MONKEYPOX IN EAST AFRICA: A BIOTECHNOLOGY PERSPECTIVE ON A PUBLIC HEALTH CRISIS. A FOCUS ON UGANDA’S SITUATION

ABSTRACT

The reappearance of monkeypox (Mpox) in East Africa, as emphasized by recent events in Uganda, emphasizes the region’s ongoing threat of zoonotic diseases and their possible global health ramifications. This paper investigates the ongoing Mpox problem in Uganda through a biotechnological lens, concentrating on the use of modern biological methods in understanding, diagnosing, preventing, and managing the virus. It also discusses the molecular characteristics of the Monkeypox virus (MPXV), including its distinct clades (Clade I and Clade II) and their varying virulence, as well as an overview of the current epidemiological situation in Uganda, citing recent outbreaks and international public health responses (Africa CDC PHECS declaration). The critical role of biotechnology in diagnostics (PCR, NGS, POCT), surveillance (serological), prevention (vaccine development, including MVA-BN and novel approaches like subunit and nucleic acid vaccines), and therapeutic interventions (Tecovirimat, monoclonal antibodies) is analysed. Furthermore, the review discusses some of the major challenges (infrastructure restrictions, resource constraints, accessibility, price, ethical concerns) and opportunities (international collaboration, capacity building) for adopting biotechnological solutions in East Africa (Uganda). This assessment indicates that integrating advanced biotechnology into public health initiatives is essential for controlling the present Mpox outbreak and enhancing readiness for future infectious disease threats in this African region).

АННОТАЦИЯ

Повторное появление оспы обезьян (Оспа) в Восточной Африке, о чем свидетельствуют недавние события в Уганде, подчеркивает сохраняющуюся в регионе угрозу зоонозных заболеваний и их возможные глобальные последствия для здоровья. В данной статье исследуется продолжающаяся проблема оспы обезьян в Уганде через биотехнологическую призму, уделяя особое внимание использованию современных биологических методов для понимания, диагностики, профилактики и лечения вируса. В нем также обсуждаются молекулярные характеристики вируса оспы обезьян (MPXV), в том числе его отдельные клады (клада I и клада II) и их различная вирулентность, а также обзор текущей эпидемиологической ситуации в Уганде со ссылкой на недавние вспышки и международные ответные меры общественного здравоохранения (декларация PHECS Африканского центра по контролю и профилактике заболеваний США). Анализируется важнейшая роль биотехнологии в диагностике (ПЦР, НГС, ПОКТ), эпиднадзоре (серологическом), профилактике (разработка вакцин, включая MVA-BN и новые подходы, такие как вакцины на основе субъединичных и нуклеиновых кислот) и терапевтических вмешательствах (тековиримат, моноклональные антитела). Кроме того, в обзоре обсуждаются некоторые из основных проблем (инфраструктурные ограничения, ограниченность ресурсов, доступность, цена, этические проблемы) и возможности (международное сотрудничество, наращивание потенциала) для внедрения биотехнологических решений в Восточной Африке (Уганда). Эта оценка показывает, что интеграция передовых биотехнологий в инициативы общественного здравоохранения имеет важное значение для борьбы с нынешней вспышкой оспы обезьян и повышения готовности к будущим угрозам инфекционных заболеваний в этом африканском регионе.

Keywords: Monkeypox, East Africa, Zoonotic Disease, Diagnostics, Surveillance, Vaccines, Therapeutics, Public Health Emergency.

Ключевые слова: Зоонозная болезнь, Восточная Африка, Диагностика, эпиднадзор, Вакцины, Лекарственные средства, Чрезвычайная ситуация в области общественного здравоохранения, Оспа обезьян.

Introduction

The East African subregion is also faced with increasing outbreaks of zoonotic diseases, which are a growing and key threat to public health security [1]. The recent re-emergence of monkeypox (Mpox) in Uganda is an example, describing the potential for such diseases to rapidly spread into public health emergencies with international consequence [2]. This resurgence comes after intervals of relative peace and serves to underscore the growing risk of zoonotic spillovers, driven by multidimensional ecological, environmental, and anthropogenic forces, including climate change, forest cover loss, increased human-wildlife interaction, and rapid urbanization [1]. The connectivity of the countries in the East African region demands harmonized regional action, as seen with the rapid unfolding of the current Mpox case in Uganda from localized clusters. A multi-dimensional response involving robust epidemiological studies, intensified surveillance, effective clinical management, and targeted public health measures is required [3]. Such health emergencies must be treated through the use of advanced scientific tools, namely from biotechnology [2]. Biotechnology possesses inherent capacities in understanding viral dynamics, creation of effective control measures, and overcoming such problems. These include sophisticated molecular diagnostics techniques and kits for the identification of pathogens, genomic sequencing methods and machines for tracking viral evolution, and swift development of countermeasures like vaccines and therapeutics [4–6]. Biotechnological advancements have been instrumental, from the first identification of the monkeypox virus (MPXV), to the development of high-sensitivity diagnostics, effective vaccines, and antiviral drugs [4,7]. One very good example is the collaboration facilitating provision of the MVA-BN vaccine (Modified Vaccinia Ankara – Bavrian Nordic), which has been FDA and EMA-approved for Mpox prevention [8]. This highlights the contribution of biotechnology to disease control [9] and strategic vaccination strategies [10], with equitable delivery overseen by the Africa CDC, international cooperation and One Health prioritization [1]. This review examines the role of biotechnology in addressing the recent Mpox epidemic in resource-scarce East Africa (Uganda). By analysing the virology of MPXV, outbreak characteristics, and the deployment of biotechnological tools for diagnosis, surveillance, prevention, and control, it identifies key challenges and opportunities for leveraging these technologies effectively in similar settings.

