Africa CDC Issues First-Ever Public Health Emergency of Continental Security Over Mpox Outbreak

Addis Ababa, Ethiopia · 13 August 2024 — The Africa Centres for Disease Control and Prevention (Africa CDC) declared the mpox outbreak a Public Health Emergency of Continental Security (PHECS), the first time the agency has issued such a declaration since its establishment in 2017. The announcement came one day before the World Health Organization would declare its own Public Health Emergency of International Concern.

The declaration followed a unanimous recommendation from a 16-member expert committee chaired by South African virologist and epidemiologist Salim Abdool Karim. The committee met on 12 August to review epidemiological data and assess the accelerating spread of the virus across the continent, particularly the emergence of a novel clade Ib strain in the eastern Democratic Republic of the Congo (DRC).

Africa CDC Director-General Jean Kaseya, MD, MPH, accepted the committee's recommendations, stating that mpox spread in Africa is "a crisis that demands our collective action."

A Novel Strain and an Accelerating Outbreak

The primary driver of the declaration was the emergence and rapid spread of clade Ib, a new variant of the monkeypox virus detected in the eastern DRC in 2023. Unlike previous clades, clade Ib appeared to be spreading mainly through sexual networks, and its detection in countries neighbouring the DRC that had never reported mpox before — including Burundi, Kenya, Rwanda, and Uganda — raised particular alarm.

At the media briefing, Karim noted that cases had already tripled the number recorded when the WHO declared a PHEIC for mpox in 2022. The case-fatality rate, in the 3% to 4% range, was considered too high, with fatalities concentrated in people living with HIV. He also highlighted that almost all the spread was human-to-human, and that more than half of all cases were diagnosed on a clinical basis alone, due to limited laboratory capacity.

Children Disproportionately Affected

Save the Children warned that newborn babies as young as two weeks old were contracting mpox in the DRC due to overcrowding in hospitals. According to the organisation, 70% of the DRC's nearly 15,000 cases involved children, with 39% under five years of age. Children were four times more likely to die from their mpox infections than adults. Some healthcare centres in Goma, the capital of North Kivu province, faced patient intake 4,000% over capacity.

The Significance of a First

The PHECS designation is a mechanism unique to Africa CDC, created to mobilise funding, strengthen laboratory and genomic sequencing capacity, and coordinate a continent-wide response to health threats. Unlike the WHO's PHEIC, which operates under the International Health Regulations and triggers global obligations, the PHECS is specifically designed to galvanise African Union member states into coordinated action.

The committee's nine main recommendations to the Director-General included developing a continental response plan, improving coordination among countries, addressing limited vaccine access with a clear strategy on who should receive vaccines, and expanding diagnostic capacity.

International Response

Following the declaration, Nicole Lurie, MD, MPH, executive director of emergency preparedness and response with the Coalition for Epidemic Preparedness Innovations (CEPI), described the development as a wake-up call to the world. CEPI announced it was working with vaccine companies to scale up vaccination and funding studies to assess immunogenicity in children and whether post-exposure vaccination could blunt illness severity.

The Africa CDC declaration preceded the WHO's own PHEIC declaration by one day. On 14 August 2024, WHO Director-General Dr. Tedros Adhanom Ghebreyesus declared the upsurge of mpox a Public Health Emergency of International Concern under the International Health Regulations (2005), following the advice of an independent IHR Emergency Committee.

"The current upsurge of mpox in parts of Africa, along with the spread of a new sexually transmissible strain of the monkeypox virus, is an emergency, not only for Africa, but for the entire globe. Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself." — Professor Dimie Ogoina, Chair of the WHO IHR Emergency Committee

Aftermath

The emergency status remained in place for over a year as efforts were scaled up across the continent. On 22 January 2026, Africa CDC officially lifted the mpox emergency status, based on a significant decline in suspected and confirmed cases following the implementation of coordinated response plans, improved diagnostic capacity, and widespread vaccination efforts. The WHO followed suit on 5 September 2025, ending the PHEIC after sustained declines in cases and deaths.

Even after the emergency declarations were lifted, mpox continued to circulate. As of early 2026, cases were still being reported across multiple WHO regions, with ongoing community transmission of the clade Ib strain in several countries. Both Africa CDC and WHO emphasised that lifting the emergency declarations did not mean the threat was over.

Sources

• Africa CDC, "Africa CDC Declares Mpox a Public Health Emergency of Continental Security, Mobilizing Resources Across the Continent," 13 August 2024, africacdc.org
• CIDRAP, "Africa CDC declares public health emergency for mpox," 13 August 2024, cidrap.umn.edu
• WHO, "WHO Director-General declares mpox outbreak a public health emergency of international concern," 14 August 2024, who.int
• Save the Children, "Newborn babies catching deadly mpox in DRC's overcrowded hospitals as cases skyrocket," August 2024
• Science Media Centre, Expert reaction to Africa CDC announcing mpox PHECS, 13 August 2024