Kelechi Deca
Africa is presently battling a creeping epidemic. Creeping in the sense that it is not receiving the quality of attention it demands. Traveling across some African countries in the last few months, the only evidence that points to efforts to contain the outbreaks of the infectious MPox disease is one or two drop down banners at airports informing people of the need to wash their hands.
In some airports, they have liquid soaps and taps for hand washing. Immediately the passenger leaves the airport, nothing else reminds of the disease. In some countries however, most public spaces, and private offices placed hand washing soap and water at the fronts of their facilities. Yet the disease is spreading fast across the continent.
Mpox was declared a continental health emergency by Africa CDC and a global health emergency by the World Health Organization (WHO) in August last year. The outbreak expanded from 12 to 23 countries and is currently active in 16, 10 of which have received vaccines. Since then, the outbreak has been managed through an Incident Management Support Team (IMST) jointly led by Africa CDC and WHO, working with 26 other partners, including UNICEF, the International Committee of the Red Cross, and Gavi, the Vaccine Alliance.
When I arrived in Nigeria two weeks ago, there were health officers at the arrival hall giving out physical forms, and digital formats to passengers to fill online at their convenience. Questions centered on whether one has had any contacts with anyone with signs of any of the symptoms. Granted that it takes about 21 days from the day of first contact with an infected person to when symptoms would manifest, most passengers won’t know if they were exposed or not.
Arriving last night from Freetown, a country that has reported cases of Mpox since early this year, there was no single health official at the arrival hall, and there were no hand washing buckets and liquid soap.
What this shows is that the health officials also work when it is convenient, rather than when it is necessary.
Most air traffic across West Africa terminates in Nigeria, meaning that infectious diseases are most likely to follow the same route. Unfortunately, we don’t seem to be serious about the situation.
Sierra Leone recorded its first case on January 10, 2025. Immediately after, the government declared a Public Health Emergency, saying at the time the move was necessary to prevent the virus from further spreading. Sierra Leone reported a rising number of confirmed mpox cases, with over 200 new confirmed cases reported in April, highlighting the increased transmission in the country. In early May, it had half of Africa’s confirmed cases, with its outbreak expanding over the past six weeks and cases rising 71% last week compared to the week before. The country was averaging about 100 new cases a day according to medical records from the Ministry of Health.
In one instance, the number of notified cases has increased by 71 percent in just a week. That is to say that it is really an epidemic that is on the upward trend. Sixty-eight percent of patients are male, mostly 30 to 35 years old, and about seven percent of the illnesses are in people who have HIV, a high-risk group seen in other African countries during the outbreak.
In its recent release, the Africa Centres for Disease Control and Prevention (Africa CDC) notes that while there is the possibility of tackling cholera in the same way as the mpox outbreak, which is showing signs of slowing down in most of the affected countries, amid an intensification of response efforts involving multiple partners.
Last month, the Incident Management Support Team (IMST) of the Africa CDC conducted a mission in Sierra Leone and found that the country’s health system was overstretched and overcrowded, with grossly inadequate bed capacity to accommodate more than 1,000 patients in mpox treatment facilities. Sierra Leone is the latest addition to the Incident Management Support Team (IMST) list of the most mpox-hit nations. Skyrocketing cases are triggering concern across Africa.
In April this year, IMST conducted a mission in Sierra Leone and found that the country’s health system was overstretched and overcrowded, with grossly inadequate bed capacity to accommodate more than 1,000 patients in mpox treatment facilities. Africa CDC notes that the treatment centres in Sierra Leone only had 60 mpox isolation beds and most of the patients were receiving home care, which makes it difficult to ensure compliance with isolation.
Authorities say that about 800 active cases are currently being managed through home-based care. Home care is very inefficient in containing highly infectious diseases because it presents very low isolation compliance. And it is very difficult to maintain people in their homes. They tend also, despite being isolated, to continue participating in social activities and then exposing more members of the community to the virus.
The assessment also revealed that surveillance in Sierra Leone is mostly passive surveillance. That is why the positivity rate is far above 50 percent. It means that the people come when they are already very advanced. They come on their own to seek care, instead of being found through active surveillance that can pick them up early and shorten the exposure of the population.
Though Sierra Leone has good mpox testing coverage and a good testing rate, it currently has a low contact-tracing ratio as only fewer than one in every six confirmed cases has had the benefit of contact identification, and the genomic sequencing rate, which should be around 5 percent, is currently well below 1 percent. Close to 24,000 people have been vaccinated so far, and almost 60 percent of them are healthcare workers.
As of this May, the country’s National Public Health Agency (NPHA) warned that all 16 districts in Sierra Leone are now affected by mpox. This is a troubling development as well as the severity of the cases, especially in people living with HIV. Sierra Leone is one of 10 countries that have received vaccine supplies with support from partners like Gavi, UNICEF, and the Africa CDC. However, with a population of 8 million people and just over 61,000 doses of the vaccine available, those at highest risk will be prioritised, officials say. This is why anyone who has seen the devastation Mpox can wrought would be worried as I am.
Kelechi Deca, a development journalist and strategic communications professional writes from Lagos
