Mpox: Why diagnostics and labs are crucial to taming its spread

Africa and indeed the world, is faced with another public health emergency - Mpox. Over 17,000 cases and 517 deaths reported and numbers are rising.

As announced by the Africa CDC, and declared by the World Health Oganisation (WHO), this has triggered a regional and global response to prevent and control further spreading of Mpox.

The role of surveillance cannot be underestimated in this response so that cases are detected, reported and tracked in real-time. This will enable case isolation, contact tracing and care provision as early as possible and prevent further spread.

This information is also key in understanding the hot spots and other public interventions such as vaccinations. But, the key to this surveillance is access to diagnostics and laboratory capacities to identify and report new cases. This capacity is key in countries with current Mpox and other neighbouring countries.

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We ask same question: Are African countries’ diagnostic and laboratory infrastructure resilient and ready to step up to the current Mpox threat? The answer lies with previous experience with Covid-19 pandemic.

This time, it is important to note that PCR testing capacity built for Covid-19 and the networks that have been established can easily be activated for Mpox testing.

Countries are already doing sequencing for Mpox leveraging the foundational capacity built for Covid-19. According to Africa CDC data, about three-quarters of member states has some capacity to perform sequencing.

This huge investment is now sitting in “genomic centres” in these countries and are a timely resource to leverage on during this Mpox pandemic. This sequencing capacity can also contribute to research and development agenda while answering questions on evolution of Mpox.

The WHO guidelines the Laboratory testing for the monkeypox virus Interim guidance 23 May 2022, urge that “testing for presence of Mpox should be performed in appropriately equipped laboratories by staff trained in relevant technical and safety procedures.

Confirmation of MPXV infection is based on nucleic acid amplification testing (NAAT), using real-time or conventional polymerase chain reaction (PCR), for detection of unique sequences of viral DNA. PCR can be used alone or in combination with sequencing”.

The ability to differentiate clades of Mpox is crucial for public health response. As we respond to this current Mpox threat, we will need appropriately equipped laboratories across African countries. These facilities have to be optimised to serve the testing needs of the countries.

Therefore, countries and the region should continue to strengthen laboratory networks that can deliver Mpox testing efficiently. Where testing does not exist, strong and efficient sample transportation networks should be in place.

While continuous training of staff to be skilled and competent to test for Mpox will continue to be critical, access to the Mpox technology and diagnostics can be a huge barrier to responding to the pandemic. Supply chain challenges are often a big issue when it comes to epidemic-prone tests.

Additionally, regulatory approval processes, high costs and logistic hurdles, such as obtaining pre-import permits and customs clearance, further impede access to these necessary supplies.

The current low Mpox testing coverage in Africa of less than 40 per cent (Africa CDC August 2024 Mpox updates) is concerning. It is time the global community invest on development of point of care and near point of care tests that will allow decentralisation of testing. 

Mpox usually starts in remote communities with no access to diagnostics. To effectively combat Mpox and other epidemic-prone diseases, African countries must enhance regional collaboration, data-sharing, and public-private partnerships. By pooling resources, engaging communities, and leveraging private sector expertise, countries can create a more unified and efficient response.

These efforts will not only address current gaps but also ensure the continent is better prepared for future pandemics, contributing to global health security and equity.