A call for global solidarity and rapid action to control mpox

WHO's declaration of mpox as a Public Health Emergency of International Concern (PHEIC) on Aug 14, 2024 highlights a disturbing pattern of repeated failures in the global response to epidemic-prone pathogens.1 This declaration marks the second PHEIC for mpox since 2022, underscoring ongoing vaccine inequities and substantial gaps in our understanding of mpox epidemiology, transmission, pathogenesis, and control strategies. Of note, between September, 2023, and January, 2024, the Mpox Research Consortium documented an outbreak of 241 suspected clade I mpox cases in Kamituga, a gold-mining town in eastern DR Congo.4 Of the 108 PCR-confirmed mpox-positive cases, the median age of individuals was 22 years, 51·9% were women, and 29% were sex workers, suggesting a role for sexual transmission.4 Genomic analyses identified APOBEC3-type mutations, indicating human-to-human transmission, with this new variant designated clade Ib.4 The spread of clade I cases from DR Congo to Uganda, Rwanda, Kenya, Burundi, and even Sweden in the past few weeks highlights the growing global threat. WHO has neither approved the MVA-BN vaccine for mpox—citing insufficient efficacy data despite its proven effectiveness during the 2022 clade II outbreak—nor issued an emergency use licence, which requires a PHEIC declaration.6 These approvals are essential for UNICEF and Gavi, the Vaccine Alliance, to purchase and distribute mpox vaccines.6 Additionally, preliminary results from the PALM007 trial in DR Congo funded by the National Institutes of Health and National Institute of Allergy and Infectious Diseases indicated that the antiviral drug tecovirimat did not to meet its primary efficacy endpoint, underscoring the urgent need for new drug trials to guide treatment strategies.7 In conclusion, WHO's PHEIC declaration must catalyse a renewed global effort to control mpox.