Mpox in Africa: funding cuts and delayed global actions fuelling new epicentres

Abstract

Mpox in Africa: funding cuts and delayed global actions fuelling new epicentresNearly 1 year after the Africa Centres for Disease Control and Prevention (CDC) issued its first-ever Public Health Emergency of Continental Security declaration, the mpox outbreak continues to intensify across the continent.On Aug 13, 2024, the Africa CDC declared this continental emergency.The next day, WHO declared a Public Health Emergency of International Concern, following a 160% increase in cases and a 19% rise in deaths compared with the same period in 2023, with 21 466 cases and 591 deaths reported from 13 African Union member states. 1,2 As of June 2025, 24 African countries have reported active mpox transmission. 3 Countries previously unaffected-including Malawi, Zambia, South Sudan, and Tanzania-are now reporting sustained local outbreaks.This geographical expansion is fueled by clade 1b-a more transmissible strain linked with community transmission-combined with porous, unregulated border crossings and weak surveillance infrastructure. 4In Sierra Leone and Uganda, confirmed weekly case counts now exceed 600 and 200, respectively. 3 The Democratic Republic of the Congo remains the epicentre, accounting for more than 80% of all confirmed cases. 5his resurgence has been exacerbated by a collapse in global health funding.On Jan 20, 2025, the US Government suspended all USAID-funded global health programmes, including outbreak response.The impact was immediate: Malawi lost more than US $350 million-13% of its national budget-disrupting HIV services, maternal health delivery, and surveillance systems. 6Uganda experienced a $160 million shortfall, resulting in more than 2000 health worker layoffs, 7 while South Africa's HIV response now faces projections of 500 000 preventable deaths over the next decade. 8accine access remains fragmented.Africa CDC estimates that at least 6 million doses of mpox vaccine were expected for a continent-wide response, yet fewer than 13 million have arrived. 9Out of 24 affected countries, only nine have received the vaccine.The Democratic Republic of the Congo received 754 000 doses; out of the required 3 million doses, Nigeria received 10 000.Rwanda, Burundi, Uganda,