Implementing a multi-sectorial Mpox strategies for strengthening public health response and recovery interventions and actions requires a multifaceted Mpox outbreak approach involving surveillance, contact tracing, community engagement, outbreak containment, and vaccination efforts. Implementing community-based OH approaches entails nurturing robust and sustainable interdisciplinary collaboration and multisectorial coordination that promote and contribute to local ownership and participatory engagement. A better understanding of the human-animal-environment (ecosystem) health interface/dependence and governance, and quality data collection in enabling evidence-based OH outbreak decisions making and practice.
Building One Health community of practice (OH-CoP) stewardship and priorities setting is essential in fostering effective domestic and external resource mobilization strategies and sustainable financing mechanisms. Catalyzing OH-CoP impacts initiatives implementation requires efficient and transparent management, trusted and reliable risk communication channels and co-participation. Moreover, developing and implementing OH-CoP training, capacity building and educational outreach programs enabling competencies and skills acquisition and deployment students and youths, professionals, community health workers and vulnerable communities.
Investing in community-led strategic partnerships and innovative financial sourcing (e,g.: internal, external) and efficient management of OH-CoP champions and voices initiatives and increasing productivity. Optimizing OH-CoP policy and governance frameworks and structure integration into existing legislation and regulations in ensuring grassroots and community-driven human, livestock, agriculture and ecosystem long-lasting sustainability and equity.
Strengthening integrated community-based OH early warning systems can improve anticipatory and effective public health emergencies preparedness and response interventions. Also, supporting timely promotion and advocacy of outbreak emergencies humanitarian policies formulation and operationization, early risk detection and rapid reporting and coordinated strategic planning to mitigation and resilience solutions. Community-led initiatives serve to catalyze the much needed partnership for resource mobilization and community engagement inclusiveness and trust building, transparency and responsiveness, social and behavioral adaptations, maintaining best practices and resilient contingency plans management in accelerating whole-community development and empowerment during and post-outbreak emergency crisis (Fig. 1).
Community-based One Health programs and interventions implementation against outbreak crisis
Leveraging on lessons learned and experiences from West Africa Ebola outbreak (2014–2015), COVID-19 (2020–2022) in tackling the growing threats and burden of emerging climate change and extreme weather sensitive infectious diseases outbreaks [2, 4, 5, 8, 9]. Such integrated and multi-sectorial strategies is necessary for strengthening emergency public health response and recovery through context-specific comprehensive and holistic public health, socioeconomic and financial response packages against Mpox outbreak to yield significant outcomes and impacts in Africa[1, 9]. There is a need to strengthen existing public health responses and lessons learned from community-based OH response against Mpox outbreak and future public health emergencies crises [7, 10].
i. Harnessing OH approach preparedness and readiness is capital through strengthening health systems to facilitate early detection, accurate diagnosis and sustained and equitable access and uptake of essential services and new programs including Mpox vaccination of high risk groups. Tapping from valuable experiences gained from responding to health crises to improve communities and high risk groups preparedness and readiness for future public health emergencies. It is important to analyze past preventive, cautionary and response actions and outcomes to b able identify successes, best practices, implementation gaps and address areas for improvement. This enables prioritizing early interventions, proactive approach that allows for rapid mobilization of resources and effective strategies tailored cultural and contextual emerging infectious diseases threats ou burden. Enhanced OH readiness leads to more efficient emergency responses, and minimizing public health losses [10]. Leveraging on emerging cutting-edge technologies and tools at primary healthcare and communities levels including expanding remotely digitalization and artificial intelligence-powered technologies access and deployment which offer new and continuous participation and learning, to foster a population trust and culture of resilience, essential for navigating complex public health challenges of Mpox threat and other public health emergencies today and in the future.
ii. Strengthening community-based and primary healthcare surveillance, contact tracing and monitoring capacities require training healthcare workers to identify Mpox cases, improve laboratory capacity for accurate diagnostics, and establish efficient reporting mechanisms.Surveillance and Medical laboratories optimization, active ports of entry or exit screening and testing travelers, sex workers and truck drivers, strengthening national disease monitoring systems and medical laboratories have been shown to substantially contribute to the increased impediment to Mpox eradication in African countries, particularly the western and central regions [11]. The disease surveillance infrastructure established by African nations during the COVID-19 pandemic is sufficient to eradicate Mpox using safe and effective vaccines, but also strengthening supply chain of medical medicines and diagnostic reagents needed to diagnose Mpox virus reservoirs and suspected cases in most African countries.
