 cases and 1, 456 deaths have been recorded since January 2024. 

In fact, the figures have risen by 160 per cent in 2024 compared to 2023. This startling revelation was made on August 4, 2024 by Kaseya.

Breaking it down, the figures reeled out began with the hardest hit country, the Democratic Republic of Congo (DRC), having 13,791 cases with 450 deaths. Others include Cameroun with 35 cases and two deaths, South Africa with 22 cases and three deaths, and Congo with 146 cases and one death. Though the Central Africa Republic (CAR) and Burundi recorded 213 and eight cases respectively, there were no deaths. Other countries such as Liberia, Ghana, and Rwanda also recorded five, four, and two cases in that order, but not a single death. Nigeria has so far recorded 24 cases, but no death. 

The disease 

Speaking with this reporter, a virologist, Dr. Nursdeen Kamal, said, “Mpox is a viral illness caused by the Monkeypox virus. Common symptoms include a skin rash or mucosal lesions lasting two to four weeks, fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes.

“Mpox spreads via infected bodily fluids. Investigations in the DRC suggest that heterosexual transmission, especially among female sex workers, is driving the outbreak, contrasting with the spread mainly among men who have sex with men in Europe in 2022. 

“The high prevalence among women raises concerns about vertical transmission risks and adverse pregnancy outcomes.”

Also, renowned virologist, Dr. Oyewale Tomori, highlighted the significance of the Africa CDC declaration of Mpox as a continental emergency before the World Health Organisation (WHO) declared it a global emergency.

He said, “The action signalled a crucial shift in Africa’s approach to responding to health crises. Africa must be commended for taking the proactive stance on Mpox.

“We cannot continue to wait for the global community to declare a health crisis before we act. Africa has the capacity and the expertise to handle its health challenges.

“Africa should focus on areas they have strength, because 50 years of Ebola, over 100 years of yellow fever, recent cases of Covid-19 has given us enough talent and capability to do our surveillance ourselves.”

Triggers 

Tomori said cross-border movements and low public awareness make most countries in the continent highly vulnerable.

“The high risk of severe infection among people living with HIV, considerations for asymptomatic infections, poor vaccination strategies, limited access to medical countermeasures, and low detection rates were other concerns. 

“The outbreak is further complicated by a high case fatality rate of over 3·9 per cent, particularly among children younger than 15 years, who account for 60 per cent of cases.

Local concerns 

In his view, a pharmacist and researcher on infectious diseases, Oyedele Yusuf, however, expressed concerns over Nigeria’s apparent complacency in the face of the growing threat, citing the country’s history of inadequate response to epidemics like Lassa fever and Covid-19.

He said, “We are not prepared for a major outbreak. The government’s track record in handling previous epidemics, like Covid-19 and Lassa fever, is a cause for serious concern.

“Early detection, isolation, and treatment are essential steps in curbing the spread of Monkeypox. Strengthening surveillance and laboratory capacity in Nigeria and across Africa is critical in combating the virus.

“There is also the need for increased investment in disease surveillance, laboratory capacity, and community health programmes.”

He stressed the need for a decentralised approach to disease control, empowering state and local governments to play a more active role.

“Everybody is complaining about vaccines. Oh, there’s no vaccine; the world does not care about us, etc, but what about the one we need to do ourselves? That’s where our leaders must be told the truth. We need to empower our people to detect cases, confirm them in the laboratory, isolate the cases in the hospitals, and treat them; these are the first important things because if you do all that, you don’t get an epidemic occurring.

 “If you detect the case in time, you treat it, and prevent spread by all the other things you need to do, the infection prevention control, and all that; then you limit the spread of the virus. And if you limit the spread, of course, then you don’t get an emergency.”

Likewise, Dr. Olufemi warned that the country was at a critical juncture in health care delivery.

He underscored the urgent need for improving disease surveillance, enhanced laboratory support, while finalising plans to produce vaccines locally to contain outbreaks like Mpox.

He emphasised the importance of raising awareness about the diseases plaguing the country while fully engaging and empowering communities in surveillance efforts.

“A balanced integration of these aspects of disease control and response is crucial for national preparedness for controlling Mpox and, and also, for responding to other current and future disease outbreaks,” he said.

According to the expert, Nigeria’s ability to effectively combat emerging infectious diseases rests on robust surveillance systems.

“The foundation for controlling any disease, including Mpox, is surveillance. Eternal vigilance is the price of liberty from any disease outbreak.

“Without early detection and monitoring, we will always play catch-up, running helter-skelter like decapitated chickens after rampaging diseases.

“For the good health of our people and our national health security, that is not a position we can afford to be in,” he said.

He described the upsurge of Mpox in the DRC, where inadequate surveillance has led to the spread of the disease to neighbouring countries, as “a cautionary tale for Nigeria.”

“Effective disease control requires the integration of several capabilities – rapid detection, reporting, laboratory confirmation, isolation and treatment of cases.

“Proper data management allows us to plan and implement an appropriate response, limiting the spread of cases and preventing a national, continental, or international emergency.”

Vaccines/treatment

A former Commissioner for Health in Kogi state, Dr. Aminu Adegbe, speaking exclusively with this reporter, said many African countries, including Nigeria, have the necessary human health workforce to prevent and control outbreaks.

He criticised successive governments for failing to provide sustained funding to create and maintain an enabling environment for health workers.

“Instead of building on our strengths, our experienced health workers, the governments have underfunded public health systems and turned around to beg foreign governments and agencies for vaccines.

“We forget that with effective surveillance, we can prevent outbreaks that become international concerns, reducing the need for vaccines,” he said.

Reflecting on Nigeria’s current capabilities, he expressed concerns over the nation’s dependence on international vaccine supplies.

“We are far from being able to produce human vaccines locally, despite past efforts. In my father’s time, Nigeria was self-reliant in many areas.

“Today, though significant efforts are being made by the government, we have wasted so much precious time and are not close to achieving an acceptable position in local vaccine production,” he said.

He warned that relying on external sources for vaccines could leave Nigeria vulnerable, “especially in times of global shortages.”

Adegbe called for a comprehensive national strategy that prioritises health system strengthening, local vaccine production, and research.

“We cannot continue to repeat the same mistakes we have made for the last 50 years. It is time for Nigeria to take control of its public health destiny and ensure that we are prepared for the next pandemic.”

The solution 

Speaking on the way out, he said, “There is a need for the government in collaboration with health agencies to develop a national strategic plan for vaccination against Mpox in addition to improving surveillance of the disease at borders and checkpoints.  Groups of people that are high-risk for Mpox should be prioritised in the provision of vaccines.

“Most importantly, there should be a rise in public sensitisation, education and advisory on ways to prevent the spread of the Mpox virus, which include limiting contact with animals such as rodents and monkeys.

“The Nigeria Centre for Disease Control (NCDC), corporate bodies, schools, faith-based organisations, and civil society groups should enlighten citizens, especially at the grassroots, on the importance of thoroughly cooking all foods that contain animal meat or parts, washing their hands frequently with soap and water and avoiding contact with people who may be infected with the virus.”

Cross-border movements 

Meanwhile, the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, has disclosed that Nigeria has intensified monitoring and screening procedures at all entry points in response to the threat posed by Mpox .

Prof. Pate said the NCDC and the Nigeria Ports Health Services, both under the Federal Ministry of Health and Social Welfare, had already initiated steps to fortify the nation’s defences even before the Africa Centres for Disease Control and Prevention (Africa CDC) declared Mpox a public health emergency.

The minister explained that the Mpox Clade 1 strain has been particularly deadly, with previous outbreaks resulting in fatalities in up to 10 per cent of those infected. 

In response, he said the Nigerian government was already deploying measures akin to those used during the Covid-19 pandemic to combat and mitigate the impact of “this viral threat.”

According to him, among the measures implemented is a new mandate requiring all travellers to complete an online health declaration form before departing for Nigeria.

Additionally, the government has activated infectious disease centres across all 36 states and the Federal Capital Territory (FCT) to enhance the country’s preparedness and response capabilities.

Prof. Pate also urged the public to maintain good hygiene practices, including frequent hand-washing with soap and water or using alcohol-based hand sanitisers, especially after contact with an infected person or animal