Since September 2023, Central Africa has recorded more than 29,000 cases of mpox, with the death toll surpassing 800. The fatality ratio sits at roughly three percent, and almost every fatal case has occurred in the Democratic Republic of the Congo (DRC).
In response, the World Health Organization (WHO) declared on 14 August 2024 that the outbreak constitutes a public health emergency of international concern (PHEIC), a designation reserved for events that pose a cross‑border threat and require coordinated global action. The current wave differs markedly from the 2022 global mpox episode, which was driven by clade II and resulted in far fewer deaths. Health officials now attribute the surge to a newly identified variant, clade 1b, which evolved from clade I and was first detected in Central Africa.
This strain spreads more rapidly, sustains human‑to‑human transmission more effectively, and carries a higher mortality risk. By September 2024, official counts had topped 29,000 infections, but the European Centre for Disease Prevention and Control (ECDC) cautions that the real figure is likely higher.
Weak health infrastructure, limited surveillance capacity and under‑reporting in the region contribute to substantial under‑ascertainment, meaning the outbreak’s true magnitude may exceed reported numbers. Why the DRC bears the brunt of the crisis is linked to local environmental and socio‑economic conditions that facilitate virus spread. Mpox is endemic in parts of Central Africa, circulating among animal reservoirs and sporadically spilling over to humans.
However, clade 1b has demonstrated an unprecedented ability to maintain transmission chains among people, altering the risk profile of the disease. The WHO’s emergency declaration is intended to unlock resources such as enhanced surveillance, contact‑tracing programs, vaccine distribution and access to diagnostic tools.
Yet the rollout faces obstacles. Vaccines that proved effective in wealthier nations during the 2022 outbreak are in short supply for the DRC, and logistical challenges hamper their delivery. Similar constraints affect the availability of rapid tests and therapeutic options.
Although the outbreak has remained largely confined to Central Africa, the PHEIC status underscores the potential for wider dissemination. The WHO’s statement signals that the international community must accelerate assistance to prevent further spread and reduce mortality, especially in a country where health services are fragile and access to care is limited.
This is not the first encounter with mpox for scientists; the virus has been known for decades. What is novel is the emergence of the clade 1b variant and the scale of the current epidemic. The WHO’s declaration aims to galvanize governments, donors and health agencies to act swiftly, but whether the response will match the urgency of the situation remains to be seen.