Materials and Methods

We used publicly available resources from CDC, WHO, and published research and review articles to critically evaluate the effectiveness of biotechnology in the current ongoing MPXV outbreak in East-Africa.

Monkeypox Virus and the East-African Outbreak

Structure, History and epidemiology

Monkeypox virus (MPXV), a large, enveloped, double-stranded DNA virus (Fig 1) that belongs to the Orthopoxvirus genus under the Poxviridae family [3], it is  the causative agent for monkeypox (mpox), a zoonotic disease [11]. They share extensive genetic homology and antigenic cross-reactivity with other viruses affecting humans, including cowpox virus, variola virus (smallpox), and vaccinia virus (utilized in smallpox vaccines) [12].

Figure 1. Basic structure of the monkeypox virus (MPXV) [13]

Table 1.

Key Features of MPXV and their basic descriptive functions

MPXV was first identified in 1958 in captive monkeys in Denmark during polio vaccine research [16]. The first human case emerged in 1970 in the Democratic Republic of the Congo (DRC) in a child from a region recently declared free of smallpox, signaling a shift in orthopoxvirus dynamics post-smallpox eradication [17]. Historically endemic to West and Central African rainforests, outbreaks have occurred via spillover from rodent and primate reservoirs as currently observed in Uganda [12]. MPXV is divided into two clades with ~0.5% genomic divergence, resulting in distinct virulence and transmissibility [18]. Clade Ib, responsible for recent DRC and Ugandan outbreaks, is associated with severe disease and higher mortality (up to 10%) compared to Clade II (<1%) [19].

Table 2.

 MPXV Clades and Sub lineages which have affected East African region recently

Mpox disease has been evidenced to occur through human-to-human transmission, which was once considered limited, but now has become a critical factor in recent outbreaks (Uganda). The key main routes include the direct contact with infectious skin lesions or respiratory droplets, contaminated fomites (e.g., bedding, clothing) and Sexual contact [7].

Table 3.

Modes of MPXV Transmission

Current situation

The persistent transmission of MPXV, particularly the surge in cases in the Democratic Republic of the Congo (DRC) [17],  has prompted intensified surveillance in Uganda due to shared borders and frequent cross-border movement. The Uganda Virus Research Institute (UVRI) has enhanced surveillance at key sites, leveraging advanced diagnostic tools to mitigate cross-border spillover risks [8], as observed in Table 4 which shows the different locations in Uganda where the surveillance and boarder control has been intensified.

Table 4.

Enhanced Surveillance Efforts in Uganda at different locations to detect and combat the transmission of the Mpox infection

Public Health Emergency Declarations: The escalating outbreak has triggered high-level international and continental responses as observed in the Table 5 where continental and global responses have intervened to help in combating the prevention and spread of Mpox in Uganda.

Table 5.

 Public Health Emergency Declarations from continental and global organizations

As of August 2024, 12 African countries reported 2,863 confirmed cases and 517 deaths, with a case fatality rate (CFR) of 18% [19]. The DRC accounts for the majority of cases and fatalities, highlighting systemic gaps in surveillance and testing.

Table 6.

2024 Mpox Outbreak Statistics in Africa showing different metrics and affected countries

Results and Discussion

After analysing the available data from different sources, we found that Uganda and other parts of East-Africa, where the MPXV outbreak is use the following Biotechnology intervention methods in different stages of the outbreak.

Diagnostics and Surveillance

The ability to rapidly and accurately diagnose monkeypox (Mpox) cases and effectively monitor the spread of the virus is paramount in controlling the outbreak in East African region particularly in Uganda. Biotechnology plays a pivotal role in this aspect, offering sophisticated tools for detection, identification, and tracking.

