Mpox preparedness and readiness in Malawi

Mpox Declaration and Response

On 14 August 2024, the World Health Organisation WHO Director-General Dr Tedros Adhanom Ghebreyesus declared the Mpox virus, surging across several African countries, as a “public health emergency of international concern” under the International Health Regulations (2005) (IHR). This action was set to help mobilize global and regional public health resources to better monitor and respond to the threats posed by the outbreak.

Mpox, once referred to as monkeypox, is a virus that causes flu-like symptoms and skin blisters across the body. Fortunately, the virus is mostly spread through direct contact with infected lesions or bodily fluids, or through contaminated materials like bedding. This means it is not typically as contagious as respiratory diseases such as COVID. The virus can also spread through respiratory droplets, although this only typically occurs with prolonged close contact in areas with limited ventilation.

In WHO’s statement Director General Dr Tedros Adhanom Ghebreyesus alludes that the emergence of a new clade of #mpox, its rapid spread in eastern #DRC, and the reporting of cases in several neighboring countries as worrying. On top of outbreaks of other Mpox clades in DRC and other countries in Africa, hence a coordinated international response is needed to stop these outbreaks and save lives.

"Just one case is sufficient to trigger transmission in any given area, it is important to support the countries that are affected to put in place effective surveillance systems to rapidly identify any new cases, effectively follow up on the contacts, and be able to contain the transmission," 

Underscoring the concern, WHO Africa Regional Director Dr Matshidiso Moeti emphasizes on need to scale up response to the Mpox outbreak, collaboration across countries and continents to raise awareness, mobilize resources and increase preparedness of health systems and countries to contain the spread of the virus.

Epidemiological Landscape and Testing Gaps

The Mpox epidemiological situation in the Democratic Republic of the Congo (DRC) revealed high case numbers. However, the full scope of the outbreak remained unclear due to a lack of robust surveillance and routine systematic testing. While confirmed cases in the DRC represent only 4% of the global total and 17% of global deaths, the DRC has seen over 16 000 suspected cases. This suggests significant undetected transmission, especially given that only 24% of these suspected cases were tested in 2024. Even with this limited testing, a concerning 62% of those tested were positive for mpox. In July 2024, Africa experienced a surge in confirmed mpox cases, surpassing the combined total from all other regions. This concerning trend was further compounded by the emergence of new cases in Kenya, Uganda, Rwanda, and Burundi during the last week of July. These countries, all neighboring the DRC, reported their first-ever mpox cases, which were directly linked to the ongoing outbreak in eastern DRC, raising concerns about further spread to other countries, including Malawi. 

Malawi faces significant risks in terms of Public Health Emergencies and climate-related events. Since 2019, Malawi has responded to multiple emergencies, COVID-19 pandemic, polio outbreak, cholera outbreak along with natural disasters like Tropical Storm Ana, Cyclone Gombe, Cyclone Freddy, floods, and droughts. The emergencies have had extensive impact on the health system and various sectors of the economy. Malawi ranks low at 154 out of 195 countries (Global Health Security Assessment 2019) in its ability to prevent, detect, and respond to epidemics and pandemics.  Malawi’s health security core capacities as defined by International Health Regulations IHR 2005 were also assessed as low in the 2019 Joint External Evaluation JEE. Malawi has significant trade relations and population movements with South Africa, which has an active Mpox outbreak. Malawi also has a considerable number of troops supporting peacekeeping missions in Eastern DRC, where Clade 1b has been reported. There is therefore notable traffic between Eastern DRC and Malawi, directly. 

Malawi's Strategic Priorities in Addressing Mpox

In response to mpox developments worldwide, Malawi has mapped out and classified strategic priorities to protect public health and prevent virus spread within its communities.

Surveillance and Prevention remain top priorities, with Malawi focused on strengthening mpox surveillance systems to promptly detect and respond to imported cases, and laboratory capacities for timely diagnosis. This includes implementing public health measures that prevent community spread.

Risk Communication and Community Engagement strategies aim to deliver clear, consistent messaging to the public, raising awareness and promoting preventive measures, particularly among high-risk groups. This approach emphasizes transparency and proactive community involvement.

Community Protection and Resilience focuses on leveraging existing community structures and resources to enhance mpox detection and response efforts. Added integrated actions with primary healthcare centers (PHCs), HIV/STI services, and health promotion initiatives work to reduce transmission risk and build community resilience.

Health System Strengthening involves improving healthcare infrastructure, particularly in rural and underserved areas, to ensure accessible and effective management of mpox cases. This includes integrating mpox treatment pathways into primary care and ensuring the availability of essential medicines, vaccines, diagnostics, infection control tools, and therapeutics as they become available.

Finally, International Collaboration is crucial, with Malawi partnering with international stakeholders to monitor global mpox trends, ensuring resource and information sharing to strengthen collective response efforts. These coordinated strategies enable Malawi to prepare, prevent, and respond effectively to the mpox threat, prioritizing public health and community safety.

Actions taken 

Coordination

WHO Malawi has since supported simulation exercise to test the Public Health Emergency Operations Center (PHEOC) Handbook, where the scenario developed was on Mpox and informed Mpox National Preparedness and Response Plan. WHO is currently supporting preparedness coordination through the Health Cluster and mobilization of resources through the Health Donor Emergencies sub-group.