It has been 200 days since mpox was declared a public health emergency of international concern (PHEIC) and it remains a significant global health threat. Earlier this week, the emergency committees for Africa CDC and WHO stated that the situation still warrants both the public health emergency of continental security (PHECS) and PHEIC designations, respectively. This confirms the continued need for proactive intervention and coordinated response. While we have observed some encouraging actions, the broader picture presents persistent challenges requiring urgent attention.
As reported by Africa CDC, an overview of continental trends shows concerning developments, with average weekly reported cases increasing nearly fourfold from 909 in August 2024 to 3,264 in February 2025. Uganda and the Democratic Republic of the Congo (DRC) are experiencing significant case increases, while Sierra Leone and South Sudan are reporting newly established outbreaks, and South Africa shows a concerning resurgence in early 2025. Further complicating this picture is the concurrent emergence of the clade 1a APOBEC3 strain, which demonstrates particularly high transmissibility and raises significant public health concerns. This is against a challenging backdrop of evolving political instability in the DRC and funding freezes, potentially compromising current containment efforts and risking further spread throughout the region.
State of Medical Countermeasures
There has been modest progress on the state of diagnostics, therapeutics and vaccines in response to mpox between our last update on day 100, and now, a hundred days later. According to Pandemic Pact data, two more vaccine trials have initiated enrolment. We have also seen an increase in vaccine doses delivered from approximately 370,000 to 697,780. However, despite these advancements, clear gaps remain across all medical countermeasures.
Diagnostics
There remains a concerning absence of true point-of-care tests, which continues to hamper early detection and containment efforts in resource-limited settings where laboratory infrastructure is scarce. This is particularly problematic for remote communities where samples must travel long distances for testing, delaying crucial treatment and isolation measures. Africa CDC reports that this has led to testing coverage dropping to just 35% in the DRC due to ongoing conflict and funding cuts leading to logistical challenges. Encouragingly, 6 additional molecular tests are currently under WHO Emergency Use Listing review, including Ustar’s PortNAT®, which promises to deliver fast, accurate and instrument-free nucleic acid testing at the point of care – a potentially significant breakthrough if approved. Furthermore, as reported by Africa CDC, DRC plans for decentralised testing includes 56 district-level GeneXpert machines in hotspot zones, and 7 qPCR units across affected provinces.
Therapeutics
The therapeutic landscape for mpox has seen little progress since day 100, with a concerning shortage of viable treatments. As per Intrepid Alliance landscaping analyses (update to be published mid-March 2025), the number of preclinical candidates has dropped from 10 to 8, with only one potential candidate and 7 early leads. The only ongoing trials are for repurposed drugs, and no new trials have initiated enrolment in the last 100 days. Therapeutics are important for reducing the morbidity and mortality of an outbreak, therefore there is a need for sustained investment in therapeutics R&D for mpox.
Vaccines
It is encouraging to see an increase in vaccine dose delivery. However, significant challenges persist in the implementation of vaccination programmes. As reported by Africa CDC, to address this, the DRC has started a promising new vaccination strategy in Kinshasa, vaccinating 24,000 people within just four days of its initiation, with ambitious plans to reach 3.5 million. Vaccine supply will need to match this accelerated pace of administration. There also continues to be a lack of vaccine efficacy data related to vulnerable populations, particularly pregnant women and young children who face heightened risk of severe complications. It is therefore encouraging to see the PregInPoxVac trial (NCT06844487 & NCT06844500) scheduled to commence in the first quarter of 2025, which aims to assess the safety and immunogenicity of the MVA-BN vaccine in pregnant and breastfeeding women, and infants under two years of age.
Conclusion
As we enter the next phase of response, there are still gaps that must be urgently addressed through sustained investment, accelerated research, and enhanced coordination between global health agencies, governments, and affected communities. The recent cuts in overseas development assistance (ODA) could significantly hamper the response as observed already with disruptions of sample transportation and surveillance, further underscoring the need for a more diversified and sustainable funding ecosystem. The coming months will require continued vigilance and a renewed commitment to ensuring that the tools needed to combat mpox reach those who need them most.
Supporting Resources on Mpox Response
- Africa CDC Special Briefing on Mpox & other Health Emergencies, Feb. 27, 2025.
- New Outbreaks Page on the Pandemic PACT Programme Website includes a dedicated Mpox Outbreak Page which offer real-time tracking of research funding and regularly updated outbreak summary reports.
- WHO lists Abbott Molecular Inc.’s Alinity M MPXV assay under Emergency Use Listing
- WHO lists Roche Molecular System’s cobas MPXV qualitative assay under Emergency Use Listing
- WHO lists Cepheid’s Xpert Mpox molecular test under Emergency Use Listing
- WHO lists KM Biologic Co.’s LC16m8 vaccine under Emergency Use Listing
- WHO prequalifies Bavarian Nordic’s MVA-BN vaccine
- WHO grants prequalification for age-extension of Bavarian Nordic’s MVA-BN vaccine for use in adolescents (12-17 years)
- Africa CDC published Mpox Continental Preparedness and Response Plan for Africa
Previous IPPS updates on mpox:
- Day 100 update
- Day 75 update (major)
- Day 60 update (minor)
- Day 45 update (major)
- Day 30 update (minor)
- Day 15 update (major)
- Day 0 statement
For more information or to provide data updates or feedback, please contact info@ippsecretariat.org.