Africa CDC and WHO Issue Third Reaffirmation of Mpox Emergency as Cases Surge Across 19 African Nations

Addis Ababa, Ethiopia · June 2025 — The Africa Centres for Disease Control and Prevention (Africa CDC) and the World Health Organization (WHO) jointly reaffirmed the mpox public health emergency for a third time in June 2025, extending the continental and international emergency designations first declared in August 2024. The decision was driven by sustained transmission across 19 African countries, the emergence of Sierra Leone as a new epicentre, and confirmed case counts in the first half of 2025 that had already surpassed the total for all of 2024.

The emergency status — comprising Africa CDC's Public Health Emergency of Continental Security (PHECS) and WHO's Public Health Emergency of International Concern (PHEIC) — was initially declared in August 2024 and had been formally extended once before, in February 2025.

Escalating Epidemiological Trends

Data presented in the editorial published in the Journal of Public Health in Africa on 20 August 2025 revealed a sharply deteriorating situation. By 18 June 2025, the number of confirmed cases in 2025 (20,936) had already exceeded the total recorded throughout 2024 (19,738) by 6%, with active outbreaks continuing in 19 countries.

A comparison of weekly averages underscored the upward trajectory. Between September and December 2024, countries reported an average of 2,777 suspected cases and 488 confirmed cases per week. From January to April 2025, those figures rose to 2,874 suspected and 682 confirmed cases per week. A more granular comparison of the three-week periods preceding each of the three emergency declarations revealed a consistent increase in suspected cases — from 1,468 before the first declaration to 2,838 and 3,430 before the second and third — and in reported deaths, which rose from 229 to 689 and 845, respectively.

Sierra Leone: A New Epicentre

Sierra Leone emerged as a particularly alarming hotspot. The country, which had reported fewer than 10 confirmed cases per week in January 2025, accounted for over 50% of all confirmed cases on the continent between epidemiological weeks 19 and 22, with weekly totals exceeding 400 confirmed cases during that period. During epidemiological week 22 alone, Sierra Leone accounted for 63% of all confirmed cases continent-wide.

In the first quarter of 2025, four additional African Union Member States — Sierra Leone, Malawi, South Sudan, and Tanzania — reported imported cases. Concurrently, three countries outside Africa — China, the United Arab Emirates, and Switzerland — confirmed their first-ever mpox cases, underscoring the persistent risk of international spread.

A Complex Clade Landscape

The mpox epidemic in Africa is characterised by multiple concurrent outbreaks driven by genetically distinct viral lineages:

Of growing concern is the emergence of novel mutations, such as lineage G.1, currently predominant in Sierra Leone, which is phylogenetically related to Clade IIb in Nigeria. Genomic analyses have linked outbreaks in non-African countries to Clade Ib, currently circulating in the DRC and parts of East Africa, underscoring the role of regional transmission dynamics in cross-border spread.

Inadequate Response Capacity

The editorial, authored by Africa CDC officials including Director General Dr Jean Kaseya, highlighted a stark resource gap. During the second phase of the mpox response (March 2025–August 2025), only 500,000 vaccine doses were secured against an estimated need of 6.4 million, with minimal funding available for infection prevention and control (IPC) commodities.

The authors noted that declining international health financing — particularly following aid reductions by the United States, United Kingdom, Italy, and others — had severely undermined containment efforts. Testing coverage in 2025 stood at 55%, a slight decline from 57% in 2024. More concerning was the marked increase in the test positivity rate, which rose from 38.8% in 2024 to 55% by week 23 of 2025, suggesting persistent community transmission, delayed care-seeking, and potential under-detection of cases.

Policy Implications and the Path Forward

The extension of the mpox emergency designation was intended to enable several critical actions: mobilisation of political leadership and emergency funding; rapid deployment of multidisciplinary Incident Management Support Teams to hotspots; strengthening of cross-border and community-based surveillance; investment in genomic surveillance and decentralised laboratory diagnostic capacity; and scaling up of community protection through risk communication, IPC, and vaccination.

The authors emphasised that reaffirming mpox as a public health emergency was also an opportunity to invest in and accelerate regional manufacturing capacities across Africa, strengthening local production of vaccines, diagnostics, and therapeutics as a cornerstone of building the continent's self-reliance.

As the editorial concluded: "In a globalised world, health security is indivisible: an injury to one is an injury to all. The unchecked spread of mpox in one region can quickly become a threat to all, as borders offer no protection against emerging pathogens."

The continental emergency status was eventually lifted in January 2026, following a sustained decline in cases and deaths, marking a transition toward long-term, sustained response strategies. However, the lessons of the mpox outbreak — the need for equitable access to medical countermeasures, sustained investment in surveillance, and the dangers of donor fatigue — continue to resonate across the global health landscape.

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Sources:

• Ngongo N, Boum II Y, Mercy K, et al. "Still not over: Africa CDC and WHO issue third reaffirmation of mpox emergency." Journal of Public Health in Africa. 2025;16(1):a1556. DOI: 10.4102/jphia.v16i1.1556. PMID: 40937112.
• Africa CDC, "Still not over: Africa CDC and WHO issue third reaffirmation of mpox emergency," khub.africacdc.org
• WHO, "Africa CDC and WHO update mpox strategy as outbreaks persist," 17 April 2025, who.int
• Anadolu Agency, "African health body declares end to mpox as continental health emergency," January 2026, aa.com.tr