U.S. Response to Mpox in the DRC: Leveraging PEPFAR as a Global Health Security Asset
October 28, 2024
The current African mpox outbreak, driven by a more deadly strain, demands attention despite competing global crises. With over 40,000 suspected cases in 2024, primarily in the DRC, the U.S. government has mobilized PEPFAR as a core response element, leveraging its HIV/AIDS infrastructure. While mpox is preventable and treatable, challenges include weak health systems, limited diagnostics, and vaccine distribution obstacles. Historical factors contribute, including ceased smallpox vaccination providing no cross-immunity to younger generations. Despite Gavi securing 500,000 vaccine doses, delivery faces hurdles including misinformation and institutional distrust. PEPFAR's reauthorization in 2025 highlights its crucial role in global health security.
The current mpox outbreak in Africa represents a significant but underreported global health threat, with PEPFAR emerging as a crucial component of the U.S. government's response strategy.
Current Situation:
1. Outbreak Scale:
- Over 40,000 suspected cases across Africa in 2024
- More contagious and deadly strain
- WHO declared PHEIC in August 2024
- Spread to multiple countries including Germany, Sweden, and India
2. PEPFAR's Strategic Role:
- Leveraging existing HIV/AIDS infrastructure
- Core element of U.S. government response
- Critical platform in DRC and affected countries
- Demonstrates importance for global health security
- Faces reauthorization in early 2025
3. Response Challenges:
- Weak health infrastructure
- Limited access to primary care
- Insufficient rapid diagnostics
- Low testing rates
- Conflict and displacement
- Stigma and discrimination
4. Vaccine Initiatives:
- WHO prequalification of Bavarian Nordic vaccine
- Gavi securing 500,000 doses
- First Response Fund implementation
- Distribution began September 2024
- Vaccination of vulnerable groups started October
5. Historical Context:
- Legacy of ended smallpox vaccination
- Loss of cross-immunity protection
- Colonial history affecting trust
- Delivery system challenges
- Misinformation circulation
The situation underscores PEPFAR's importance in addressing emerging health threats while maintaining critical HIV services, highlighting the need for sustained support and program reauthorization in 2025.