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Scientists react to the WHO declaring Mpox a Public Health Emergency of International Concern.
Dr Brian Ferguson, Associate Professor of Immunology, University of Cambridge, said:
“The WHO has declared a PHEIC due to the continued spread of monkeypox virus in multiple African countries. The DRC has reported a large increase in cases of Mpox, nearly 8000 in 2024 alone. Cases have also now been found in countries that have not reported Mpox previously; Burundi, Kenya, Rwanda and Uganda. It is thought that the majority of these cases are of caused by clade 1b monkeypox virus, which is more virulent than the clade 2 virus that caused the global outbreak in 2022. These three factors are the main drivers behind the WHO’s decision to declare a PHEIC. This is timely and sensible as co-ordinated, multinational efforts are required to stop the further spread of the virus and to stop history repeating only two years later.
“The situation is concerning because of the spread of the clade 1b virus, which is considered to cause more severe disease, and because there are many children being infected in DRC during this new outbreak. 40% of cases are in children under 5 years old. As mpox disease is more severe in immunocompromised individuals, it is also a concern that the current outbreak is taking place in a region where HIV prevalence is relatively high but access to antiretroviral drugs is poor. There is further concern about the lack of access to vaccines and a globally slow response to vaccine production and distribution. Even though there are existing effective vaccines, there are not enough doses and they are not being getting to where they are needed. The WHO is attempting to address these issues, but this requires greater international effort to produce and deliver vaccines. Equally urgent is the need for increased surveillance, including molecular epidemiology, and better diagnostics to provide clearer information about the transmission and virulence, particularly of the clade 1b virus.”
Dr Jonas Albarnaz, a Research Fellow specialising in pox viruses at The Pirbright Institute, said:
“A concern is that clade 1 monkeypox virus is associated with a more severe disease and higher mortality rates than the clade 2 virus responsible for the international mpox outbreak in 2022. An outbreak of clade 1 virus is ongoing in DRC since 2023, with thousands of cases suggesting that there’s sustained human-to-human transmission. A significant number of cases among children has been reported in this outbreak as well. Clade 1 monkeypox virus is known for causing more severe disease in young children, pregnant women, and immunocompromised people. The emergence of the new clade 1b variant changed this picture as cases have been reported outside DRC (Burundi, Kenya, Rwanda). Most of the clade 1b has been in young adults, and sexual networks seem to be driving its spread. However, there is no evidence that this variant transmits better or causes a more severe disease than clade 1a. This may change as we learn more about this new variant.
“There are multiple outbreaks happening at present:
“This coordinated effort to contain MPXV spread in Africa is welcome and may prevent what happened in 2022 from happening again. There was an ongoing clade 2 MPXV outbreak in Nigeria since 2017 with evidence of sustained human-to-human transmission, but this situation only caught global attention when it spread to Western countries and caused the international outbreak in 2022.
“Two main challenges remain:
Prof Jimmy Whitworth, Emeritus professor London School of Hygiene and Tropical Medicine, said:
“The current epidemic of Clade 1b mpox in eastern Democratic Republic of Congo and neighbouring countries is very concerning, and it is to be welcomed that Africa Centres for Disease Control (Africa CDC) and the World Health Organization have declared this to be a public health emergency. These declarations amount to a call for action, and should lead to the prompt mobilization of money and resources, and a co-ordinated international response to the epidemic. The epicentre of the epidemic in South Kivu is undergoing a protracted humanitarian crisis and getting the necessary facilities in place for surveillance, diagnostic testing, contact tracing and case management, is going to be very challenging. The amount of vaccine required has been estimated by Africa CDC to be 10 million doses. The cost and availability of vaccine is going to be a great challenge, but it is really important that, unlike in the COVID-19 pandemic, there is global solidarity, that the vaccine reaches the people who need it most and that it is not stockpiled by rich countries. This is a real challenge for the global health security community to demonstrate that they can work together for global public good and not for narrow national interests. Let us hope they take that opportunity, otherwise we risk this epidemic spreading across the African continent, and possibly beyond.”
