As the world breathes easier after weathering the 2022–23 global mpox outbreak, another more lethal strain of the virus is surging in central Africa — largely ignored, underfunded, and under-monitored.
The clade I variant of mpox, concentrated in the Democratic Republic of the Congo (DRC), has proven significantly deadlier than its globally notorious cousin, clade IIb, which made headlines across 100 countries in 2022. Despite having a mortality rate between 3% and 10%, and despite new signs of accelerated mutation and cross-border spread, the global response remains muted.
And yet — this outbreak could be stopped, if the global community truly cared to act.
From Local Epidemic to International Threat
In 2023 alone, 14,626 cases and 654 deaths were attributed to clade I mpox in central Africa. The hardest hit were children under 15 and their caregivers, often lacking access to antibiotics or intensive care — key tools that can reduce mortality from this devastating illness.
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By 2024, a new mutated sub-variant, clade Ib, was identified. It emerged from the Kivu region, a conflict-prone area bordering Uganda, Burundi, and Rwanda, and quickly caused over 16,000 new cases and 511 deaths, spilling into camps of internally displaced people and, eventually, reaching Sweden via a returning traveller — the first recorded case of clade I in Europe.
Despite these troubling signs, no coordinated international action has been taken to stem the outbreak.
A Stark Reminder of Health Inequity
One of the clearest reasons for the continued spread is vaccine inequity. The Jynneos (US) or Imvanex (Europe) vaccines — instrumental in controlling the global outbreak of clade IIb — remain unavailable in Africa. At US$100 per dose, the vaccine is priced far beyond the reach of low- and middle-income countries, and donations during the 2022 outbreak fell far short.
In contrast, when mpox hit Western countries, responses were swift. Public health agencies collaborated closely with at-risk communities, particularly men who have sex with men (MSM), providing education, community engagement, testing, contact tracing, and vaccinations.
But in countries like the DRC, where mpox is more often transmitted heterosexually and within family settings, similar strategies have not been deployed — or funded.
“This is a story we’ve seen before,” says Orkin. “Diseases that primarily affect the Global South are too often neglected until they threaten the Global North.”
Tools to Stop Mpox Exist – But They Aren’t Equally Shared
The tools to stop the outbreak are available and proven effective:
- Community engagement
- Contact tracing
- Laboratory surveillance
- Vaccination
In particular, early vaccination — within four days of exposure — can significantly reduce the risk of developing mpox and lessen symptom severity. However, millions of vaccine doses will be required to halt the spread across central Africa.
Equally vital is access to free diagnostic testing and laboratory infrastructure to identify the clade of mpox and track its spread. Without this, countries are flying blind.
What’s at Stake for the World?
The risk to the general population in wealthy countries remains low, but the likelihood of international spread is rising, particularly as travel increases. The first confirmed European case of clade I marks a sobering milestone and should serve as a wake-up call.
More importantly, this moment represents a test of global solidarity. If the world acts now — with urgency and equality — the outbreak can be contained. If it waits, clade Ib could become the next international emergency.
A Call for Immediate Global Action
Stopping this outbreak requires three key actions:
- Mass vaccination: Millions of doses of the Jynneos/Imvanex vaccine must be made available and distributed equally and affordably to African nations.
- Laboratory capacity: Investment in testing and sequencing infrastructure is needed to track the evolution and spread of the virus in real time.
- WHO intervention: A Public Health Emergency of International Concern (PHEIC) declaration from the World Health Organization could:
- Fast-track emergency vaccine licensing in African nations.
- Enable bulk purchasing and distribution of vaccines.
- Coordinate cross-border response efforts.
Final Thought
The world has the means to stop this outbreak. What’s lacking is the will. Let us not wait until the virus spreads further — or mutates into something worse — before treating central Africa’s mpox crisis with the urgency it demands.
As Chloe Orkin argues: “We live in an interconnected world. Health inequity anywhere is a threat to health security everywhere.”
