In August 2024, a flurry of urgent announcements hit the news. On August 13, the Africa Centers for Disease Control and Prevention declared mpox a public health emergency for the continent. The very next day, the World Health Organization elevated the mpox outbreak to its highest threat level, sparking a report titled, “WHO declares 2024 mpox surge a ‘public health emergency of international concern.'”
Today, those emergency declarations remain, but mpox has slipped from the spotlight. This piece continues an annual series that revisits previous stories to see their current status.
When Caroline Mugun arrives at her job in Mombasa, Kenya, she finds patients behind partitions. “You can really see the pain they’re in. It’s something else,” she notes. Mugun works in an mpox isolation ward managed by Doctors Without Borders, where patients are treated while their painful lesions heal. The goal is to prevent the virus, which spreads through close contact and sexually, from further spreading. Interestingly, before this outbreak, Kenya had no reported mpox cases, but now the Africa CDC indicates that the infection has reached the capital, causing concern about a potential rise in cases, similar to what has occurred in other urban areas.
Kenya isn’t alone in this struggle. Many nations, from Gambia to Burundi and Uganda to South Sudan, are encountering mpox for the first time during this outbreak. Currently, 26 African countries are facing mpox outbreaks, a significant increase from just 13 a year prior, according to Africa CDC. While some estimates indicate that cases are declining in key nations, more than 100,000 suspected mpox cases have been recorded this year.
Critics argue that the global response has been inadequate, expressing concern that the world hasn’t acted quickly enough to control the virus. This frustration persists even though $1.1 billion has been committed by countries and organizations towards mpox control efforts. A closer look at the current mpox crisis reveals implications for future infectious disease outbreaks.
“Walking blind”
When the WHO raised alarms a year ago, a new strain of mpox—designated as clade 1b—was quickly spreading, particularly among sex workers and their clients. The outbreak’s epicenter was in the conflict-affected eastern Democratic Republic of Congo, an area teeming with mineral resources and attracting workers from neighboring countries. This new strain soon appeared in nearby nations including Burundi, Kenya, Rwanda, and Uganda.
A year later, this strain has proliferated, reaching as far as China and the United Kingdom, the U.S., and Turkey. Meanwhile, significant outbreaks of other mpox strains have occurred in Africa. According to Africa CDC, there have been over 700 deaths this year, but experts believe the true number is likely far higher.
Dr. Chris Beyrer, an epidemiologist at Duke University, commented, “We are kind of flying blind. But honestly, it’s more like walking blind,” due to the stagnant response. Many factors contribute to the lack of data, including stigma associated with sexually transmitted diseases and the emergence of cases in remote regions with limited surveillance. Additionally, cuts to foreign aid under President Trump have negatively impacted the response, particularly in the Democratic Republic of Congo, which had previously received substantial U.S. assistance.
Despite these challenges, data suggests the virus is geographically expanding, although recent spikes appear to be declining in several African nations, driven largely by a decrease in cases in the DRC, Sierra Leone, and Uganda.
“Three steps backward”
Even as cases drop, many mpox specialists are voicing serious concerns about the global response. Dr. Boghuma Titanji from Emory University remarked, “This has been a really frustrating year… for every step forward, it feels like we’ve taken three steps back.”
Vaccination, in particular, is cited as a glaring area of failure. Despite mpox being preventable with a vaccine, only about 907,000 individuals have received at least one dose across a dozen African countries, with just over 3 million doses distributed so far—well short of the Africa CDC’s target of 10 million doses by the end of 2025.
The issues began when the WHO declared the public health emergency, before it even authorized the mpox vaccine. Beyrer expressed frustration, pointing out that it seems contradictory to issue an emergency declaration while delaying vaccine approvals.
Promises of vaccine donations have also fallen short. President Joe Biden pledged to send 1 million doses to Africa in September 2024, but by July 2025, only around 90,000 had actually arrived on the continent. Furthermore, nearly half of the remaining doses are now too close to expiration to be shipped, translating into significant financial loss.
However, there’s a flicker of hope. In early September, Kenya is slated to launch an mpox vaccination campaign, and Nurse Mugun noted that many are eagerly looking forward to this rollout.
The U.S. Centers for Disease Control and Prevention and the Department of Health and Human Services did not provide comments about the vaccine situation when contacted.
In response to questions about its strategy regarding mpox, the U.S. State Department announced plans to supply over 200,000 vaccine doses to five African nations, pledging effective usage of the doses.
What about the future?
Dr. Titanji raised concerns that the slow response could undermine the effectiveness of the WHO alert system and the Africa CDC’s emergency declaration. She questioned the impact of maintaining a high-level alert without significant containment progress.
In contrast, Dr. Jean Kaseya of Africa CDC argued that real progress has been made, citing a significant increase in the number of African countries approving the mpox vaccine—increasing from none last year to 17 today. Additionally, the capacity for testing suspected cases has expanded dramatically.
Kaseya emphasized that collaboration and coordination among African nations in resource allocation is unprecedented. Yet, he conceded that much remains to be done. Titanji also agreed, stressing that the world is seeing this virus entrench itself among humans, which could result in further evolution.
Anne Rimoin, a professor at UCLA and an mpox researcher, added a note of caution, stating that while the U.S. has so far been fortunate in avoiding major outbreaks, that situation may not persist. “Ignored diseases abroad can quickly knock on our door,” she warned, emphasizing the need for vigilance.
