Why mpox is ‘concerning’ but not the next COVID, according to experts

The mpox outbreak is a very different situation from the COVID pandemic, experts say but we cannot be “complacent”.

While the outbreak of mpox in multiple African countries is concerning, the situation differs from what the world went through just four years ago with COVID-19, experts tell Euronews Health.
There is, however, an urgency to respond to mpox, particularly as cases of a likely more transmissible new offshoot continue to spread, especially in the Democratic Republic of the Congo (DRC), and are likely to be imported to other countries.
One case of that new variant, clade 1b, has been confirmed in Sweden, and another case has been confirmed in Thailand this week, both in individuals who had travelled to countries struggling with outbreaks.
Meanwhile, European health authorities raised the risk level for the region last week, days after the World Health Organization (WHO) named mpox a global health emergency.
Euronews Health spoke to experts about whether Europeans should be concerned and some of their key messages on the possibility of eliminating the virus.
Mpox is an infectious illness caused by the monkeypox virus that most often causes a skin rash or lesions among other symptoms, such as fever or muscle aches.
The virus was previously declared a global health emergency in 2022, but experts say it is very different from the world’s last health crisis, COVID-19.
“People shouldn’t be alarmed in Europe about having a COVID-like situation suddenly happen again because of mpox,” Dr Marc-Alain Widdowson, WHO Europe’s lead on high threat pathogens, told Euronews Health.
COVID-19, for instance, is a respiratory virus while mpox is “quite difficult to catch,” he added.
“You need a degree of prolonged contact to be able to get it or intense contact, such as sex [which has] been the predominant mode of transmission in Europe,” he said.
A less severe variant of mpox known as clade II continues to spread in European countries, with WHO Europe estimating there are roughly 100 new cases a month in the region.
One concern, however, is that the mpox virus has evolved with clade 1b – the new strain of the historically more severe clade 1 virus – spreading to several African countries that didn’t previously have cases.
Experts have said it is likely more transmissible but that more information is needed about it.
“We already haven’t eliminated clade II [in Europe], the last thing we want is to have an introduction of clade I,” Widdowson said.
“The concern is [clade] 1b, the new variant, is showing much greater human-to-human transmission,” Dr Shema Tariq, a principal research fellow at University College London, told Euronews Health.
But while COVID-19 was more easily spread through a population as an airborne pathogen, mpox requires “human-to-human contact, so it is harder to transmit,” Tariq said.
Widdowson added that mpox is a virus that European countries have been dealing with for the last two years, so they know how to contain it.
“But having said that, we can’t be complacent and we need to make sure that we investigate and shut down any importations into the region,” he said.
Experts say there was a missed opportunity in Europe during the last health emergency to not fully eliminate mpox, but that the new global focus on this virus could help to reinvigorate those efforts.
“I think we have an opportunity now to look carefully at our response, to think about vaccinating the people who are at greatest risk of acquiring clade II, to be really looking out for cases, testing and making sure we have adequate diagnostics to know whether we’re dealing with clade II or clade I virus,” Tariq told Euronews Health.
Widdowson, meanwhile, recommends that European governments broaden surveillance and report data “quickly and transparently”.
This includes isolating patients, tracing their contacts, and researching what the virus is doing.
In Europe, clade II was spreading most often between men who have sex with men, but the new clade may affect different demographics.
WHO does not, however, recommend border closures or traveller restrictions, which Widdowson said can contribute to stigma.
For Tariq, the outbreaks unfolding at the moment provide “very important lessons” about global vaccine equity.
There’s been criticism of developed countries for failing to share vaccines equitably, especially during the COVID-19 pandemic.
Sharing pathogen information in exchange for access to vaccines and treatments in developing countries is one of the key issues that has been holding up negotiations on a global pandemic treaty.
For mpox, the European Commission announced plans with pharmaceutical company Bavarian Nordic to supply more than 215,000 doses of the MVA-BN mpox vaccine to the Africa Centres for Disease Control and Prevention.
French prime minister Gabriel Attal has said that 232 vaccination sites were open in the country and that the government would also donate 100,000 vaccine doses through the European Union to the most impacted countries.
But there should be an automatic mechanism for providing vaccines, according to Widdowson.
“We cannot hope to get rid of the threat in Europe if [there are] continuing outbreaks and continuing high numbers in the DRC,” he said.
The mpox emergency also highlights that “infections don’t have borders,” according to Tariq at UCL.
“We live in a joined-up interconnected world. We cannot be complacent and contain infections where they are originating,” she said.
“We have to support colleagues in the most highly affected regions to be able to manage this outbreak, not just for their populations, but also for our populations as well,” she added.