In August 2024, the news came in quick succession. On Tuesday — Aug. 13, 2024 — Africa Centers for Disease Control and Prevention declared mpox a public health emergency of continental concern. The very next day, the World Health Organization followed suit elevating the mpox outbreak to its highest threat level. We published a story with the headline: “WHO declares 2024 mpox surge a ‘public health emergency of international concern.’“
Today, those emergency declarations are still in effect but mpox has faded from the headlines. This story is a continuation of our annual series — “Whatever happened to …” — that follows up on previous reporting to see where things stand now.
When Caroline Mugun shows up at work in Mombasa, Kenya, the patients are behind subdividers.
“You see the agony the patient goes through. It’s on another level,” she says.
Mugun works in an mpox isolation ward run by Doctors Without Borders, where patients stay as their painful lesions heal. The hope is to prevent the virus, which is contagious and spreads sexually and through close contact, from further expanding its reach. Before this outbreak, Kenya had never reported mpox cases before. Now, Africa CDC says the virus has shown up in Kenya’s capital and it worries cases could grow exponentially, as has happened in other urban centers.
Kenya is far from alone. During this mpox outbreak, many countries — from Gambia to Burundi, from Uganda to South Sudan — have dealt with mpox for the first time. Today, 26 African countries are in the midst of mpox outbreaks, up from 13 a year ago according to Africa CDC. And, while recent estimates suggest cases are dropping in several key countries, Africa CDC says, there have been over 100,000 suspected mpox cases so far this year.
Critics say the global response has fallen dangerously short, expressing frustration and fear that the world has not acted more swiftly to contain the virus. These critiques come despite the fact that $1.1 billion has been pledged by countries, foundations and international organizations to support mpox control. Here is a look at where the mpox crisis stands and what that means for future outbreaks of other serious diseases.
“Walking blind”
When WHO rang the alarm bells a year ago, a new strain of mpox — officially called clade 1b — had just emerged and was spreading fast, particularly among sex workers and their clientele. The epicenter of this outbreak was the war-torn eastern part of the Democratic Republic of Congo. Far from the forest, where mpox typically spillover from small infected animals, this area is known for immense mineral wealth, and it attracts laborers from many of the neighboring countries. Soon, the new strain was popping up in those nearby nations: Burundi, Kenya, Rwanda and Uganda.
Fast-forward a year to now, and the new strain has taken off. It’s shown up in places as far apart as China and the United Kingdom, the U.S and Turkey. There have also been big outbreaks in Africa of the other mpox strains. By Africa CDC’s count, there have been over 700 deaths so far this year. However, mpox experts say, the numbers are likely a severe undercount.
“We have really gone off a kind of data cliff,” says Dr. Chris Beyrer, an epidemiologist and director of the Duke Global Health Institute at Duke University. “We are flying blind. But since the response is so stalled, I’m not sure it’s really flying. I think we’re probably more like walking blind.”
There are many reasons for the limited data, including stigma associated with a sexually transmitted disease and cases often emerging in remote areas where there’s limiter surveillance and diagnostic capacity. However, Beyrer says, another reason for the imprecise figures is President Trump’s cuts to foreign aid. The Democratic Republic of Congo was among the top recipients of U.S. foreign assistance, and some of that money went to the mpox response, including the transportation of samples from clinics to laboratories for testing.
What data there is suggests that the geographic reach of the virus has expanded substantially but, in recent months and weeks, the number of cases on the continent seems to be dropping, driven by a decline in cases in the DRC, Sierra Leone and Uganda.
“Three steps backward”
Even with cases dropping, plenty of mpox specialists are raising grave concerns about the global response.
“This has basically been a very frustrating year,” says Dr. Boghuma Titanji, an assistant professor of infectious diseases at Emory University. “I feel like for every two steps of progress that have been made, there have been three steps backward.”
Many point to vaccines as the epitome of how the response has gone wrong.
Mpox is a vaccine-preventable disease, and yet, to date about 907,000 people have been vaccinated with at least one dose of the mpox vaccine in a dozen African countries. Just over 3 million doses have been delivered to the continent. That’s according to Africa CDC, which had previously put the target at 10 million doses available by the end of 2025.
The challenges started early on: When the WHO declared the public health emergency, it still had not green-lit the mpox vaccine.
“It’s like: ‘Well, you either have an emergency or you don’t,'” says Beyrer. At the time, Tedros Adhanom Ghebreyesus, the director-general of the WHO, pushed back on the notion that anyone was moving slowly, saying WHO experts didn’t have complete information with which to assess the efficacy and safety of the vaccines. “We will not take shortcuts,” he said.
The U.S. vaccine donation is an example of a pledge that failed to fully materialize. Then-President Joe Biden promised to send 1 million doses to Africa in September 2024. However, as of July 2025, only about 90,000 had made it to the continent. Of the remaining doses, about half are now too close to their expiration date to ship, according to Yap Boum, the deputy head of Africa CDC’s mpox response.
“They can no longer be sent to the continent, which is a huge loss, because that one dose of vaccine is $100,” Boum says.
However, he says, there’s hope that things will improve. In August, the U.S. authorized the shipment of 219,000 mpox vaccine doses. And in early September, Kenya is supposed to start an mpox vaccination campaign. Nurse Mugun says people are eagerly awaiting the rollout.
The U.S. Centers for Disease Control and Prevention, as well as the U.S. Department of Health and Human Services, did not respond to NPR’s request for comment on the U.S. vaccine pledge.
What about the future?
Titanji of Emory University worries that the lack of response may undercut the value of the WHO alert system. Same with Africa CDC’s emergency declaration, which marked the first time the body ever issued a Public Health Emergency of Continental Security. “If we have had the highest level of alert for 12 months on a particular emergency and that hasn’t really put a dent in the containment, how impactful is this lever?” she asks.
Dr. Jean Kaseya, director-general of Africa CDC, disagrees with the suggestion that not much has happened to contain mpox. “Africa didn’t have this capacity. It’s now that we are building capacity,” he says.
He pointed out that a year ago, no African country had granted regulatory approval for the mpox vaccine that the U.S. was hoping to send. Now, 17 countries have approved it. Similarly, he says, the laboratory network used to test suspected mpox cases has grown significantly in the hot spots. For example, Burundi had two labs capable of testing mpox a year ago and now has 56.
Plus, he adds, this is the first time there has been coordination and collaboration across the continent with an African body helping to lead the charge and fairly allocate resources. Kaseya argues that without the emergency declaration, the resources that have been pledged would not have materialized. Still, he acknowledges, there is a lot more work to be done.
Titanji agrees there is more work to do. She warns that the world is watching in real time as the virus becomes entrenched in the human population. “The virus will evolve the more opportunities that it is given,” she says.
Anne Rimoin, a professor of epidemiology at the UCLA Fielding School of Public Health and an mpox researcher, says that so far in this mpox emergency, the U.S. has been largely spared — but that may not last. “Diseases we ignore abroad can quickly land on our doorstep,” she says. “We’ve been lucky so far. I don’t know how long our luck will hold out.”