The detection of the first clade I mpox case in the U.S. this November, followed by a subsequent case in Canada, is far more than a fleeting headline. It is a stark reminder of the interconnectedness of global health. Clade I mpox, a public health emergency of international concern concentrated in Central and Eastern Africa, has already caused more than 57,000 suspected cases and more than 1,200 deaths in 2024 alone. Travel-associated cases have now extended to Europe, Asia, and North America, with the first U.S. case linked to travel from an endemic region.
This development underscores the urgent need for sustained, coordinated action to prevent clade I mpox from following the trajectory of clade II. The latter has resulted in the continued global circulation of over 100,000 cases across 122 countries, including 115 nations where mpox was not previously reported.
The emerging threat of clade I mpox presents the incoming Trump administration with a unique opportunity to demonstrate leadership, bolster global health, and underscore the value of preparedness. Proactively addressing this challenge can protect the U.S. from future outbreaks while reaffirming its commitment to global health security and collaboration.
A Global Health Emergency With Far-Reaching Implications
Clade I mpox poses a grave public health challenge, particularly in endemic regions like the Democratic Republic of the Congo (DRC), where minors account for 75% of cases. Neighboring countries, including Burundi and Uganda, have also reported rising numbers, with over 3,000 confirmed cases in Burundi and more than 1,550 in Uganda as of November 2024. Travel-associated cases have now appeared in Germany, India, Sweden, Thailand, and the U.K. Although clade I mpox has historically been considered more severe than clade II, the overall case fatality rates for either clade are likely very context-dependent. For example, areas with better access to healthcare and strong healthcare infrastructure have similar case fatality rates for both clades.
Without urgent, coordinated global containment efforts at the source, clade I risks becoming a persistent global health threat just like clade II — one that exacerbates existing inequalities and further strains already overburdened healthcare systems.
Global health security is about more than reacting to crises — it’s about building systems capable of identifying, containing, and mitigating threats before they spiral out of control. While the immediate risk to the U.S. public remains low, our world’s interconnectedness leaves no room for complacency. Early, decisive action can transform a looming crisis into a testament to the power of prevention and preparedness.
A Roadmap for U.S. Leadership
The incoming Trump administration has a critical opportunity to turn the response to mpox clade I into a global health success story. By adopting a proactive and strategic approach, the U.S. can save lives, strengthen its leadership in global health security, and prove that investing in prevention yields invaluable dividends.
To seize this moment, the administration under President-elect Donald Trump must act decisively, making pandemic preparedness a top national security priority. Here’s what must be done:
Invest in Global Health Infrastructure
The U.S. has committed more than 1 million doses of the modified vaccinia Ankara-Bavarian Nordic (MVA-BN; Jynneos) vaccine to the global mpox response, with recent shipments to the DRC and other African nations. However, only a fraction of the required 10 million doses for Africa has been delivered, underscoring the need for continued investment. Campaigns in countries like the DRC are critical but face logistical challenges, including misinformation and limited vaccine uptake. Sustained investments in health infrastructure, community engagement, and vaccine campaigns are essential to contain clade I at its source.
Prevent Clade I from Becoming Endemic
We must learn from the global circulation of clade II mpox. Containment strategies should focus on expanding diagnostic and surveillance capabilities, supporting public health systems in endemic regions, and funding research to better understand clade I transmission dynamics.
Enhance Diagnostic and Surveillance Systems
Containment begins with knowledge. Supporting robust surveillance systems in endemic regions, expanding diagnostic capabilities, and funding research to understand clade I transmission dynamics are critical to staying ahead of the virus. These measures also strengthen global health security, building resilience against future threats.
Strengthen Domestic Preparedness
The U.S. must prepare for additional imported cases of mpox. Healthcare providers need updated training to promptly identify and report cases, and the nation must maintain robust stockpiles of vaccines and therapeutics, along with rapid deployment protocols. Recent findings from the NIH-sponsored STOMP study on tecovirimat (Tpoxx), the only antiviral medication currently available for mpox, revealed that while the drug was safe, it did not improve the resolution of lesions or reduce pain in patients with mild to moderate clade II mpox. These findings underscore the urgent need for further research and development of additional antiviral treatments and therapeutics tailored to address both clade I and clade II mpox. Strengthening diagnostic capabilities and supporting the development of novel medical countermeasures remain critical components of a comprehensive response.
Support Innovative Global Solutions
The World Health Organization’s (WHO) prequalification of the MVA-BN/Jynneos vaccine is a major step forward, enabling low-resource countries to access vaccines. However, challenges remain, including limited global supplies. The U.S. should support clinical trials for alternative vaccines and dosing strategies, especially for vulnerable populations. These investments also enhance biosecurity by reducing the likelihood of global spread. At a time when there is speculation about the U.S. potentially leaving the WHO under the country’s new leadership, it is critical to recognize the pivotal role the organization plays in coordinating global health efforts. Now is a moment to double down on our commitment to the WHO, ensuring global health security through collaboration, not retreat.
Adopt a Comprehensive Biosecurity Approach
Mpox clade I’s emergence underscores the biosecurity threats posed by zoonotic diseases. A comprehensive strategy must include wildlife monitoring, enhanced border health measures, and education campaigns in endemic regions to reduce exposure to infected animals and contaminated materials.
The Stakes and the Opportunity
Failure to act decisively risks allowing mpox clade I to follow clade II’s path to global circulation. Public health experts, like us, warn that without coordinated global efforts, clade I could become entrenched in new regions, increasing household and healthcare-associated transmission. Vulnerable populations, particularly children and historically stigmatized populations, would face disproportionate harm, exacerbating global health inequities.
Yet, this is also a moment of opportunity. The Trump administration has a chance to build on existing efforts and reaffirm the U.S.’s commitment to global health security. The lessons from COVID-19 and clade II mpox are clear: early investment in prevention and preparedness saves lives and reduces long-term costs. It is not only a moral imperative but a strategic necessity to ensure clade I mpox does not become the next global health crisis.
This is a chance to lead; to invest in a safer, healthier future; and to show the world that the U.S. is committed to protecting not just its own borders but the interconnected health of the planet.
Syra Madad, DHSc, MSc, MCP, is Chief Biopreparedness Officer of NYC Health + Hospitals, affiliate faculty at Boston University’s Center on Emerging Infectious Diseases, and founder of Critical Health Voices. Jason Kindrachuk, PhD, is an associate professor and Canada research chair in the Department of Medical Microbiology & Infectious Diseases at the University of Manitoba in Canada. Anne W. Rimoin, PhD, MPH, is a professor of epidemiology at the UCLA Fielding School of Public Health.
Source link : https://www.medpagetoday.com/opinion/second-opinions/113735
Author :
Publish date : 2025-01-12 17:00:00
Copyright for syndicated content belongs to the linked Source.