Mpox made for scary headlines in 2022 and 2023: tens of thousands of cases worldwide, with 30,000 in the U.S. in just one year. There were reports of painful lesions and mammoth efforts to mobilize vaccines.
In 2025, it seems like just a memory. Only it's not.
"You see the agony the patient goes through. It's on another level," says Caroline Mugun, a nurse at an mpox isolation ward in Mombasa, Kenya.
Over the past year, the virus has spread rapidly across borders in Africa. Twenty-four African countries are in the midst of mpox outbreaks — up from 13 a year ago, according to the Africa Centres for Disease Control and Prevention (CDC). For many of these countries — from Gambia to Kenya, from Uganda to South Sudan — this is the first time they've ever seen cases of mpox.
Today — Aug. 14 — marks the one-year anniversary of the World Health Organization declaring mpox a Public Health Emergency of International Concern. This rare distinction indicates the highest level of alert. But critics say the global response has fallen dangerously short, 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"
Historically, mpox was associated with remote forested areas in west and central Africa. The virus was known for occasionally jumping from small wild animals to people, often children who hunted them. While it was initially called monkeypox because of lab cases in primates, the main carrier is thought to be other infected animals, like rodents. The name was changed in 2022.
When the WHO rang the alarm bells a year ago, mpox had a very different profile than in its early days.
A new strain of the virus — 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, 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. There have also been big outbreaks in Africa of the other mpox strain. By Africa CDC's count, there have been roughly 97,000 suspected mpox cases across the continent and nearly 600 deaths so far this year. However, mpox experts say, the numbers are likely a severe undercount.
"Your case counts are kind of like shadows on a wall — they're not telling you that very precise picture," explains Anne Rimoin, a professor of epidemiology at the UCLA Fielding School of Public Health and an mpox researcher. She says there are many reasons for this, including stigma associated with a sexually transmitted disease and a large portion of affected individuals living in remote areas where there's limited surveillance and diagnostic capacity. The result is that many mpox patients are likely not getting medical care and not getting recorded in the data.
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.
"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."
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. This is making Dr. Olivier le Polain, the unit head of Epidemiology and Analytics for Response at the WHO's Health Emergencies Programme, optimistic. "When all the information points toward the same types of trends, it gives us some confidence that the trend is genuine," he says.
"Three steps backwards"
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 backwards."
Titanji and others can tick off a whole range of reasons for why the virus remains uncontrolled. For starters, the epicenter of the epidemic — in the eastern Democratic Republic of Congo — is in the midst of a brutal conflict, with rebels in control of key cities and little medical care available. Another big issue: This outbreak has overlapped with a dramatic drop in global health aid both from the U.S. and from a number of European countries, such as France.
"Mpox can certainly serve as a textbook case study on how a global health crisis unfolds and evolves when you have biological risk colliding with political and economic forces," says Rimoin.
Vaccines
Many point to vaccines as the epitome of how the response has gone wrong.
Mpox is a vaccine-preventable disease, and yet, to date, only about 886,000 people have been vaccinated 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.
In Kenya, nurse Mugun — who works for Doctors Without Borders — says people want the mpox vaccine but the country has not yet launched an immunization program.
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?
Mpox researchers and doctors say the lackluster global response portends poorly for mpox's future potential as well as other disease threats.
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.
Rimoin 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."
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