Advancing mpox outbreak control in Central Africa through epidemiological modelling, data-driven insights, and capacity strengthening

Context Mpox, caused by the monkeypox virus (MPXV), has been spreading rapidly in Central Africa. In August 2024, the World Health Organization (WHO) declared a Public Health Emergency of International Concern due to rising cases, particularly in the Democratic Republic of the Congo (DRC) and neighbouring countries, including Burundi and, more recently, Angola. While parts of DRC have begun vaccinating against mpox, Burundi and Angola have yet to introduce vaccines. The region faces many other health threats, including outbreaks of Ebola, Marburg virus disease, and cholera, which are exacerbated by ongoing conflict and population displacement in DRC. The Challenge Two mpox strains (clades) are spreading in DRC under different circumstances. Clade Ia, historically present, circulates mainly in rural areas via zoonotic and household transmission. Clade Ib, a more recently emerged strain, is spreading in cities, and disproportionately affecting sex workers. In Burundi, however, clade Ib presents differently, with a higher fraction of cases in young children. The reasons for this are unclear: potential explanations include differences in transmission patterns, or underreporting of adult cases due to isolation policies - many cases of mpox may go, making it important to estimate population exposure. In Angola, the mpox clade(s) circulating, and extent of spread, remain unknown. With limited resources, optimising mpox vaccine allocation is essential. Data-driven evidence is needed to determine the priority population groups for vaccination to reduce transmission and severe outcomes. Aims and Objectives This project will generate such evidence for the mpox response as well as transferable knowledge and methodologies applicable to other outbreaks. First, researchers will use modelling to estimate mpox spread and assess potential vaccine impact across different sub-national regions in DRC and Burundi, informing vaccine distribution strategies. Second, clinical records on patients and their contacts will be digitised and analysed to identify likely transmission routes and risk factors for severe disease. Third, a pilot serological (blood test) study will determine the feasibility of a larger survey measuring how many people have antibodies against mpox in Burundi and better understand household transmission. Fourth, a genomic study will be conducted to sequence the first 100 mpox cases in Angola to determine which strain(s) are circulating, how the virus is spreading, and how it is evolving over time. Finally, local expertise will be strengthened through a combined training workshop and hackathon in Burundi and research training fellowships bringing Central African scientists to the UK. Public health professionals, data scientists, and policymakers will receive hands-on training in outbreak data analysis, modelling, genomic epidemiology, and digital tools to improve epidemic response. Potential Applications and Benefits This project will improve outbreak control, inform vaccine decisions, and strengthen response systems in a region experiencing frequent and severe public health threats,  thus improving global pandemic preparedness. Findings will be shared with local public health agencies, WHO and the African CDC to ensure direct public health impact. Via knowledge-sharing, bi-directional training, and capacity-strengthening, researchers in DRC, Burundi, Angola and the UK will be equipped with the skills needed to manage future health crises more effectively.