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The silent epidemic: Mpox's resurgence in Africa calls for urgent global health action

The silent epidemic: Mpox's resurgence in Africa calls for urgent global health action
Wilmot James, Richard Migisha and Nikki Romanik
By Wilmot James, Richard Migisha and Nikki Romanik
24 Mar 2025
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Without US funding, there has been immediate disruption to controlling the mpox outbreak. Now is the time for global health leaders, philanthropic organisations and other high-income nations to step up and fill the void left by the funding withdrawal.

The viral zoonotic disease mpox (formerly known as monkeypox) has periodically affected African nations since its discovery in 1958. 

Historically, it remained confined to specific regions, primarily within central and west Africa. However, the outbreak that began in 2022 marked a significant escalation, with cases spreading beyond usual endemic regions. By mid-2022, the virus had reached multiple continents, prompting the World Health Organization (WHO) to declare a public health emergency of international concern in early May, 2022. Unlike previous outbreaks, the 2022-2023 epidemic saw a significant number of cases in Europe and the Americas.

During the 2022 epidemic, early public health responses in high-income countries including surveillance programmes, vaccination campaigns, and behavioural interventions helped curb transmission. However, as global attention has waned and resources have shifted elsewhere, the burden of mpox has increasingly fallen on African nations. With limited access to vaccines and healthcare infrastructure stretched thin, the virus has continued to circulate widely on the African continent. Among the affected countries, the Democratic Republic of the Congo (DRC), Burundi, and Uganda have experienced the highest rates of transmission. What was once seen as a global health crisis has now settled into a persistent public health challenge for Africa, exacerbating existing inequities in global disease response.

Since the beginning of 2025, the African continent has reported more than 5,000 laboratory-confirmed and nearly 21,000 clinically suspected cases. The discrepancy between laboratory-confirmed and clinically suspected case numbers highlights that true burden of mpox in Africa is largely unknown, as the gold standard of diagnosis is viral genetic sequencing, a technology not widely available in countries most affected by the virus. While wealthier nations swiftly deployed vaccines and targeted response strategies, African health ministries have had to rely on piecemeal support from foreign aid, international organisations, and non-governmental entities. 

Progress is mixed


Progress in combating the virus has been mixed. In 2025, 30,041 cases were notified of which 7,049 were confirmed with 306 deaths from 16 countries on the continent. Tanzania reported 20 new cases since the last update on March 12, 2025. Uganda has seen a rapid increase in cases with 375 new laboratory confirmed cases and seven deaths reported on the last update on March 12. 

This is a 27% average increase in the number of new cases in the past four weeks. The DRC remains a “major concern” according to the Africa Centres for Disease Control and Prevention’s Jean Kesaya, with 2,183 cases reported in week nine amid declining testing linked to ongoing conflict in the eastern DRC and challenges in transporting samples. A previous epicentre for mpox, Burundi has seen a nearly 95% reduction in case volumes since a peak in October 2024. Meanwhile, South Africa reported three new cases of mpox in February — the country’s first confirmed cases since September 2024. The South African cases were linked to travellers from Uganda — a reminder that infectious diseases do not respect borders, and that even minor outbreaks in one region have the potential to affect distant countries.  

 Any discussion of global public health in 2025 must address the elephant in the room: the Trump administration’s decision to cut US funding for foreign aid programmes and withdraw from the WHO. These actions have disrupted funding streams and collaborative frameworks essential for effective epidemic response. Without US funding, there has been immediate disruption to controlling the mpox outbreak. The ability to detect and test for mpox, including the ability to transport samples from remote districts to laboratories, has declined significantly. In addition, logistical challenges have worsened and rollout of the mpox vaccine has been disrupted.

A 2022 report from the non-governmental organization Resolve to Save Lives highlighted several proven approaches for national governments to enhance epidemic detection and containment, including investment in early warning systems, community-based surveillance, and rapid response capabilities. The abrupt reduction in US support undermines these strategies, leaving Africa constrained in its ability to prevent small outbreaks from becoming widespread crises.

Political instability


The withdrawal of US support is occurring in a setting of increased political instability and ongoing conflict in several African countries. This consequences are most apparent in the DRC, with a recent report from the Africa Centres for Disease Control acknowledging that the ongoing conflict and resulting humanitarian crisis is probably masking the severity of the mpox epidemic and driving higher transmission rates. Furthermore, genetic sequencing of mpox samples from the DRC has identified a variant that may have increased transmissibility, potentially a consequence of the heightened spread.

Without the backing of major economies like the United States, multilateral agencies such as the WHO and Africa Centres for Disease Control will face significant funding gaps, affecting their ability to provide timely assistance, vaccines, and technical support. The US retreat from multilateral engagements hampers the collective global ability to respond to diseases. This shift not only endangers lives in affected regions but also poses a risk to global health security, as neglected outbreaks in one part of the world can quickly escalate into global crises.

As mpox and perennial disease outbreaks continue to challenge African health systems, the need for robust international support has never been more urgent. The current policy trajectory threatens to reverse years of progress in epidemic preparedness and response, leaving the most vulnerable populations at increased risk. Now is the time for global health leaders, philanthropic organisations, and other high-income nations to step up and fill the void left by the US withdrawal. Investing in African health infrastructure, expanding vaccine manufacturing capabilities, and strengthening regional disease surveillance networks will be critical in ensuring that future outbreaks are contained before they spiral out of control.

Strengthen coordination


To effectively address mpox in Africa, leveraging existing institutions such as the Africa Centres for Disease Control and regional partners, including WHO, Gavi, and Unicef, is essential. These organisations can strengthen coordination, improve surveillance, and support national health systems. 

National governments should focus on enhancing local infrastructure and response strategies, including vaccination campaigns, while philanthropy and international organisations could provide critical, though temporary, financial support. In view of the observed cross-border spread across the continent, there is a need to promote regional collaboration to mitigate the persistent challenge of mpox. Additionally, improving diagnostic capabilities and regional vaccine production in Africa should be a priority and would ensure a more self-reliant response to future outbreaks. 

It is imperative for the global community to reaffirm its commitment to collaborative health initiatives and ensure that unilateral political decisions do not compromise progress made in combating infectious diseases. The health of one region invariably affects the health of all, and in our interconnected world solidarity and support are not just moral imperatives — they are practical necessities. DM

Dr Wilmot James is a Professor and Senior Advisor to the Pandemic Centre at the School of Public Health, Brown University, Rhode Island; Dr Richard Migisha is Field Supervisor, Uganda Public Health Fellowship Program, Uganda National Institute of Public Health; and Dr Nikki Romanik is a Distinguished Senior Fellow in Global Health Security at Brown University School of Public Health. She was the former Special Assistant to the President, Deputy Director and Chief of Staff of the Office of Pandemic Preparedness and Response Policy at the Biden-Harris White House. 

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