Two years ago, mpox was one of the most urgent stories in global health. A new and more dangerous form of the virus was spreading rapidly in central Africa, prompting both the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC) to declare emergencies. In 2026, the situation has improved significantly, but health officials warn that the disease is far from finished [1].
What mpox is
Mpox, formerly known as monkeypox, is a viral disease related to smallpox. It causes fever and a painful rash and can be severe, particularly for young children, pregnant people and those with weakened immune systems. It spreads mainly through close physical contact, including sexual contact, and through contact with contaminated materials. There are two main families, or "clades," of the virus. Clade II drove the global outbreak of 2022, which affected many countries outside Africa. Clade I, historically found in central Africa, has generally caused more severe illness, and a newer subtype called clade Ib began spreading rapidly in the Democratic Republic of the Congo (DRC) in 2023 and 2024.
The emergency ends, the outbreaks continue
In January 2026, Africa CDC ended its declaration of mpox as a Public Health Emergency of Continental Security, saying the response was shifting toward long-term control and elimination [1]. The decline was substantial: between early and late 2025, suspected cases fell 40%, confirmed cases fell 60% and the suspected case fatality ratio dropped from 2.6% to 0.6% [1]. WHO now classifies the multi-country outbreak as a "graded health emergency," a lower level of alarm, and has extended its standing recommendations on mpox to August 2027 [1]. But mpox remains active. Between July 6 and August 16, 2026, 11 African countries recorded active transmission, with 1,153 confirmed cases and seven deaths [1]. WHO described weekly confirmed cases in Africa as "somewhat stable" at around 200 per week, while warning that the true numbers may be higher because of reporting delays and reduced surveillance [1]. Since January 2025, 35 African countries have been affected, with 52,424 confirmed cases and 238 deaths reported through mid-August 2026. Globally, 105 countries reported 65,784 confirmed cases and 264 deaths from January 2025 through July 2026 [1].
Madagascar: the largest outbreak
The biggest current hotspot is not in central Africa but in Madagascar, the island nation off Africa's southeast coast. WHO describes Madagascar's outbreak as the largest mpox outbreak in the world and in the African region since December 2025 [1]. As of August 16, 2026, the country had reported 3,436 confirmed cases and 22 deaths [1]. In the six weeks ending August 16, Madagascar accounted for 785 of the 1,153 confirmed cases recorded across Africa, followed by Angola, Kenya, the DRC and Cameroon [1]. Its outbreak is notable because Madagascar had not been one of the traditional centers of mpox, which shows how the virus can establish itself in new places. Madagascar faces challenges common to many outbreaks: limited testing capacity, health systems with few resources and the difficulty of reaching rural communities.
Clade Ib in Europe
The more severe clade Ib has also traveled beyond Africa. WHO's September 2026 situation report noted that Chile and Hungary reported clade Ib cases for the first time, and that community transmission of clade Ib, meaning spread among people with no travel link to an affected area, has been reported in Czechia, France, Germany, Ireland, Italy, the Netherlands, Portugal, Switzerland and the United Kingdom [1]. Spain has reported the most clade Ib cases in Europe, with 241, followed by France with 173, Portugal with 162 and Germany with 140 [1]. Local spread in wealthy countries is a notable shift. Earlier clade Ib cases outside Africa were mostly linked to travel [2]. Community transmission suggests the virus is now circulating within some networks, although case numbers remain relatively small and deaths outside Africa are rare.
Vaccines and the response
Vaccines exist for mpox, and WHO says vaccination will remain central to the response in places where the virus is endemic [1]. During the emergency, donors and manufacturers shipped millions of vaccine doses to African countries, but supplies were long limited relative to need, and distribution in conflict-affected areas of the DRC was difficult. Funding pressures complicate the next phase. Global health aid has been cut sharply since 2025, including by the United States, and WHO has cautioned that reduced surveillance means reported cases may be undercounts [1]. Moving from emergency response to long-term control requires sustained investment in testing, vaccination and community outreach, the kind of work that is often hardest to fund once headlines fade.
How countries respond
Controlling mpox relies on familiar public health tools: testing suspected cases, isolating people who are infected, tracing their contacts and vaccinating people at highest risk, such as close contacts and health workers. In endemic areas, health officials also focus on community education, because stigma can discourage people from seeking care. WHO's extension of its standing recommendations through August 2027 signals that the agency expects countries to keep these measures in place for the foreseeable future [1].
Lessons from the emergency
The 2024 emergency exposed gaps that public health experts say must not be repeated. Testing in many affected areas was limited, so cases often went unconfirmed. Vaccines arrived months after the emergency was declared, partly because of regulatory and supply hurdles. And conflict in eastern DRC made it difficult to reach displaced communities. The decline in cases since then shows that the response eventually worked, but experts note that it took sustained international money and attention to get there.
Why it matters
The mpox story illustrates a common pattern in global health: emergencies mobilize attention and money, but diseases often linger after the emergency ends. Africa's progress in reducing cases and deaths is real. Yet outbreaks in new places such as Madagascar, and community spread of a more severe strain in Europe, show how quickly the virus can find new footholds. Health officials say the goal now is elimination in endemic areas, a goal that will depend on whether countries and donors keep investing after the crisis label is removed.
Sources
- 1. "Africa: 11 African Countries Record 1,153 Mpox Cases in Six Weeks," AllAfrica, September 15, 2026 (reporting on WHO Multi-country outbreak of mpox, External situation report, September 14, 2026). https://allafrica.com/stories/202609160093.html
- 2. "WHO confirms first case of new mpox strain outside Africa as outbreak spreads," The Sun (Malaysia),
- 2024. https://thesun.my/world/who-confirms-first-case-of-new-mpox-strain-outside-africa-as-outbreak-sprea ds-AN12867601 Information in this article is current as of October 10, 2026. Bracketed numbers refer to the sources listed above.