Prof Trudie Lang, Professor of Global Health Research and Director of The Global Health Network, University of Oxford, said:
“The local health research teams working to tackle mpox in Africa will be pleased with this important and timely decision from WHO.
“There are currently two variants of mpox circulating in Africa. Clade 1 and Clade 1b. Clade 1b has recently emerged and there are many unknowns that need to be addressed.
“Teams are working rapidly, in highly challenging settings in partnership with international organisations to gather this vital data. There is emerging evidence of differences in transmission and symptoms; such as more commonly passed person to person and from mothers to their babies in pregnancy. It can be a very dangerous infection and there have been deaths, but to understand the mortality rate we need to understand better the number who are infected overall, including those with milder disease and how infected they are? We need to also understand better the relationship between transmission route and severity of disease. This disease impacts highly vulnerable communities and there is already much stigma associated with this. Therefore, we need to understand people’s perceptions and practices to enable effective public health interventions and messages to encourage treatment seeking and guide safer practices to reduce risk of infection.
“Indeed, the most important reason this decision will be welcomed and supported is because the most immediate and vital requirement is community level education and awareness so those most vulnerable can be guided to reduce their risk and supported to seek treatment.
“Vaccines are imperative and the existing, as well as those in development, and need to be tested in the regions where Clade 1b is escalating to assess if they work in this variant and to get traction in preventing further spread to further new regions both in Africa and globally.”
Dr Boghuma Titanji Assistant Professor of Medicine, Department of Medicine at Emory University, said:
“A Public Health Emergency of International Concern (PHEIC) is a critical designation by the WHO, marking an ‘extraordinary event’ that poses a substantial threat to global health through the spread of disease across borders. This designation is reserved for situations that are ‘serious, sudden, unusual, or unexpected,’ with far-reaching public health implications beyond the affected nation. Declaring a PHEIC signals the urgent need for a coordinated international response and immediate global action.
“The WHO’s recognition of the current mpox outbreak as a PHEIC, in tandem with Africa-CDC’s declaration of a continental emergency, underscores the gravity of the crisis. This pivotal step highlights the critical funding gaps that must be addressed to ensure that the declaration leads to the necessary resources for controlling and ultimately ending the outbreak.
“This decision is a stark reminder to the global community of the vital importance of early intervention when infectious diseases are still geographically contained. However, previous PHEIC declarations have exposed the shortcomings of the current framework in managing crises that demand a sustained, multi-tiered response. While a PHEIC is instrumental in mobilizing international coordination, securing funding, and expediting the development of vaccines, treatments, and diagnostics, these efforts must be matched by continuous support. In the case of mpox, it is crucial that this translates into resources for testing and surveillance, vaccines and therapeutics, as well as much-needed funding for research to understand the dynamics of this outbreak.
“The essence of a PHEIC declaration is to catalyze prompt, evidence-based actions that mitigate the impact on public health and society, while avoiding unnecessary disruptions to travel, trade, or the marginalization of affected communities. To succeed, the global health community must view this declaration not just as an urgent call to action but as a commitment to a sustained, coordinated effort that can prevent the ongoing mpox outbreak—and future threats—from escalating into full-scale global emergencies.”
Dr Josie Golding, Head of Epidemics & Epidemiology in Wellcome’s Infectious Disease team, said:
“Epidemics pose a threat to health and health equity globally. Mpox has affected West and Central African communities for decades, only gaining global attention during the 2022 outbreak in Europe and North America. The current surge of cases in Africa demonstrates the ongoing and growing threat of Mpox. The WHO declaration of a PHEIC and Africa CDC announcement on Tuesday are a strong signal for those across the continent and worldwide to join forces and coordinate efforts to control this virus. We should not wait for diseases to escalate and cross borders before acting. Effective outbreak control requires sustained, coordinated efforts worldwide – from local and national governments, and public and private industry to funders, regulators and NGOs.”
Declared interests
Dr Brian Ferguson: No declarations of interest
Dr Jonas Albarnaz: I was part of the UKRI Mpox Research Consortium (led by Geoff Smith and Bryan Charleston), but this funding has ended.
Prof Jimmy Whitworth: No interests to declare.
Prof Trudie Lang: No conflict of interest
No others received