Integrated OH contact tracing and monitoring systems is another critical element of the response and recovery, particularly considering the human–human or animal-human transmission using dual syndromic surveillance (e.g. Thermal surveillance) and laboratory-based sequencing and real time genotyping testing confirmation [9]. For example, in Rwanda and Cameroon community health workers and health authorities were trained to effectively and efficiently performed these tasks and allowing rapid and prompt early detection and notification, tracing and quarantine advice to suspected individuals who have met confirmed cases to halt potential chains of transmission and documented Mpox clade Ib case severity management [3, 12]. Ongoing Mpox outbreak has resulted in numerous suspected and asymptomatic cases in African countries, including the DRC, Burundi, Cameroon, Rwanda and Nigeria. Although the number of reported cases in Africa was lower than in European countries and the United States, there were undoubtedly many more suspected cases and asymptomatic undiagnosed in Africa during the latest outbreak [5].
Enhancing data-driven and evidence-based policies based on building clinical and laboratory quality data, monitoring and evaluation data in promoting a robust veterinary and environmental waste biosafety and biosecurity measures and strengthening medical products supply chain reliance and impacts. These integrated public health, veterinary, environment and community based insights provide avenue for comprehensive and quality outbreak emergency preparedness packages and response impact. However, addressing challenges and gaps in financial resource mobilization, conflict related displacement and encroachment, growing demography, limited access to preventive vaccines and essential medicines, wildlife worsening the persisting vicious cycle of poverty linked inequities in the global south. For example, two countries accounts for 92% of all cases on the African continent, the DRC with approximately 80%, and highlighting the need for improved community-based OH surveillance and readiness. The DRC recorded 90% mortality of 65 cases of Mpox and only 10 laboratory-confirmed cases registered in the present outbreak [5, 13]. Furthermore, highlighting the challenges of Mpox and others emerging zoonotic diseases surveillance, preparedness and response in resource-constrained settings in most affected communities in the global south mainly in Africa.
iii. Building Outbreak Quality Database Repository Hubs and/or Platforms Implementation for Knowledge Translation and Deployment is vital in expanding and building a robust data-driven evidence policies reforms and targeted response, enhanced monitoring and evaluation systems, that is crucial for generating valuable Mpox insights and lessons learned that inform timely evidence health policies frameworks and emergency response strategies. Passive and active surveillance of Mpox outbreak continuous data collection enables identification of nature and trend, risk factors, and multifolds intervention effectiveness, and community benefits. Such data-driven approach allows public health experts to make informed decisions and adapt strategies as new information emerges. Leveraging advanced analytical tools enhances understanding of population behaviors and healthcare accessibility and medical products including Mpox vaccines availability, and optimal vaccination coverage.
Fostering collaborative and participatory investment and targeted response and recovery actions leads to a more proactive and agile public health infrastructure and ensure equitable access to most effective therapies,vaccination and prevention strategies capable of swiftly addressing and quelling the current and future Mpox outbreak burden across Africa (Fig. 2).
Mapping Mpox distribution of confirmed cases reported from 13 affected African countries
iv. Increased Vulnerable Communities Awareness, Educational Outreach and Trust Building Strategies is needed in combating stigma and misinformation through effective public health messaging and media campaigns is vital for raising awareness about infectious diseases like Mpox outbreak. Ensuring reliable sources, transparent communication and scientifically accurate information can support vulnerable groups and public empowerment and capacities to adopt healthier behavior lifestyle adaptations, promoting care seeking culture and practices [4].
