A new report from The Independent Panel for Pandemic
Preparedness and Response traces how mpox, once a sporadic
disease in West and Central Africa mainly caused by contact
with infected animals, is now causing outbreaks in dozens of
countries around the world and counts humans as a
reservoir.
The Independent Panel’s latest report –
Hiding in Plain Sight: Mpox and the Cost of Neglecting Known
Threats – finds that the long-term neglect of mpox
contributed to two preventable global health emergencies and
made the disease a widespread public health risk.
The
report also shows how new variants of the monkeypox virus
have emerged over a relatively short period of time, adding
risks to people and burdens on already stretched health
systems.
“We must stop ignoring sporadic diseases
with epidemic potential,” said the Right Honourable Helen
Clark, Co-Chair of The Independent Panel.
“Mpox was
neglected at our peril. Preventable health emergencies are a
sign of failure. They happen when community health care is
neglected, signals are missed, and pathogens are allowed to
spread beyond their original habitats. These gaps leave us
all vulnerable.”
Mpox is nowhere near as dangerous
as smallpox, caused by the related variola virus, but it
causes painful lesions that last weeks, may require
hospitalisation, is more dangerous for people with advanced
or untreated HIV, and has caused foetal and child
deaths.
“There were earlier opportunities to control
mpox, which was primarily a zoonotic illness in endemic
countries in West and Central Africa,” said the report’s
lead author, Dr Els Torreele.
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“With 145 countries
reporting mpox in the last four years and many outbreaks of
sustained human-to-human transmission, the opportunity to
stop it locally was missed. We are all paying a price with a
disease that now counts humans as a reservoir.”
The
right tools were not in the right place at the right
time
The report documents that prior to 2022,
smallpox vaccines and treatments with potential against mpox
existed because of health security investments and
biodefence research. However, these were first used widely
to support mpox control during the 2022 global emergency,
when high-income countries were also affected. This was an
opportunity to document the vaccine’s efficacy against
mpox, but it was still not made available in the original
endemic regions – particularly in the Democratic Republic
of the Congo, which had been reporting around 2,000
suspected cases each year.
Vaccines against mpox were
deployed on the African continent only after the emergence
of a new viral subtype, a cross-border surge and the
declaration of a second public health emergency of
international concern in August 2024. When finally
available, vaccines were provided to several countries
experiencing outbreaks in a staggered manner. Ultimately, it
is unclear how much impact they had on the 2024–2025 mpox
outbreaks. An mpox vaccine stockpile was announced only in
August 2026.
Further, tools like rapid diagnostic
tests and therapies were not available where they were most
needed. Only about one-third of suspected cases in the
Democratic Republic of the Congo could be confirmed with
testing
“Many of the lessons of mpox are similar to
those from the COVID-19 experience,” said Dr Joanne Liu, a
member of The Independent Panel.
“Tools like
vaccines were not prioritised for the people who needed them
most. And the one tool that would have made the biggest
difference – an affordable, rapid diagnostic test that
could be used in communities – still does not
exist.”
Lessons must be applied and not only
learned
Lessons from mpox are being relearned in
2026, Independent Panel Co-Chairs Helen Clark and Ellen
Johnson Sirleaf write in the report’s
foreword.
“The Ebola Bundibugyo virus has caused two
prior outbreaks in this century. Yet it too surprised the
world in 2026, and communities affected were stranded with
no near point-of-care tests, no vaccines, no treatments, and
eroded trust in government and institutions.
A world
that cannot manage known diseases will not be ready for
Disease X, the next pandemic threat.”
Mpox is now
global
The consequences are still unfolding. In 2026,
82 countries have confirmed more than 14,000 cases.
Madagascar, which had never previously recorded an mpox
case, now faces the world’s largest outbreak of 2026 with
more than 3,400 cases and 22 deaths as of mid-August. In the
EU/EEA in the last 12 months, almost 3,800 confirmed mpox
cases were reported, and among people with known travel
history, most had not travelled, indicating local
transmission. People continue to be affected in the
Democratic Republic of the Congo, where health workers must
manage multiple health challenges, including
Ebola.
Focus on community systems to avoid
emergencies
“Instead of parachuting in emergency
funds for community engagement, leaving behind posters that
fade on clinic walls, communities must be supported through
sustained investment that builds lasting resilience.” said
Dr Torreele.
“A response should not only be
evaluated through numbers of cases, countries affected, or
doses of vaccines deployed, but also by how it leaves
communities at risk better prepared and able to stay
healthy.”
The report is the result of a review of
literature and in-depth conversations with people directly
involved in the two mpox emergencies and in ongoing mpox
research. The lessons explained in the report are considered
in the context of the main recommendations of The
Independent Panel to address gaps in pandemic prevention,
preparedness, and response as set out in its 2021 report,
COVID-19: Make it the Last
Pandemic.
