In response to the escalating threat posed by the mpox virus – particularly the new Clade Ib variant – Minister of Health Chheang Ra issued a directive to bolster the country's defences against the potential spread of this virulent disease. 

The order, released on Friday, August 23, called for provincial governors, particularly those in border areas, to enhance quarantine measures and ensure strict monitoring of international arrivals. 

The move comes in the wake of a broader regional concern, with neighbouring countries reporting cases of the new variant and ramping up their own health security measures.

The urgency of the situation was underscored by the World Health Organization's (WHO) recent declaration of Clade Ib as an international public health threat. 

“The variant, which has been associated with more severe health outcomes and higher mortality rates than its predecessors, has sparked a global response aimed at containing its spread,” WHO declared on August 14. 

Cambodia's strategic response

Cambodia, which reported 20 cases of mpox between 2023 and 2024 – all of which were of the less severe Clade II variant – has not yet detected any instances of the more dangerous Clade Ib. 

However, Ra's statement makes it clear that the country is taking no chances. 

“In this context, Excellencies and Lok Chumteav, please ensure careful monitoring and prevention of infectious diseases that may be imported from other countries by strengthening quarantine measures.

“It is crucial to prevent and respond to the spread of diseases at the borders to protect the health of the Cambodian people,” the minister stated, emphasising the importance of proactive measures in line with the government's health priorities.

The directive comes as Cambodia's neighbours are also grappling with the new variant. Thailand, which has become the first country in Asia to detect Clade Ib, has reported that a European male who arrived from Africa tested positive for the virus. 

Thai authorities are currently monitoring 43 close contacts of the 66-year-old patient and have implemented strict surveillance measures at international entry points, particularly for travellers from countries experiencing mpox outbreaks.

Regional mpox situation: A growing concern

The regional situation is increasingly tense, with several Southeast Asian countries reporting cases of mpox, although primarily of the Clade II variant. 

Thailand is particularly concerned about the potential impact of Clade Ib as it enters the busy tourism season. 

“The Southeast Asian nation, which has reported about 800 cases of the mpox Clade II variant since 2022, is keen to contain the virus as it heads into the busy tourist season when millions of holidaymakers are expected to visit the country,” according to Bangkok Post, published on August 23. 

The country has not only ramped up health screenings but is also preparing quarantine facilities to manage potential outbreaks.

The Philippine Department of Health (DOH) reported its tenth confirmed case on August 19, a 33-year-old male with no travel history outside the country. 

While this infection involved the milder Clade II variant, the Philippine government remains vigilant, closely monitoring the situation and updating guidelines to encourage consultation and testing for suspected cases.

Similarly, Vietnam is on high alert, with Ho Chi Minh City alone reporting 49 cases of mpox in 2024, predominantly among men who have sex with men (MSM). 

“The city continues to enforce rigorous public health measures and has initiated genetic sequencing of certain virus samples to monitor for any changes in the virus strain,” according to Vietnam Net.

According to the Pasteur Institute in Ho Chi Minh, the southern region of Vietnam has recorded 199 occurrences of mpox over the past two years, with eight fatalities. The city alone accounts for 156 infections and six deaths, making it the most affected area in the region.

Of the 49 cases recorded this year, all are male, with ages ranging from 18 to 53.

In Malaysia, officials are closely monitoring the situation but have not yet implemented a vaccination programme. 

Malaysia’s deputy health minister has emphasised the need for a thorough study before any mass inoculation is considered, reflecting a cautious approach in the face of a rapidly evolving public health threat.

“The Malaysian authorities are stepping up surveillance at international entry points, and all travellers from countries that have reported mpox cases are required to monitor their health for 21 days after their arrival in Malaysia,” according to The Straits Times. 

Singapore will stay nimble and vigilant as it navigates through a "dangerous and troubled world" of growing geopolitical tensions, fragmentation in the global economy and external threats including the latest mpox outbreak, said Singaporean Prime Minister Lawrence Wong.

Speaking to local media on his 100th day in office, he said the island republic will continually find ways to strengthen partnerships, build new connections and maintain relevance on the global stage.

New Straits Times quoted Wong as saying, "Unfortunately, we must expect even more [crises and shocks] in the coming years because we are in a world with increasing geopolitical tensions and armed conflicts everywhere.”

The Lao health ministry issued a notice on September 19, 2023, confirming the first case of mpox in the country, and asking local residents to keep a close watch on and prevent the spread of the disease. It noted the first mpox infection was imported.

The notice urged health departments across the nation to intensify disease prevention and control work, with focus given to border localities to respond to the disease. 

WHO's global response and the threat of Clade Ib

WHO has sounded the alarm on the global spread of mpox, particularly the new Clade Ib variant, which has been linked to severe disease outcomes. 

WHO director-general Dr. Tedros Adhanom Ghebreyesus declared the mpox outbreak in the Democratic Republic of the Congo (DRC) and neighbouring African countries a Public Health Emergency of International Concern (PHEIC) on August 14. 

The declaration was based on the rapid spread of the new variant, especially through sexual networks, and the rising number of cases in bordering countries.

Mpox has been reported in the DRC for more than a decade, and the number of cases reported each year has increased steadily over that period. 

“Last year, reported cases increased significantly, and already the number of cases reported so far this year has exceeded last year’s total, with more than 15,600 cases and 537 deaths,” according to WHO. 

The organisation's response includes working with vaccine manufacturers to ensure equitable access to vaccines and initiating efforts to accelerate vaccine distribution to lower-income countries. 

WHO also highlighted the need for an initial $15 million to support response activities. 

Currently, two vaccines recommended by WHO’s Strategic Advisory Group of Experts on Immunisation are in use, but the organisation has not called for mass inoculations, instead advising that only those at risk should be vaccinated.

Globally, the most affected region in June was Africa, with 567 infections, followed by the Americas (175 cases), Europe, excluding the Eastern Mediterranean region (100 cases), Western Pacific (81 cases) and Southeast Asia (11 cases). 

From January 2022 to June 2024, a total of 99,176 laboratory-confirmed cases of mpox, including 208 deaths, have been reported to the UN health agency from 116 countries in all WHO regions. Apart from Africa, “the outbreak continues at a low level of transmission globally”, the organisation said.

The Americas account for the majority of both infections and fatalities, with 62,904 confirmed infections and 141 deaths. 

Notably, the African Region, with 4,232 cases, has reported 35 deaths, reflecting a higher fatality rate in comparison to other regions. 

The overall monthly change in new cases shows a slight decline of 3 per cent, indicating a potential slowing of the outbreak's spread.