Three years after mpox shocked the world, a silent crisis is unfolding in Africa while the rest of the world seems to have moved on.
When mpox (formerly called monkeypox) grabbed global headlines in 2022, it seemed like the next big pandemic threat. Three years later, the story looks very different depending on where you are. In Africa, mpox is still spreading and cases are rising in some countries. In the rest of the world, transmission has slowed, but the virus has not disappeared.
Africa: a growing public health crisis
Across Africa, mpox has become a major epidemic. Between January 2024 and May 2025, 26 countries reported more than 139,000 suspected cases, including 34,824 confirmed infections and 1,788 deaths. Alarmingly, over 21,000 cases were confirmed in just the first few months of 2025. The Democratic Republic of Congo, Sierra Leone, and Malawi are currently the hardest hit.
Researchers are especially concerned about a new Clade 1a variant with APOBEC3 mutations, which may make the virus more contagious and harder to control. Unlike the 2022 to 2023 outbreak, mostly linked to sexual networks outside Africa, this variant is spreading widely among children, rural communities, and health care workers.
Weak health care systems, ongoing conflicts, and limited international support are making things worse. Many infections go undetected because testing is scarce, and vaccination campaigns are far from sufficient. So far, only about 700,000 people have been vaccinated across 11 African countries, a small fraction of what’s needed.
Outside Africa: a fragile calm
In other parts of the world, the picture is calmer. The Clade IIb strain that caused the 2022–2023 outbreak still circulates at low levels, mostly in specific social networks. Public health campaigns, targeted vaccination, and community engagement have helped keep numbers down.
However, the virus hasn’t vanished. Since 2023, travel-related Clade I cases have appeared in the U.K., Germany, Thailand, India, Sweden, and the United States. These cases haven’t caused major outbreaks, yet, but they are a reminder that global risks remain.
This is why the World Health Organization (WHO) continues to classify mpox as a Public Health Emergency of International Concern.
Vaccines and treatments
We’re not defenseless.
The main vaccine against mpox is the Modified Vaccinia Ankara (MVA-BN) vaccine, known as JYNNEOS (U.S.), Imvanex (Europe), and Imvamune (Canada). It is also approved in Switzerland, Singapore, Nigeria, and the DRC. This vaccine has been critical for both pre-exposure and post-exposure protection.
Other older smallpox vaccines, like ACAM2000, are still available but come with more side effects. Japan continues to use its long-standing LC16 vaccine.
For treatment, tecovirimat (TPOXX) remains the go-to antiviral. It is approved in the EU, U.K., and Canada, and available in the U.S. through special access. But recent trials (STOMP and PALM 007) show that tecovirimat works best when started early in severe cases and may not speed recovery for mild infections. Other antivirals like brincidofovir and cidofovir, plus vaccinia immune globulin (VIGIV), are sometimes used in severe cases.
New tools are coming: Moderna is testing an mRNA mpox vaccine, and biotech companies are developing next-generation antivirals.
Preparing for the future
Mpox is a warning sign for how we handle emerging infections. The world needs:
- Stronger surveillance and genomic sequencing
- Better diagnostic capacity in low-resource countries
- Fair access to vaccines and treatments, including regional stockpiles
- Community education that reduces stigma
- A One Health approach that links human and animal health
- Simulation exercises and sustainable funding for outbreak preparedness
Mpox hasn’t gone away. The world has a chance to act now before another orthopoxvirus crisis catches us unprepared.
Melvin Sanicas is an infectious disease physician.
