Totally Fine Foundation · Issue 012 · Outbreak / Health-system magazine

Mpox: The Emergency After the Emergency

Last reviewed · Totally Fine Foundation editorial desk · 9 min

WHO closed the global alarm in September 2025. The virus answered by changing address — into households, into children, and onto an island now carrying the largest clade Ib outbreak on earth.

Metrics

The emergency was called off. The outbreak was not.

The emergency that was declared over

WHO ended the mpox public health emergency of international concern on 5 September 2025 — thirteen months after it had declared one over a new strain spreading out of eastern Congo. The wording of the all-clear is narrower than the headlines that carried it. The same decision kept mpox a graded emergency, kept the Director-General's standing recommendations in force until 20 August 2026, and sat on a plain admission: more than a thousand confirmed cases still surface every month.

Africa CDC, which had declared its own continental emergency a day before WHO in August 2024, held that emergency open four months longer, until 22 January 2026. Two institutions, two clocks, one outbreak that nobody was calling finished.

Sources: WHO — Mpox PHEIC / IHR Emergency Committee status; Africa CDC — Continental response and PHECS transition

Where the numbers actually live

By WHO's June 2026 ledger, 61,061 confirmed cases and 244 deaths had been recorded since the start of 2025 across 103 countries. The monthly line is falling — 1,142 cases in May 2026 — and WHO says plainly why that should not be read as recovery: the decline tracks declining surveillance as much as receding disease.

The clearest example sits inside the same report. The Democratic Republic of the Congo, the historical centre of this outbreak, reported only eight cases in the last six-week window — not because the disease left, but because the country's testing was diverted to a separate Bundibugyo virus outbreak. Read every count here as a floor, not a ceiling.

Sources: WHO — Multi-country mpox External Situation Report no. 67

The outbreak changed its address

Clade Ib was first identified in September 2023 in Kamituga, a remote South Kivu mining town, where it spread mainly through adult sexual networks. That is the version most readers met in 2024. It is no longer the whole picture. A peer-reviewed cohort downhill in Uvira found the same virus moving overwhelmingly through households — 67.9 percent of exposures — with sexual contact behind just 6.0 percent, and a median patient nine years old.

In DRC as a whole, UNICEF recorded children under fifteen as roughly 60 percent of suspected cases and 80 percent of deaths. The disease did not soften as it travelled; it found a younger, more domestic route, which is exactly why the response now turns on paediatric vaccines and household measures the early framing never planned for.

Sources: Eurosurveillance — Clade Ib transmission in Uvira (Bugeme et al.); UNICEF / WHO — UNICEF DR Congo mpox response (with WHO on the conflict nexus)

The island that became the epicentre

Since December 2025, Madagascar has carried the largest mpox outbreak of clade Ib in the world. WHO's count to 14 June 2026 was 2,117 confirmed cases and seven deaths, with test positivity in the latest week at 65 percent — a figure WHO reads as ongoing transmission and inadequate surveillance — and the blunt assessment that the outbreak is not yet under control.

Vaccination has been scaled up: 79,125 people had received a first dose of MVA-BN, though stockouts and cold-chain failures keep undercutting it. The African region as a whole still carried 63.9 percent of May's global cases. The map moved; the weight did not lift.

Sources: WHO — Multi-country mpox External Situation Report no. 67

The ledger of doses

The vaccine story is a logistics ledger with a gap built into it. Gavi facilitated 1,215,460 donated doses and funded another 500,000 directly; deliveries reached DRC, Uganda, Sierra Leone, Kenya and others. Set against Africa CDC's estimate — relayed by Oxfam — that roughly ten million doses are needed to control the outbreak, early-2025 deliveries of about one million were a tenth of the need; the figure has since passed three million, still short.

Below the delivery line runs a quieter one: a little over 650,000 doses actually administered by April 2025. Price is a named bottleneck — MVA-BN is among the most expensive vaccines UNICEF distributes, at up to $65 a dose. Japan's three-million-dose donation arrived, and roughly a third was reportedly wasted in DRC for want of storage. In Europe, surveillance shows the same uptake gap from the other end: only about a fifth of confirmed cases had completed two doses.

Sources: Gavi / Oxfam — Vaccine access and equity (Gavi, Oxfam, WHO, Africa CDC); ECDC — Mpox worldwide overview and EU/EEA surveillance

How to read the risk

The honest register here is neither alarm nor relief. WHO and ECDC both rate clade Ib's risk as moderate for higher-exposure groups and low for the general population. Outside Africa, clade Ib has surfaced as travel-linked cases and confined network transmission — Norway's first case, local clusters in Spain and Thailand — not generalised spread.

