Mpox surged in parts of East, West and Central Africa in 2024, prompting the World Health Organization (WHO) to declare it a public health emergency of international concern in August. This was just over a year after it said an earlier mpox emergency was over, marking the first time the WHO has declared two such alerts consecutively over the same infection.
The emergency that ended in 2023 was driven by the clade IIb variant of mpox, formerly known as monkeypox. During that outbreak, which began in 2022, the virus spread to several countries where it hadn鈥檛 been reported before, such as in parts of Europe and North America. These nations managed to contain it using vaccines, quarantine and contact tracing, so their number of cases is now .
Meanwhile, a variant called clade Ia has been surging in the Democratic Republic of the Congo (DRC). 鈥淲hat we forgot to do during the containment of that global epidemic was to put a focus on really where the tap was fully open, which was in endemic regions in Africa,鈥� says at the University of Manitoba in Canada. 鈥淚n the DRC, there weren鈥檛 vaccines [or] antivirals, [and] there were issues with healthcare access, diagnostic testing, community knowledge 鈥� all those things got forgotten by many different international governments.鈥�
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To make matters worse, a new variant, called clade Ib, emerged in September 2023, quickly spreading, partly among sex workers, in the in eastern DRC, primarily in the town Kamituga.
The situation initially seemed relatively stable, with clade Ia and clade Ib together leading to fewer than 100 cases a week in the DRC. But that figure had by July 2024, when clade Ib had also been reported in the cities of Bukavu and Goma near Kamituga. 鈥淭he size of the outbreak is unprecedented,鈥� says at the University of Oxford.
Within a month, mpox had spilled over to neighbouring nations that hadn鈥檛 reported cases before, such as Burundi, Uganda and Rwanda. By late November, suspected and confirmed infections across 20 countries in East, West and Central Africa , with more than 1000 known and suspected fatalities.
But the DRC has remained the hotspot of the outbreak, experiencing its largest number of cases of any mpox epidemic so far, with around 8600 confirmed and 39,000 suspected infections in 2024 鈥� about three times more than it logged in all of 2023.
To slow the spread of the virus, affected countries have enforced quarantine and contact tracing. Vaccines have also been part of the response. In early September, the DRC received its first ever doses of mpox vaccine, one called Jynneos, which started being given to people a month later. and have also received vaccine doses.
This was a major step towards containing the outbreak, but cases wouldn鈥檛 have escalated the way they have if the vaccines had arrived sooner, says Kindrachuk. What鈥檚 more, fewer than 300,000 doses have arrived so far across affected countries in Africa, a small fraction of the 10 million doses that are projected .
鈥淎mazing work鈥檚 been done by local researchers and health workers to contain the outbreak, but they鈥檝e not been supported nearly enough by the international response in terms of availability of diagnostics, drugs, vaccines and long-term investments to research mpox,鈥� says Olliaro.
That means there is still a high risk of mpox spreading to other countries in Africa, but the fact that some other continents have now experienced an mpox outbreak means the pandemic risk is low, says Kindrachuk. 鈥淭hose countries where we鈥檝e seen these pan-continental exportations have really good, robust surveillance systems because of what happened in 2022,鈥� he says. 鈥淵ou have healthcare workers that are kind of more attuned to what mpox looks like than what they were previously, [and] testing access is higher. So those things already limit disease.鈥�
