Let’s talk about mpox, a viral infection that’s been steadily gaining global attention. Caused by the Monkeypox virus—a member of the Orthopoxvirus genus—the disease is characterized by fever, swollen lymph nodes, and a distinctive rash that often progresses through several phases over 2–4 weeks. First identified in laboratory monkeys in 1958 and later in humans in 1970, primarily in Central Africa, mpox has lingered as a concern in endemic regions for decades.
Two genetic variations, or clades, are key to understanding its impact:
Clade I
(Congo Basin) is known for higher severity—with mortality rates up to ~3.3% in Central African outbreaks.
Clade II
(West Africa) became globally widespread during the 2022–2023 outbreak and carries a fatality rate below 0.2%, though still serious for vulnerable groups.
Transmission happens mainly through close contact—skin-to-skin interaction, respiratory droplets, or contaminated objects—and can take 1–21 days to manifest symptoms. While most people recover with supportive care, serious complications can arise, especially in children, pregnant individuals, or immunocompromised patients.
Why start here? Because when the WHO keeps mpox on its Global Health Emergency List, understanding the virus—its severity, spread, and impact—is exactly why the world stays alert to this evolving crisis.
Background: WHO Emergency Declarations
Let’s dive into how the WHO has formally handled mpox—and why this framework matters.
What is a PHEIC? Public Health Emergency of International Concern is the WHO’s highest alert level. It signals an extraordinary event with potential for international spread that requires coordinated global response.
Timeline of Mpox Emergency Declarations July 23, 2022: WHO declared mpox a PHEIC after a global spread of a clade IIb strain. May 11, 2023: With cases declining, WHO lifted the emergency. August 14, 2024: A resurgence driven by clade Ib in Central Africa prompted WHO to re-declare PHEIC.
Since then, WHO has met regularly, updated recommendations, and monitored the outbreak. These declarations are tools, not theatrics—they enable unified strategy, funding, technical support, and timely interventions when mpox threatens to escalate.
Why the Emergency Status Was Renewed (2024–2025)
WHO reissued PHEIC status in August 2024 based on four major realities:
Emergence of Clade Ib
By late 2023, a new variant known as clade Ib appeared in the DRC. This strain spreads rapidly and shows higher hospitalization and mortality rates—around 3%—especially among children and immunocompromised people. By August 2024, it had surfaced in Burundi, Kenya, Rwanda, Uganda, and even in a traveler from Sweden—confirming international transmission.
Surge in Cases and Fatalities
By December 2024, Central Africa had reported over 29,000 cases and 800 deaths since the start of the year. The DRC alone had recorded about 17,000 cases and 535 deaths by mid-2024—roughly a 3.2% case-fatality rate.
Multi-Clade Outbreaks
Unlike previous single-clade outbreaks, this resurgence featured clades Ia, Ib, and remnants of II circulating concurrently—complicating efforts and increasing mutation risk, reinforcing demand for global coordination.
Under-Detection in Fragile Systems
Many affected regions lack robust testing and surveillance, meaning the actual caseload is likely far higher than reported—intensifying urgency for global action.
In short: a deadlier strain, rising deaths, cross-border spread, and fragile health systems converged to justify the PHEIC renewal on August 14, 2024.
WHO’s Latest Decision: Keeping Mpox on the Emergency List
On June 5, 2025, the WHO’s Emergency Committee met for the fourth time since the August 2024 PHEIC declaration. Following their deliberations, Director-General Dr Tedros reconfirmed that mpox continues to meet PHEIC criteria.
Why the WHO remains cautious: rising case counts; geographic spread including West and Central Africa and undetected transmission; systemic challenges like surveillance and diagnostic gaps; and the risk of hidden spread complicating containment. WHO issued updated recommendations targeting surveillance, rapid testing, vaccination, and risk communication.
Current Epidemiology & Situation
Global Case Numbers: Since early 2024, there have been over 37,000 confirmed mpox cases and 125 deaths across 25 countries, with the DRC accounting for 60% of cases and 40% of fatalities. More than 29,000 suspected cases and 812 deaths occurred during the clade Ib epidemic in Central Africa.
Regional Breakdown: In the DRC, as of mid-May 2025, 7,411 confirmed cases and 22 deaths were recorded—driven by clades Ia and Ib. Uganda reported active transmission in 79% of districts, Burundi had under 50 weekly cases, Sierra Leone faced exponential rise of clade IIb, and Malawi confirmed 11 cases since April.
Cases Outside Africa: Four clade I cases in the U.S., one in Australia in May 2025, and 12 in the UK were all travel-linked.
Testing & Surveillance Gaps: Under-detection remains major, with declining testing in Uganda and Burundi. A 2025 Nature study found that mpox circulated undetected in Nigeria for eight years.
Summary: Mpox is not contained. Active transmission across Africa, sporadic global cases, and weak surveillance make it a persistent evolving threat requiring sustained global attention.
WHO’s Temporary Recommendations
Following the June 5, 2025 meeting, WHO issued updated recommendations through August 20, 2025:
Strengthen Surveillance & Diagnostics
Scale community surveillance, early warning systems, rapid tests, and genomic sequencing in rural Africa.
Emergency Preparedness & Clinical Care
Set up isolation units, maintain care protocols covering pain, lesions, nutrition, and hydration.
Targeted Vaccination
Ring vaccination around cases, vaccinate high-risk groups using Jynneos and ACAM2000 under emergency use.
Risk Communication & Community Engagement
Culturally sensitive campaigns on isolation, masks, hygiene, and stigma reduction using rights-based frameworks.
Equity & International Funding
Implement Strategic Preparedness & Response Plan with US$290 million target through August 2025; previous six-month plan targeted US$135 million.
Implications of Maintaining PHEIC Status
Global Coordination & Legal Obligations: Enables IHR alignment, information sharing, and equitable strategy.
Resource Mobilization & Funding: Triggers emergency funds—including US$1.45 million in 2024—and requires hundreds of millions for vaccines, diagnostics, and workforce.
Technical Assistance & Vaccine Access: Expedites emergency use listings, supports ring vaccinations and lab strengthening.
Public Awareness & Risk Communication: Signals seriousness, boosts media attention, government action, and consistent messaging.
Research & Policy Development: Drives R&D funding, study of variants, vaccine effectiveness, transmission pathways, and policy adaptation.
Challenges & Gaps
Weak Surveillance & Diagnostics: In the DRC only 37% of suspected cases are tested due to limited labs.
Violence and Humanitarian Constraints: Conflict in eastern DRC disrupted surveillance, causing a 31% rise in weekly cases.
Vaccine Shortages & Unequal Rollout: Africa needs 6.4 million doses but has received only 1.3 million.
Funding Shortfalls: Over US$220 million remains unfunded; current commitments fall short and slow.
Community Engagement & Misinformation: Mistrust and fake news persist; tailored messaging and real-time monitoring are essential.
Research & Innovation Gaps: Strain-specific studies and treatment trials are limited; AI surveillance tools need rapid expansion.
Why It Matters Now
Sustained Surge: Over 37,000 confirmed cases and 125 deaths since early 2024, mostly in the DRC.
Geographic Expansion: Beyond Africa with cases in U.S., UK, Australia, Canada, India, Pakistan and wastewater detections.
Mutation & Adaptation Risks: Emerging mutations may increase transmissibility and persistence.
Zoonotic Spillover Realities: Deforestation and wildlife contact heighten new spillover risks.
Fragile Health Infrastructure: Decreasing testing, unstable funding, and vaccine scarcity increase outbreak risk.
Letting up now risks reversal. Maintaining emergency status supports coordination, funding, surveillance, and equity, protecting against deeper crisis.
What Comes Next
Next IHR Emergency Committee Review expected mid‑September 2025.
Temporary Recommendations extend through August 20, 2025 and will be reassessed thereafter.
SPRP Funding: US$290 million needed by August; WHO targets US$147 million by June.
Enhanced Surveillance & Genomic Tracking: Scale sentinel networks, sequencing, and wastewater monitoring.
Vaccination Scale-Up: Ring and pre-exposure vaccination for priority groups; ramp up equitable production and delivery.
Community Engagement & Communication: Intensify culture-sensitive outreach, misinformation counteraction, and stigma reduction.
Research & Development Acceleration: Trials on clade Ib vaccines, antivirals, transmission studies, and One-Health research agenda.
Wrap-Up
We’ve explored why WHO keeps mpox on the Global Health Emergency List: ongoing cases, persistent clade Ib transmission, surveillance gaps, conflict zones, vaccine inequities, and funding shortfalls combined necessitate global coordination. Removing mpox from emergency status now risks fragmentation, funding loss, and weakened response. The path ahead—driven by mid‑Sept review, funding targets, vaccination, diagnostics, surveillance, communication, and research—must remain urgent, equitable, and sustained to push mpox back from the brink and protect vulnerable communities worldwide.
