Once considered a rare tropical disease confined to remote parts of Central and West Africa, mpox formerly known as monkeypox emerged in 2022 as a global health emergency that exposed deep vulnerabilities in pandemic preparedness infrastructure worldwide. Unlike the Ebola crisis of 2014–2016, which spread through direct contact with bodily fluids and was largely contained geographically, mpox demonstrated that a disease with moderate transmissibility could rapidly slip through the cracks of international public health systems and spread silently across dozens of countries. Understanding how this happened, and what the global response reveals about the future of infectious disease control, is critical.
Background: What is Mpox?
Mpox is a viral zoonotic disease caused by the monkeypox virus, a member of the Orthopoxvirus genus in the same family as smallpox. The disease was first identified in 1958 in laboratory monkeys used for research, and the first human case was recorded in 1970 in the Democratic Republic of the Congo (DRC). For decades, it was considered a relatively obscure illness that primarily affected individuals in forested regions of Central and West Africa who had contact with infected animals such as rodents and primates.
The disease typically presents with flu-like symptoms fever, fatigue, muscle pain followed by a distinctive rash that progresses into raised, fluid-filled lesions across the body. While the case fatality rate for the West African clade has historically hovered around 1% in countries with access to modern healthcare, the Central African clade, known as Clade I, carries a significantly higher mortality rate of up to 10%, disproportionately affecting children and immunocompromised individuals.
Mpox spreads primarily through prolonged skin-to-skin contact with an infected individual, contact with contaminated surfaces, or respiratory droplets during extended face-to-face interactions. Unlike airborne diseases, its transmission requires relatively close, sustained contact, a characteristic that initially led health officials to believe containment would be manageable.
The 2022 Outbreak: A Disease That Surprised the World
In May 2022, clusters of mpox cases began appearing in countries where the virus had never been detected: the United Kingdom, Spain, Portugal, Canada, and the United States, among others. By the time the World Health Organization (WHO) declared mpox a Public Health Emergency of International Concern (PHEIC) in July 2022, over 16,000 cases had been reported in more than 75 countries.
What made the 2022 outbreak unusual was not just its geographic spread, but its pattern of transmission. The outbreak was driven primarily by close physical contact within certain social networks, particularly among men who have sex with men (MSM), and spread through sexual activity in ways that had not been previously documented at this scale. This created a significant challenge for public health communication: how to convey targeted risk information without stigmatizing specific communities, a lesson painfully familiar from the early years of the HIV/AIDS epidemic.
By August 2022, the United States had become the country with the highest number of reported cases globally, with over 20,000 confirmed infections. The response was hampered by delays in vaccine deployment, insufficient testing capacity, and messaging that many community advocates described as unclear and slow to reach the populations most at risk.
Clade I Returns: The 2024 African Resurgence
Just as the global 2022 outbreak appeared to be winding down, a more alarming development emerged from the DRC. In 2024, a new variant of Clade I mpox designated Clade Ib began spreading rapidly in the eastern DRC and neighboring countries including Burundi, Kenya, Rwanda, and Uganda. Unlike the 2022 outbreak, this strain was transmitting more efficiently through sexual contact and household exposure, and was killing at significantly higher rates.
By August 2024, the WHO once again declared mpox a PHEIC, marking only the second time in history that the same disease had received that designation twice. The Africa Centers for Disease Control and Prevention (Africa CDC) simultaneously declared a continental public health emergency, the first such declaration in its history.
The contrast with the 2022 global response was stark. While wealthier nations had managed to vaccinate significant proportions of their high-risk populations with the two-dose Jynneos vaccine, African nations had received almost none. Of the approximately 200,000 vaccine doses that had been pledged to Africa by mid-2024, less than half had actually been delivered. This disparity echoed the painful inequities witnessed during the COVID-19 pandemic, when wealthy nations secured billions of doses while low-income countries waited months or years for access.
Vaccine Equity and the Structural Problem
The mpox crisis laid bare a structural failure in global health preparedness: the persistent gap between disease surveillance in wealthy nations and the capacity to respond in the countries where outbreaks originate. The DRC, despite being the epicenter of mpox for over five decades, had no domestic vaccine manufacturing capacity and remained dependent on international donations that arrived too slowly and in insufficient quantities.
Efforts to bridge this gap have accelerated since 2024. The African Union has pushed for expanded manufacturing partnerships under the "Africa CDC's New Public Health Order," and the WHO has worked to facilitate technology transfers that would allow African nations to produce vaccines domestically. However, these initiatives take years to bear fruit, and in the meantime, communities in eastern DRC continue to face one of the most dangerous mpox strains ever recorded.
Dr. Ngashi Ngongo, the Africa CDC Incident Manager for mpox, emphasized in a 2024 briefing that the crisis required not just donations but sustained systemic investment: "We cannot continue to respond to each new outbreak by going back to the same donors with the same requests. We need manufacturing, we need infrastructure, and we need the political will to build it now — not after the next emergency."
Parallels with Past Outbreaks and the Lessons of History
The mpox crisis shares important characteristics with each of the outbreaks explored in previous Young Press investigations. Like the Ebola epidemic of 2014–2016, mpox demonstrated that a disease long dismissed as a regional problem in Africa could rapidly become a global concern when the right conditions aligned. Like the 1918 influenza pandemic, it revealed that the biology of a pathogen — particularly its mode of transmission — does not determine its global impact alone; social, political, and economic factors shape the damage it causes just as powerfully.
And like the rising tide of antimicrobial resistance, mpox illustrates the danger of complacency. The virus had been present in human populations for over five decades, documented, studied, and repeatedly flagged by researchers as a potential pandemic threat. Yet when it finally spread beyond its traditional range, the world was underprepared — lacking sufficient vaccine stockpiles, testing infrastructure, and a coherent global communications strategy.
The lesson, repeated across Ebola, the Spanish Flu, antibiotic resistance, and now mpox, is consistent: public health crises do not appear without warning. They emerge from environments we have built, from inequities we have allowed to persist, and from warnings we have chosen to defer. The only question is whether humanity will choose to act before the next emergency, or respond reactively once again.
Sources
https://www.who.int/news-room/fact-sheets/detail/mpox
https://www.cdc.gov/poxvirus/mpox/index.html
https://africacdc.org/news-item/africa-cdc-declares-mpox-a-public-health-emergency-of-continental-security/
https://www.nejm.org/doi/full/10.1056/NEJMoa2207323
https://pmc.ncbi.nlm.nih.gov/articles/PMC9380325/
© The Young Press
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