Scaling up integrated OH Mpox community awareness and health education outreach activities is crucial for at high risk groups and communities to gain a better understanding of transmission dynamics and prevention strategies. Intensifying collaboration, inclusiveness and community programs ownership by local community leaders and health district ensures the entire communities participation and set expected outcomes including cultural adapted health messages resonate and proactive response and recovery actions plans and activities across diverse populations. Promoting peer-peer educational campaigns and outreach activities have proven effective to dispel myths, social media disinformation and illed-perception surrounding Mpox, often rooted in misinformation and stigma, which can lead to societal reluctance in seeking medical care or adhere to public health measures. Ultimately, increasing community awareness and equity in Mpox vaccination safety and impact information sharing facilitates greater participation in vaccination campaigns, uptake and preventive initiatives, enhancing community resilience against Mpox outbreak and emerging infectious disease threats.
Fostering community involvement and participation in co-design and co-implementation of community-based outreach activities are vital for addressing stigma and misinformation, building mutual trust, and encouraging adherence to public health measures. Health communication strategies must be culturally sensitive and inclusive to ensure that marginalized populations receive adequate support and access to healthcare services.
v. Scaling up Community Engagement and Risk Communication strategies plays a vital role in this response; public health messages must be communicated in culturally sensitive manners to build trust and ensure compliance with health directives. These community-led initiatives can empower locals to take ownership of the Mpox response, promote the early reporting of symptoms, and foster productive collaboration between health authorities and communities [12]. In conjunction with vulnerable communities supportive therapies and isolation measures, quarantine protocols for confirmed and suspected cases or asymptomatic reservoir constitute a fundamental layer of response [4]. Additionally, establishing dedicated Mpox treatment centers can ensure that infected individuals receive appropriate medical care including stigma and mental health services and psychosocial support, while minimizing the risk of outbreaks in healthcare and communities settings. Investing in One Health approach Mpox outbreak containment and recovery strategies are critical, particularly in densely populated urban and remote rural poor areas including porous cross borders enhanced integrated surveillance and quarantine of human and animal suspected signs, where the risk of rapid transmission is heightened [4, 7, 14].
vi. Intensified Vaccination Campaign and Coverage Effectiveness Efforts particularly to health professionals, vulnerable frontline and at high risk groups (e.g.: immuno-deficient patient, Sex worker, bushmeat consumers and sellers, with the use of the JYNNEOS vaccine or a similar modified vaccine virus strain, can be instrumental in controlling the spread of Mpox [13]. Contextual and cultural adapted vaccination campaigns and educational outreach should prioritize high-risk populations, including healthcare workers, sex workers and individuals with increased exposure risk and vulnerability, as well as the surrounding communities [14]. However, understanding of cultural beliefs and practices that may impact vaccination reluctance and resistance, vaccine hesitancy and uptake, low/weak availability of vaccine and access inequity, supply chain and storage logistics challenges, including vaccine supply, distribution, and storage, must be effectively managed to ensure equitable access across diverse geographic regions [1]. Fostering global solidarity and international collaboration amongst all stakeholders, research institutions and academia exchange of knowledge and technical know-how is an asset and plays a pivotal role in promoting behaviour change for successful vaccination access and uptake, in quelling and timely lifting the Mpox outbreak PHEIC in Africa.
Effective and continuous Mpox vaccination campaigns and social media disinformation strategies coupled with robust community-based surveillance, and contact tracing are essential to significantly reduce infection or lethality rates during ongoing outbreaks in Africa and elsewhere. The implementation of these strategies limits Mpox transmission, protects vulnerable populations and timely case management using new drug Tecovirimat treatment coupled with palliative care management. It has be documented that vaccination not only provides individual immunity but also promotes herd immunity, which is crucial for community health. By closely Mpox asymptomatic surveillance and monitoring case trends and quickly isolating confirmed cases, the spread of infections can be curtailed efficiently. This comprehensive approach enhances public health outcomes and safeguards community well-being [10, 13].
v. Leveraging Strategic Partnerships and Collaboration with global stakeholders and organizations offers a strong and dynamic platforms for Mpox outbreak response leadership, coordination and governance, including WHO-AFRO and Africa CDC technical assistance. These are crucial for resource mobilization, technical assistance, and information sharing [5]. Strengthening international collaboration to scale local manufacturing and pharmaceutical vaccines and medical products regulatory framework, maximizing production and supply chain management to boost accessibility and update for impact in the fight against infectious diseases within Africa. In line with Africa Vision 2063”The Africa we want”, enhanced knowledge exchange and resource sharing is paramount to health, socioeconomic growth and development. A unified global outbreak preparedness and emergency response agenda and co-benefits both non-affected and affected regions is play a major role in the overall global health security sustainability [4, 6, 14].