That undercuts the imminent-global-pandemic framing without licensing the opposite error, the it is over framing that the lifted emergencies invited. The outbreak is smaller in the headlines and larger in the places least able to measure it. That tension is the dossier.

Sources: ECDC — Mpox worldwide overview and EU/EEA surveillance; US CDC — Mpox situation summary and clinical overview

Claims and evidence

The mpox emergency is over.

Claimant: Headline reading of the lifted emergencies

Evidence status: disputed

Counterclaim: Both WHO and Africa CDC framed the change as de-escalation; WHO keeps mpox a graded emergency with standing recommendations to 20 August 2026.

Independent assessment: False as stated. The emergencies were lowered, not the outbreak; Madagascar's outbreak began after the PHEIC ended, and over a thousand cases still surface monthly.

Sources: WHO — Multi-country mpox External Situation Report no. 67; WHO — Mpox PHEIC / IHR Emergency Committee status

Clade Ib is an imminent global pandemic.

Claimant: Alarm-driven framing

Evidence status: disputed

Counterclaim: WHO and ECDC rate the risk moderate for higher-exposure groups and low for the general population; spread outside Africa is travel-linked or network-confined, not generalised.

Independent assessment: Overstated. The risk tiers and the travel-linked pattern outside Africa do not support an imminent global pandemic — while equally not supporting the opposite 'it is over' claim.

Sources: ECDC — Mpox worldwide overview and EU/EEA surveillance

Vaccines alone will end the outbreak.

Claimant: Vaccine-centred optimism

Evidence status: disputed

Counterclaim: WHO stresses surveillance, rapid containment, stigma reduction and reaching the most-affected; large outbreaks emerged after major DRC deliveries.

Independent assessment: False as stated. Vaccines are necessary but not sufficient: administered doses lag deliveries, and Madagascar's outbreak grew after significant regional vaccine roll-out.

Sources: Gavi / Oxfam — Vaccine access and equity (Gavi, Oxfam, WHO, Africa CDC)

Timeline

  1. — WHO declares mpox PHEIC — Clade Ib spreading beyond DRC

    WHO Director-General declared mpox a Public Health Emergency of International Concern (PHEIC) for the second time, citing the rapid spread of the new Clade Ib variant from eastern DRC to neighboring countries including Burundi, Rwanda, Uganda, and Kenya.

    Sources: WHO — WHO Mpox Outbreak — Disease Outbreak News

  2. — First Clade Ib case confirmed in Sweden — intercontinental spread

    Sweden confirmed the first Clade Ib mpox case outside Africa, in a traveler returning from an affected country. WHO urged enhanced surveillance at points of entry globally.

    Sources: ECDC — Mpox Surveillance — ECDC; WHO — WHO Mpox Outbreak — Disease Outbreak News

  3. — Vaccine deliveries resume to East Africa after supply gap

    WHO and GAVI confirmed resumption of Bavarian Nordic and LC16m8 vaccine shipments to DRC, Burundi, Uganda, and Rwanda after a 6-week supply gap. Total doses committed: 3.5 million for 2026.

    Sources: WHO — WHO Mpox Outbreak — Disease Outbreak News; ReliefWeb — Mpox Response in DRC — ReliefWeb

Open questions

  • Has the outbreak ended now that the emergency declarations have been lifted?
  • How far will the outbreak in Madagascar, now the epicentre, spread?
  • How many of the vaccine doses needed have been funded, delivered and administered?
  • Can vaccines alone end the outbreak?
  • How is the war in eastern Congo affecting outbreak control, after WHO documented that 128 of 143 mpox patients fled Goma's isolation units as fighting closed in?

Source registry

  1. WHO — Multi-country mpox External Situation Report no. 67; humanitarian; 2026-06-26
  2. WHO — Mpox PHEIC / IHR Emergency Committee status; official_position; 2025-10-30
  3. ECDC — Mpox worldwide overview and EU/EEA surveillance; official_position; 2026-06-26
  4. UNICEF / WHO — UNICEF DR Congo mpox response (with WHO on the conflict nexus); humanitarian; 2025-02-07
  5. Gavi / Oxfam — Vaccine access and equity (Gavi, Oxfam, WHO, Africa CDC); humanitarian; 2025-05-01
  6. Eurosurveillance — Clade Ib transmission in Uvira (Bugeme et al.); research; 2025-12-18
  7. US CDC — Mpox situation summary and clinical overview; official_position; 2026-06-01
  8. Africa CDC — Continental response and PHECS transition; official_position; 2026-01-22

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