Molecular Diagnostics

Polymerase chain reaction (PCR) and real-time PCR (rt-PCR); these are the signatures of molecular diagnosis. Through these methods, amplification of viral nucleic acid materials allows the identification of MPXV DNA in clinical specimens with a high level of sensitivity and specificity even during the initial stages of infection [9]. Through the power of the real-time PCR (rt-PCR) it is nowadays possible to perform viral load quantitation, a crucial step in clinical management and public health response [2]. Next-Generation Sequencing (NGS); NGS has revolutionized our capacity to research infectious diseases the like of Mpox, COVID-19 and others [20]. Through this method, we scientists are able to learn valuable information regarding the monkeypox virus strain, its potential origin, and its evolutionary history by sequencing the entire genome of the virus isolated from patient samples in East Africa [21]. Phylogenetic analysis (investigating the genomic sequences in cases to see how the virus is spreading in the population and potentially pinpointing the origin of the outbreak), strain characterization (investigating whether the outbreak has been due to the West African or Central African clade, which has implications for severity of disease and transmissibility), and mutation detection (detected genomic changes that might affect virulence, viral transmissibility, or efficacy of diagnostics and therapeutics) all depend on such data [22]. For Mpox, it enables whole sequencing of the MPXV genome, giving important information on the current strains circulating in East Africa which gives information about the viro-type affecting the Uganda [20]. The sequencing also enables monitoring of the mutations of the virus, which impact its transmissibility and virulence [23]. Point-of-Care Testing (POCT); while less firmly established for Mpox particularly in developing countries such as Uganda, POCT is an improvement and one that can be especially beneficial in resource-limited settings like Uganda [24]. The focus is on creating rapid, user-friendly diagnostic tests kits that can be utilized in rural communities to enhance surveillance and initiate control measures quickly [25]. Molecular diagnostic techniques, particularly those based on the detection of the virus’s genetic material, are crucial for confirming cases of Mpox, hence these are now considered as the gold standards for detection and prevention of the disease.

Serological Assays

The enzyme-linked immunosorbent assay (ELISA); this serological test allows the detection of antibodies that signify previous infection [26]. This technique lays a significant foundation in detecting the disease progression over time and asymptomatic or unreported infections but are of no use for the diagnosis of acute cases [27]. Vaccine Efficacy Studies; Mpox has been treated with antiviral medications and therapies, such as immune globulins and smallpox antivirals [2]. Because the virus can mutate and be resistant to current remedies, it is crucial that research on new therapeutic compounds continues [28]. Serological tests, including enzyme-linked immunosorbent assays (ELISA) [26], are designed to identify antibodies created by the body following an infection with monkeypox. Serological tests are useful for retrospective examination but useless for the diagnosis of acute infections since it may take days to develop antibodies. Detecting those who could have had infection at some stage in the past even if they did not develop symptoms or the cases were not molecularly positive will determine the actual spread of an outbreak. The administration of MVA-BN vaccine, specifically licensed to prevent monkeypox, was as a result of a new agreement between the Africa CDC and pharmaceutical companies[1].

Table 7.

Biotechnology Tools for MPXV Diagnostics, and Surveillance

Prevention and Control

As of February, 2025 the ongoing monkeypox outbreak in East Africa particularly in Uganda, has claimed 19 deaths and more than 2000 people are confirmed with the disease [1]. Beyond diagnostics and surveillance, biotechnology plays a crucial role in developing strategies and tools to prevent the spread of Mpox and control the ongoing outbreak in East Africa (Uganda). Through vaccine development, therapeutic interventions and biosecurity measures, Biotechnology has been employed.

Vaccine Development

The root of infectious disease prevention and control is the development of vaccines as has been the case in the recent COVID-19 pandemic [29], but their application in preventing outbreaks and controlling MXPV remains to be evaluated. Multiple vaccines have been developed such as MVA (Modified Vaccinia Ankara vaccine that made use of the attenuated virus) [30]. This was already available for smallpox and was better and purportedly safer compared to other replication-competent vaccines [31]. It is also suitable for immunocompromised individuals making it an excellent alternative for high-risk groups in East Africa (Uganda) such as healthcare workers and close contacts. Despite the presence of an apparently viable substitute, researchers continue to take the lead in vaccine development and using several new approaches that entail exploring the use of subunit vaccines, where researchers isolate specific viral proteins known to cause more effective immunological responses [32]. The antigens isolated can be manufactured on a massive scale, current existing research shows that sub-unit specific antigen derived vaccines are currently being tested in-vivo [33] and employment of viral vectors to generate vaccines as well [34]. Viral vectors such as adenoviruses may be utilized to deliver pathogenic genetic material [28]. Nucleic Acid vaccines (DNA/RNA) may be a suitable choice for utilization in prevention and treatment of MXPV, because they involve the utilization of genetic material instructions that are delivered in cells to produce viral proteins allowing a more robust response and a stronger immune protection against the virus [35].

