Mpox is back: the WHO sounds the alarm again

On 14 August, the World Health Organization did the only thing it had left to do, and declared the mpox outbreak in central Africa a public health emergency of international concern, the second time in two years that the disease has earned the organisation’s highest alarm. The decision, announced by the director-general after the emergency committee could not reach a consensus, places the crisis squarely in the category that the world has grown skilled at declaring and slow at funding: an epidemic that is dangerous now, in the places where it is spreading, and certain to become more expensive if it is left alone.

The centre of the storm is the Democratic Republic of the Congo, where the disease has been endemic for decades and where the new outbreak is different from the one that circled the globe in 2022. The strain in question, clade 1b, is transmitted more readily through close contact, has appeared in countries that had never reported mpox before, and has struck the young hardest; in the DRC, more than half of the suspected cases have been in children under fifteen, a profile that the earlier outbreak, concentrated among adult men in Europe and North America, never had. The difference matters because it changes the response: this is no longer a disease of a particular network, manageable with vaccines aimed at a particular population, but an outbreak spreading through crowded households and clinics in a region where the vaccine supply is measured in the thousands and the need in the millions.

The global record on such alarms is not encouraging, and it is the reason the declaration deserves a certain scepticism, of the useful kind. The emergency that the WHO declared for mpox in July 2022 produced a wave of vaccines and attention that ended as soon as the outbreak in the rich countries subsided, leaving the disease to smoulder in the Congo where it had always smouldered, and the new emergency is, in large part, the bill for that attention span. The African Union’s health agency had asked for the declaration weeks earlier, and its plea for vaccines, tests and research funding has been answered, so far, with pledges rather than deliveries. The emergency status is a mechanism for drawing resources; the test of its sincerity is whether the resources actually arrive.

There are reasons for hope buried in the failure. The vaccines that were developed in a hurry in 2022 exist and can be shipped; the countries now affected have learned, from the last round, what surveillance and community outreach look like; and the WHO, scarred by its slow response to covid-19, is moving faster on paper than it ever has. What is missing is not knowledge but distribution, and distribution is a matter of money and political will rather than of science.

The declaration is therefore both overdue and insufficient, and the honest way to read it is as a promise that the world intends to do better this time. The promise has been made before, in the same language, and the difference between this emergency and the last will be measured in the weeks ahead, in vaccine doses crossing borders, in tests reaching clinics, and in whether the children of the Congo, who did nothing to create this outbreak and cannot be blamed for its neglect, are treated as part of the world that the WHO’s alarm is meant to protect. The alarm has sounded; the world has heard it. Hearing it has never been the hard part.