By fostering pharmaceutical partnerships among countries, organizations, and institutions, collective expertise and resources can be leveraged with technologies advancements and innovations to address global public health challenges more effectively. Increased collaboration facilitates coordinated local and regional preparedness and response actions, ultimately leading to stamp out Mpox and better health outcomes. Hence, community based One Health interconnected approach is essential for effectively navigating and managing emerging infectious diseases/health threats that transcend national boundaries. As such, the Africa Centers for Disease Control and Prevention (Africa CDC), can facilitate a cohesive preparedness and emergency response technical support and assistance in ensuring that uniform guidelines and strategies are implemented across countries [5, 15].
The Mpox outbreak PHEIC declaration has had a significant impact on Africa and has highlighted the necessity for a coordinated response to quell similar outbreaks and preserve lives. Significant efforts have been made to ensure tight coordination with communities and governments, with country teams working on the frontlines to bolster preparedness and resilience measures to quell Mpox outbreaks. With the increasing spread of the virus, further scaling up through coordinated international efforts is essential to support African countries outbreaks/pandemics preparedness and response programs and interventions according to International Health Regulations, 2005 and global health security agenda of health equity for all [4, 7]. Fostering Africa CDC preparedness and technical capacities initiatives are crucial for Emergency Use Listing and Response for Mpox vaccinations, which potentially speed up vaccine and vaccination access and uptake for impact coverage in most remote and hard to reach communities in Africa. Emergency Use Listing also allows partners like GAVI and UNICEF partnership and support to obtain last mile access to and uptake of vaccines and vaccination impact against preventable diseases including Mpox. WHO and partners including established pharmaceutical and biotechnologies firms is collaborating with African governments on local production of vaccines and medicines by local, while strengthening manufacturing regulations and reliance harmonization for potential safe and efficacious medical products, as well as the interim Medical Countermeasures Network [7].
Furthermore, tailored community outreach activities to educate on disease prevention precautionary and control measures are dependent on correct knowledge and evidence-based findings of disease clade, transmission dynamics and severity. Laboratory and molecular assays capabilities useful in accurately awareness and educational outreach on distinct transmission routes, clinical manifestations, and afflicted groups in comparison with the 2022 pandemic [4, 16]. Public health activities must be tailored to specific local situations in order to counter mistrust, cultural differences, and disinformation. The involvement of community- and faith-based leaders, at-risk populations, and survivors is critical. As vaccine programs begin, community engagement and building trust is critical for securing the uptake and adherence to booster dosses, while limiting the spread of Mpox at high risk groups including sex workers, and immuno-compromized groups. Prioritizing One Health operationalization can increase collaboration and optimal response outcomes, while minimizing stigma, and ultimately enhance health outcomes, and satisfactory co-benefits [7]. Likewise, the recent outbreak of Mpox PHEIC by the Africa CDC and WHO owing to the possibility of international transmission and the necessity for a coordinated response actions globally. The recent detection of travel-associated clade I cases first reports outside Africa in Thailand and Sweden is indicative of the potential for clade I Mpox to spread from Africa to the rest of the world. This is, similar to the 2022 global clade II outbreak, revealing the time for global solidarity and partnership is now. Despite these ongoing country and Africa CDC efforts, the response and recovery to Mpox PHEIC in Africa remains challenging coupled with lingering community healthcare disparities, climate change and conflict political instability, and shortage of resource to persisting technical capacities gaps and consequences [4, 8, 17, 18].