Therapeutic Interventions

While vaccination plays a role in prevention of viral related diseases, therapeutic measures need to be effective in controlling established infections and reducing the severity of the disease [36]. Biotechnology has made a significant contribution toward creating antiviral therapies for treating Mpox. Overview of Antiviral Drugs; Tecovirimat (TPOXX) is an antiviral drug licensed for use exclusively against smallpox, monkeypox, and vaccinia complications [37]. It achieves this by inhibiting the activity of the VP37 protein, which is required for the envelopment and release of the virus [38]. The development of Tecovirimat involved concerted virology and pharmacology research backed by biotechnological drug discovery and characterization technologies. Its potential use against high severity monkeypox in Uganda would likely reduce morbidity and mortality. Potential to Develop New Antiviral Drugs or Immunotherapies; biotechnology presents a number of ways to come up with new therapeutics against monkeypox, such as Monoclonal Antibodies which are man-made antibodies engineered to bind specifically to viral proteins and neutralize the virus or tag it for destruction by the immune system [39]. Small Interfering RNAs (siRNAs) [40] and Antisense Oligonucleotides [41–43] which are short nucleic acid molecules that have the capability to silence expression of viral genes, thereby inhibiting viral replication [42]. Repurposing Existing Drugs; this is opted to enable screening of existing antiviral drugs that are currently licensed to treat other diseases for assessing if they have any activity against monkeypox [44–46]. Studies and development of these novel therapeutic modalities have the promise of significantly improving clinical management of monkeypox infection in Uganda and possible future epidemics.

Biosecurity and Biosafety

Additionally, biotechnology is necessary for the safe study and management of Mpox as well as for the prevention of future outbreaks through different biosafety mitigations. Design of Instruments and Procedures; Biotechnology offers the instruments for creating extremely sensitive and precise diagnostic reagents that are used in lab settings [47]. Additionally, it makes it easier to create rules and procedures for laboratory work, such as the use of personal protective equipment (PPE) and safe handling techniques to reduce the likelihood of unintentional virus exposure [48]. The significance of biosecurity protocols Measures taken to stop deliberate misuse of biological agents are referred to as biosecurity [20]. The development of techniques for identifying and countering possible biosecurity threats is made easier by biotechnology. Furthermore, using biotechnology to understand the virus’s genetic makeup helps guide biosecurity interventions to stop future outbreaks, whether they are caused by humans or natural causes, and assess risk prospects. Biotechnology is a key component in stopping and managing the East African monkeypox outbreak. From the development and potential use of vaccines and antiviral drugs to the enforcement of tight biosecurity measures, biotechnological innovation has a pivotal role to play in mitigating the impact of this public health crisis as well as in preempting threats in the future.

Table 8.

Biotechnology Strategies for MPXV Prevention, Treatment and Control to combat the current epidemic in Uganda

Challenges and Opportunities in Applying Biotechnology in East Africa

While biotechnology offers immense potential in addressing the Mpox outbreak in the world, and East Africa particularly in Uganda, its effective application is not without challenges. The Table7 below will highlight both the hurdles that need to be overcome and the significant opportunities that exist for leveraging biotechnology to combat this and future public health crises in this African region.

Table 9.

Challenges, Ethical Considerations, and Collaborative Strategies

Conclusion

The recent monkeypox outbreak in Uganda is a sober reminder of the perpetual threat posed by emerging and re-emerging infectious diseases. Through this review, it has been clearly brought out how crucial a role biotechnology must play in controlling this public health crisis, offering an efficient range of tools to understand, diagnose, prevent, and cut off the virus transmission. From the rapid and accurate diagnosis of MPXV through advanced molecular diagnostics to the fine-scale genomic characterization that can track its evolution and transmission patterns, biotechnology has been central to an appreciation of the outbreak dynamics. Further, the potential for application of existing and new vaccines, developed and optimized through biotechnological interventions, combined with targeted antiviral therapies, gives tangible hope for halting the virulence and contagion of the disease. The application of a biotechnology strategy to the Ugandan monkeypox epidemic demonstrates its indispensable contribution to public health. This has enabled the acquisition of a better understanding of the virus, facilitated early intervention, and resulted in more effective countermeasures. While there are infrastructural, resource, accessibility, and ethical challenges to implementing these advanced technologies in Uganda, opportunities for partnership, capacity development, and subsequent investigations are monumental. Lastly, the manner in which the Mpox outbreak has been handled in Uganda postdates and clearly demonstrates the overarching importance of integrating biotechnology in public health planning. Continual investment in research and development, local capacity enhancement, and global collaboration are essential to realizing the full potential of biotechnology not only in containing this outbreak but also in preventing and preparing for future infectious disease crises. A sustained emphasis on applying biotechnological technologies will be essential to the provision of global health security and resilience to the ever-evolving landscape of infectious diseases.

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