Health Under Siege: Mpox and the Populations on the Ethiopia–Somalia–Kenya Border

Dear Editor, The World Health Organization (WHO) declared Mpox a Public Health Emergency of International Concern (PHEIC) on August 14, 2024, for the second time since 2022 [1]. Mpox is a zoonotic disease caused by a double-stranded DNA virus from the orthopoxvirus genus, leading to symptoms that generally appear within a week of exposure, lasting 2–4 weeks, though they may persist longer in individuals with weakened immune systems [2]. The ongoing surge of Mpox in certain regions of Africa, coupled with the transmission of a novel sexually transmissible variant of the virus, poses an urgent crisis for both Africa and the global community [1]. The novel variant has shifted the disease's transmission dynamics beyond the traditionally recognized zoonotic and close-contact spread and also demonstrated potential for prolonged viral shedding, increasing the risk of sustained community transmission [3]. As of February 23, 2025, a total of 26,837 laboratory-confirmed cases, including 106 deaths among confirmed cases, have been reported to WHO from 26 Member States across Africa [4]. Between February 2024 and February 2025, 20,565 confirmed cases and 81 deaths have been reported with the majority occurring in the Democratic Republic of the Congo (DRC), according to the WHO [4]. With an average of 3264 cases in February 2025, this raises concerns about the potential for cross-border transmission to other previously unaffected countries [5]. Key areas along the Ethiopia–Somalia–Kenya border, including border crossings, transit hubs, informal settlements, and rural regions, are particularly susceptible to rapid Mpox transmission. This region faces a significant health burden due to the simultaneous presence of infectious diseases, noncommunicable diseases, and injuries [6]. Factors such as poverty, limited access to healthcare, and population displacement caused by ongoing conflicts and natural disasters exacerbate these challenges, significantly heightening the risk and potential impact of an Mpox outbreak [6]. The region also faces shortages of healthcare personnel, diagnostic equipment, treatment facilities, and isolation wards for infectious diseases like Mpox [7]. The already strained healthcare infrastructure may become overwhelmed by the Mpox outbreak, leading to insufficient care and increased mortality rates. Vulnerable groups, including individuals with compromised immune systems (such as those living with HIV/AIDS), the elderly, and children, are particularly at risk. Displaced populations, including refugees and internally displaced persons living in overcrowded and unsanitary conditions, face heightened risks due to their limited access to healthcare [6]. Marginalized communities in remote or underserved areas will encounter additional challenges in accessing Mpox testing, treatment, and prevention measures. The Africa Centers for Disease Control and Prevention (Africa CDC) highlights surveillance and testing gaps in the Mpox response, and to this regard, regional networks have been established [5]. However, real-time disease reporting remains inadequate due to weak data collection mechanisms. As the outbreak continues with an average of 3264 cases in February 2025, tremendous efforts have been made to aid countries in acquiring vaccines and ensuring herd immunity. These efforts include the establishment of the Access and Allocation Mechanism (AAM) for Mpox and the prequalification of vaccines by the WHO to ensure better access to vaccines, treatments, and diagnostics [8]. So far, the WHO, Gavi, and the European Commission through the AAM and the Health Emergency Preparedness and Response Authority have allocated and distributed over 2.8 million vaccine doses to affected countries, including Kenya [9]. Although the Africa CDC has recently highlighted vaccination strategies that did not maximize coverage, it remains positive to intensify efforts to improve vaccine delivery strategies, strengthen surveillance, and accelerate laboratory decentralization [5]. A comprehensive approach is essential to combating the Mpox risk in the Ethiopia–Kenya–Somalia border region. Strengthening cross-border collaboration and border health security measures, such as traveler screening and public awareness in local languages, is crucial for coordinated efforts across Ethiopia, Kenya, and Somalia in mitigating the role of international travel and trafficking in Mpox spread. So far, cross-border health initiatives have been established, building upon the Africa CDC strategic framework for strengthening cross-border surveillance and information sharing in Africa [10]. These initiatives, in response to the growing threat of emerging and reemerging diseases, have shown tremendous success in addressing disease outbreaks. Regular cross-border meetings involving health ministries and international health organizations can strengthen these initiatives by facilitating information exchange, situation assessments, joint planning, and surveillance. Participatory epidemiology also presents an opportunity to improve Mpox surveillance in remote and underserved areas. This approach engages local communities in disease detection and reporting through participatory methods and mapping of disease hotspots. Although a mistrust in government efforts exists in these border regions, when participatory epidemiology is well integrated into surveillance frameworks, it will strengthen community trust in public health interventions and improve timely responses to disease threats. To this regard, existing community-based surveillance should be strengthened by training community health workers to identify and report Mpox symptoms, which can leverage digital tools like mobile apps to further enhance real-time data collection and communication with health authorities. Furthermore, building local capacity through training healthcare workers will improve the region's health system. In this regard, international organizations like the African Union, the WHO, and the Africa CDC should be involved to strengthen local efforts with expertise and resources. Adequate resources and support are fundamental. In light of the recent suspension of foreign aid by the US government, a significant emphasis must be placed on domestic financing drawing on the 2001 Abuja Declaration to spend at least 15% of countries’ annual budgets on health. Ensuring domestic funding among countries and securing funding from governments, international donors, and other organizations is essential for sustaining surveillance, response activities, vaccine procurement, improving laboratory capacity through training, better diagnostic tools for rapid disease diagnosis, and establishing more laboratories. Partnerships here should ensure that African countries continue to have direct access to vaccines, avoiding the pitfalls of dependence on donations, as seen during the COVID-19 pandemic. Estimates from the Africa CDC revealed that 10 million vaccine doses are required to contain the current regional outbreak, and an additional 10 million individuals need to be vaccinated to protect high-risk groups based on forecasts [9]. Procuring and distributing vaccines by mid-2025 through Gavi and WHO-led initiatives will be key in reaching at-risk populations. However, to ensure a stable vaccine and diagnostics supply, investments and initiatives in local vaccine manufacturing in Africa have to be prioritized. In this region, protecting vulnerable populations, such as refugees, IDPs, and nomadic communities, should be a priority. To achieve this, we propose expanding healthcare access through mobile clinics and improved facilities, ensuring targeted vaccines and necessary care. Additionally, addressing social determinants of health, such as improving water, sanitation, hygiene infrastructure, and food security, will reduce disease susceptibility. Tackling poverty and inequality through economic development and social protection programs is essential for better health outcomes. Conclusively, we believe that urgent action is required from governments, health organizations, and policymakers to implement the outlined strategies. Governments must commit to increased funding and policy integration, whereas international organizations should provide technical and logistical support. A coordinated, well-resourced response will be essential in mitigating the impact of Mpox and safeguarding public health in this vulnerable region. Abdisalam Yusuf Ali and Nsikakabasi Samuel George conceptualized the article. All authors contributed to the writing of the draft. Nsikakabasi Samuel George reviewed and edited the draft. All authors read and approved the final manuscript. The authors declare no conflicts of interest. Abdisalam Yusuf Ali affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained. The authors confirm that the data supporting the findings of this study are available within the article.