Photo: SERGII IAREMENKO/SCIENCE PHOTO L / SIA / Science Photo Library via AFP
Faced with a growing outbreak and new variant of mpox, the World Health Organisation has declared a global health emergency.
This is the second alert for mpox, previously called monkeypox, in two years.
But the virus "is not the 'new Covid'", regional director for Europe, Dr Hans Kluge said in a statement on Tuesday. We know how to control mpox, through public health measures and access to vaccines, he said.
New Zealand experts have echoed these messages. While pandemic planning reports have highlighted mpox as having "pandemic potential", the risk of it spreading widely is low.
Here's how Aotearoa would respond to an outbreak of the virus.
A global health emergency, again
Mpox, a viral infection that causes pus-filled lesions and flu-like symptoms, is usually mild but can kill. It can be transmitted through physical contact with someone who is infectious, with contaminated materials, or with infected animals.
There are several vaccines available that prevent both smallpox and mpox, due to how closely related the viruses are.
In May 2022, an mpox outbreak spread across Europe, the Americas, and then all six WHO regions, with 110 countries reporting about 87,000 cases and 112 deaths. The outbreak affected primarily, but not only, gay, bisexual and other men who have sex with men.
The WHO subsequently declared a Public Health Emergency of International Concern, the organisation's highest level of global alert, defined as "an extraordinary event which is determined to constitute a public health risk ... through the international spread of disease and to potentially require a coordinated international response".
The emergency was declared over in May 2023 after a sustained decline in global cases.
From 1 January 2022 to 30 June 2024, about 100,000 laboratory-confirmed cases and 208 deaths were reported to the WHO from 116 countries or territories.
The current outbreak
There are two types of mpox, clade I and clade II. The infection that caused the global outbreak in 2022 was from clade II. In contrast, the current outbreak is being driven by a new offshoot of clade I.
Clade I is endemic in the Democratic Republic of Congo and historically has caused more severe illness and death. Analysis of previous outbreaks found "both case incidence and mortality in the DRC outbreak are concentrated in children".
The current outbreak is more widespread than previous ones, with the virus spreading to neighbouring countries.
On 14 August, the WHO determined the upsurge of mpox in the DRC and neighbouring countries constituted another Public Health Emergency of International Concern.
The following day, Sweden's public health agency recorded a case of clade I, marking the first time the strain has been found outside the African continent.
The same week, it was reported China would begin screening people and goods entering the country for mpox.
Pandemic plans
To be clear: Mpox is not another Covid pandemic.
The New Zealand Pandemic Plan was updated in July, setting out the country's strategy for preparing for and responding to future pandemics. It was written with influenza and coronaviruses primarily in mind.
It updates the 2017 framework with changes reflecting the health system reforms and some aspects of the Covid-19 pandemic response. It will be updated again after the conclusion of the Royal Commission of Inquiry, and other relevant work.
Fundamentally, it is broken down into six phases: plan for it; keep it out; stamp it out; manage it (pandemic management); manage it (post-peak management); recover from it.
In response to pandemics and other crises potentially affecting national security, the Department of Prime Minister and Cabinet will activate the Officials Committee for Domestic and External Security Coordination system. This provides for a coordinated government response.
The ministry engages with DPMC regularly, and "ODESC activation is not considered necessary", public health director Dr Nicholas Jones says.
Another document, authored by infectious diseases research platform Te Niwha and commissioned to support the Public Health Agency and other relevant partners, lists mpox as a possible pandemic scenario.
However, influenza remains one of the most likely pandemic agents, it says.
'Nothing like Covid'
"I'd imagine that Aotearoa's response would look nothing like Covid-19," Dr John Taylor, a senior lecturer in virology at Auckland University's School of Biological Sciences, says.
While the current outbreak of subclade Ib indicates the virus may be more transmissible than previous forms, transmission is still mostly through close physical contact.
"I think widespread transmission in the New Zealand population is unlikely."
Watching what unfolds in Europe will inform measures required here, he says.
Canterbury University professor of applied mathematics and Covid-19 modeller Michael Plank agrees the risk of mpox spreading in New Zealand is low.
"Mpox has distinctive symptoms and is a notifiable disease ... meaning health practitioners have to officially report any cases they see."
Given the way it transmits, isolation of cases and contact tracing would be important measures to curb spread.
"It may be that offering vaccines to high-risk groups or identified contacts could also be an important intervention."
Waiting and watching
The Ministry of Health and Health New Zealand are "closely monitoring" the outbreak in Africa, following the WHO's global alert, the agencies say.
"We are awaiting the WHO's recommendations before determining next steps on how this impacts current public health advice in Aotearoa New Zealand. Mpox is a rare infection and the risk of it spreading widely in New Zealand remains low."
African health officials have appealed to the international community not to impose travel bans on outbreak-affected countries, but instead to support the continent in rolling out testing and vaccinations.
The ministry says at this stage there are no plans to implement border health measures.
To date, 53 Mpox cases have been reported in New Zealand since the disease became notifiable on 9 June 2022. All cases were clade II.
"If you think you may have been exposed to mpox or if you develop symptoms, especially a rash, you should stay home and seek medical advice. You can contact your nearest sexual health clinic, your GP, or Healthline on 0800 611 116, which offers interpreter services."
Meanwhile, University of Otago epidemiologist Dr Michael Baker told Morning Report people in New Zealand should not be particularly concerned, and the focus should be on supporting Africa through the outbreak.