vii. Driving Public Health Response Funding Mpox outbreak highlighted the poor response of African Union (AU) member states. Despite the seriousness of the situation, the AU and its members have a track record of under-delivery in global health security. This lack of help is aggravated by the serious economic depression that is currently afflicting many African countries, which are already under strain due to the unequal burden of debt payments [19, 20]. Owing to these limitations, the PHEIC declaration struggles to translate into effective action on the ground without significant financial commitments or political will from member states [4]. This lesson highlights the need for financing support from multiple organizations to help drive public health responses. As a result, the WHO forecasts an initial budget requirement of $15 million to support surveillance, preparedness, and response efforts in Africa [8, 16, 21]. However, to allow for an urgent scale-up, the WHO has approved $1.45 million from the WHO Contingency Fund for Emergencies, with a greater need to combat the outbreak.
Strengthening local and country emergency One Health preparedness and response, as recommended by Africa CDC and WHO should be prioritize as funding Mpox response and recovery programs. African CDC and WHO have enabled scaling up of the response capacities to the outbreak, which has so far been underwhelming because of inadequate budget commitments of $1 million from WHO and $10.4 million and might require larger funds to contain the ongoing outbreak in African Union members countries [4, 6, 21, 22]. Investing on One Health community of practice is necessary in deepening the vulnerable people knowledge, bridging multidisciplinary interactions and fostering multisectorial collaboration and data-driven decisions making,and inspired new contextual ideas and approaches in accelerating social transformation.
viii. Improved OH Community Resilience and Equity is crucial in strengthening the health infrastructure access and update of health commodities through comprehensive geographical access and training, enhanced diagnostic capabilities, and systemic resource mobilization to significantly bolster the community healthcare resilience and participatory initiatives. More resilient community systems and activities including local engagement in decision making, shared resources, inclusiveness and equitable allocation of resource are needed to address outbreak related health inequities. Also, addressing the social and behavioural determinants (e.g.: stigma, trust, knowledge, adherence) of health is essential in enhancing resilience and survival champions against Mpox outbreaks, which often are disproportionately marginalized within affected communities [4, 19, 24, 23]. Furthermore, stigma and discrimination associated with Mpox infection can be conquered through psychosocial support programs targeting the most vulnerable groups is critical; as the historical context of the disease has led to misconceptions that can deter individuals from seeking care or reporting their conditions. Hence, OH community-based and primary healthcare approaches that merge human and animal clinical, environment and sociocultural insights are necessary for effective intervention [2, 4, 16, 23]. In conclusion, the public health response to Mpox in Africa must be comprehensive and adaptive, incorporating surveillance, contact tracing, community engagement, outbreak containment, and vaccination as the key components. Despite facing formidable challenges, concerted efforts to mobilize health authorities, communities, and international partners have the potential to mitigate the impact of Mpox outbreaks effectively [24,25,26].
The lessons learned from previous Ebola outbreaks and COVID-19 pandemic are invaluable assets in shaping future community and public health emergency responses to infectious disease threats, and underscoring the importance of OH approach community preparedness and resilience for health equity for all and upholding global health security across Africa [3, 6, 27, 28]. Sustained government and multi-stakeholders commitment and financial investment remain crucial to strengthening community and primary healthcare infrastructures, precautionary and preventive packages in addressing socio-cultural and behavioural determinants of health during crises. Scaling community-based OH approach is core to improve primary healthcare preparedness and readiness strategies to effectively detect, prevent, respond and manage future outbreaks and crises [18, 29]. It also requires establishing robust and sustained early warning health system to ensure early warning alerts and readiness to respond rapidly to local and global health emergencies such West Africa Ebola outbreak and COVID-19 pandemics [26]. Investment in integrated OH resilience measures will ultimately safeguard the health and well-being of African vulnerable communities and building a stronger foundation of health systems to better withstand the unprecedented challenges posed by re-emerging and reemerging infectious diseases threats and burden [4, 24, 28, 30, 31]. Scaling up equitable access to primary healthcare and ample resource allocation for targeted Mpox vaccination efforts are essential to ensure that marginalized and high-risk communities receiving equitable access to healthcare services[22], improves community health outcomes and livelihoods in tackling health disparities those often exacerbate the impact of Mpox outbreaks [4, 22, 29, 32, 33].