An armed conflict that has been going on for decades. Underdeveloped and deficient health infrastructure. Hundreds of thousands of people who do not have access to drinking water and live in desperate hygienic conditions. And a wild nature that represents a hot spot for new zoonotic viruses. This is why the Democratic Republic of Congo continues to be the scene of some of the worst epidemics on the planet, such as Ebola in recent years, and that of Mpox which in recent weeks has begun to worry the world so much that it has become an “international emergency” for the WHO.
Since 2022, the African monkeypox epidemic has infected over 37,000 people and caused 1,451 deaths and, although the virus has struck 15 countries, over 96% of cases are concentrated in the Democratic Republic of Congo. However, the situation worsened in 2024 due to the appearance of a mutation of the virus that made it more contagious and aggressive, so much so that it caused more than 13,000 infections and 450 deaths between January and July. Is there a risk of a new pandemic? The memory of the consequences of the spread of Sars-Cov-2 is still a recent wound and many are suspicious of the new health emergency and to clarify this we spoke with Matteo Bassetti, a well-known infectious disease specialist and director of the Infectious Diseases Department of the San Martino Polyclinic in Genoa.
The Mpox virus
The virus that has alarmed the World Health Organization is a new strain of Mpox known as clade 1b. It is not the same viral agent that caused the global epidemic that infected nearly 100,000 people in 116 countries around the world in 2022, spreading mainly in homosexual communities. And compared to that relatively less aggressive virus (defined as clade 2), the one spreading in Congo is much more dangerous.
“This is a more contagious virus, which is not limited to circulating in a particular group of people, but is spreading extensively, affecting men, women and especially children, with a lethality that, in the conditions present in the Democratic Republic of the Congo, seems 10 times higher than what was seen with clade 2,” Bassetti explains. “Contagion occurs through direct contact with the typical skin lesions caused by the disease or with the body fluids of the sick person. It can probably also occur through droplets of saliva that are emitted by speaking or breathing, but in that case very close and prolonged contact would certainly be necessary. It is not an airborne disease – that is, the virus cannot survive in the air – and therefore we must not fear a spread of the virus comparable to that which we have seen in the Covid pandemic.”
Is there a risk of a pandemic?
In the African countries affected by the current epidemic, Mpox has recorded a mortality rate of about 3 percent, which seems to reach 10% in children. Since it is currently limited to the African continent, where health resources are almost never comparable to those in our country, it is impossible to predict how serious the infections would be in our parts. It is plausible, however, that in a developed health system, mortality would be much lower than what has been seen in recent months in the Democratic Republic of Congo.
Even the diagnostic capabilities, surveillance and prevention in a health system like the Italian one are something else entirely. And for this reason, Bassetti believes that at the moment the chances of Mpox spreading here, or in the West, as it is doing in Africa are absolutely remote.
“Mpox has already left Africa, it is impossible to exclude that there will be some deaths in Italy, but it will not spread to the West, we are perfectly capable of dealing with the situation.”
Matteo Bassetti, infectious disease specialist
“The virus has already left the African continent, as demonstrated by the cases in Sweden, Spain and Thailand, but in Europe, after the 2022 clade 2 epidemic, we have strengthened diagnostic and therapeutic capacities, surveillance and the availability of vaccines, and therefore we are perfectly able to deal with the situation”, underlines the expert.
“Some imported cases are likely to arrive, and it is impossible to exclude that there will be some deaths, but a sustained spread in Italian or European territory should not scare us. What we should be concerned about instead is the situation in Africa: improving diagnostic capabilities, surveillance systems and prevention strategies there, including vaccination, would prevent Mpox from becoming a health catastrophe in Congo and other African states, would save many lives and would minimize the risks of the disease spreading here too”.
Patients stampede at hospital for suspected monkeypox case