We do not know how to control this outbreak.
For the second time in three years, the World Health Organization has declared mpox a global health emergency — this time driven by a deadlier strain tearing through the Democratic Republic of Congo and spreading into African nations that had never before encountered the virus. Congo, already fractured by conflict and humanitarian crisis, carries nearly the entire weight of the toll: over fifteen thousand cases and more than five hundred deaths, with newborns and children among the most vulnerable. The world possesses vaccines but not enough of them, and the conditions on the ground — displacement camps, overcrowding, impossible isolation — have rendered the familiar tools of containment nearly useless. What unfolds next will test whether global health institutions can move with the urgency the moment demands.
- A new mpox strain is killing at three times the rate of the 2022 outbreak, with entire families — including newborns as young as two weeks old — arriving at treatment centers together.
- Congo accounts for 96% of African mpox deaths, yet the country remains mired in internal conflict and humanitarian collapse, making a coordinated response extraordinarily difficult.
- The virus has crossed into East Africa for the first time, appearing in Burundi, Kenya, Rwanda, and Uganda, signaling a geographic expansion that health authorities had not previously seen.
- Global vaccine supplies are critically insufficient, and Congo has approved two vaccines but launched no immunization campaign — leaving displacement camps near Goma with no meaningful protection.
- Doctors Without Borders advisers on the ground have said plainly: the world does not yet know how to control this outbreak, and the tools that worked in 2022 are not equal to this moment.
On a Wednesday in August, the World Health Organization raised an alarm it had not sounded in three years, declaring mpox a global health emergency for the second time. The virus was moving through more than a dozen African countries, and in the Democratic Republic of Congo, the numbers had grown devastating — 15,600 cases and 537 deaths, a toll already surpassing the entire 2022 outbreak before it had been brought under control.
Congo bore the crisis almost entirely alone. In June, 96% of all mpox deaths across Africa occurred within its borders — a country already torn by internal conflict and humanitarian emergency. But the disease was no longer confined there. For the first time, it had crossed into East Africa, reaching Burundi, Kenya, Rwanda, and Uganda. The current strain was proving far deadlier than its predecessor: where the 2022 outbreak killed roughly one in five hundred infected people, this version was killing three in every hundred. Young children, the immunocompromised, and people living with HIV faced the greatest risk.
In overcrowded displacement camps near Goma, isolation was impossible. Newborns as young as two weeks old were contracting the disease, and entire families arrived at treatment centers together — mothers, children, and infants all bearing the fever and blistering rash that defines the illness. Dr. Sylvie Jonckheere of Doctors Without Borders, who had worked recently in Congo and Burundi, described the heartbreak of watching complete families fill treatment wards, and delivered a sobering verdict on the global response: "We do not know how to control this outbreak."
Vaccines existed — Congo had approved two of them — but the world lacked sufficient doses to meaningfully slow transmission, and no immunization plan had been launched in Congo. From January through late July 2024, African health authorities recorded a 160% increase in cases compared to the same period the prior year. The outbreak had largely faded in Europe and the Americas; in Africa, it was accelerating. What came next would depend on whether the international community could mobilize faster than the virus was moving.
On Wednesday, the World Health Organization sounded an alarm that had not been raised in three years: mpox was spreading fast enough, and killing enough people, to warrant a second global health emergency declaration. The virus was moving through more than a dozen African countries with little sign of slowing, and in the Democratic Republic of Congo, the numbers had already grown grim. Fifteen thousand six hundred cases. Five hundred thirty-seven deaths. That toll had already surpassed what the 2022 outbreak had claimed before it was brought under control.
Congo bore the weight of this crisis almost entirely alone. In June, ninety-six percent of all mpox deaths reported across Africa occurred within its borders—a country already fractured by internal conflict and struggling through a humanitarian emergency. But the disease was no longer confined there. For the first time, it had crossed into East Africa, appearing in Burundi, Kenya, Rwanda, and Uganda alongside the Central and Western African nations where mpox had always circulated. The virus moves through close contact with infected people or animals, through contaminated meat, and through sexual transmission. It can pass from a pregnant woman to her unborn child.
The current strain ravaging Congo was proving far deadlier than its predecessor. Where the 2022 outbreak killed roughly one in five hundred infected people, this version was killing three in every hundred. Young children, the immunocompromised, and people living with HIV faced the steepest risk. In overcrowded displacement camps near Goma, where families were packed into tight quarters, isolation was impossible. Newborns as young as two weeks old were contracting the disease. Entire families arrived at treatment centers together—mothers, children, infants—all burning with fever, covered in the characteristic rash that would blister, pustulate, and eventually scab over the course of two to four weeks.
Dr. Sylvie Jonckheere, an infectious disease adviser for Doctors Without Borders who had recently worked in Congo and Burundi, described the scene with visible anguish: the heartbreak of watching complete families end up in your treatment center, including the very youngest children. She also delivered a stark assessment of the global response: "We do not know how to control this outbreak." The tools that had worked before were insufficient now. Vaccines existed—Congo had even approved two of them—but the world did not have enough doses to make a meaningful dent in transmission. During the 2022 crisis, the United States had seen cases plummet from over thirty thousand to around seventeen hundred as vaccination campaigns ramped up and people changed their behavior. But in Congo's displacement camps, where thousands lived in close quarters, behavioral change meant little. And no immunization plan had been launched.
From January through late July 2024, African health authorities documented a one hundred sixty percent increase in mpox cases compared to the same period the year before. The disease had first been identified in research monkeys in 1958, with the first human case confirmed in Congo in 1970. The 2022 declaration had sent it spreading across more than seventy countries that had never seen it before, eventually affecting nearly one hundred thousand people worldwide. This time, the outbreak had largely faded in Europe, Asia, and the Americas. In Africa, it was accelerating. The Centers for Disease Control and Prevention in the United States had already warned medical professionals and the public to watch for signs of global spread. What came next would depend on whether the world could move faster than the virus—and whether Congo could contain an outbreak that was already beyond the reach of the tools at hand.
Notable Quotes
We do not know how to control this outbreak.— Dr. Sylvie Jonckheere, Doctors Without Borders infectious disease adviser
It's really heartbreaking when you see entire families end up in your treatment centre. It's the mom, it's all the kids, including the very, very young ones.— Dr. Sylvie Jonckheere
The Hearth Conversation Another angle on the story
Why did the WHO wait until now to declare this a global emergency, when the numbers in Congo have been climbing for months?
The declaration itself is a recognition that the outbreak has crossed a threshold—it's not just a Congo problem anymore. It's in thirteen countries now, including places like Kenya and Rwanda where mpox had never been seen before. That geographic spread, combined with a death rate three times higher than 2022, triggered the alarm.
You mentioned entire families in treatment centers. What does that tell us about how the virus is moving through these communities?
It tells us that isolation isn't happening. In a displacement camp near Goma, you can't quarantine one person away from their family. Everyone lives in the same space. So when one person gets sick, everyone gets sick. That's why you see newborns and their mothers and their siblings all arriving together.
The article says Congo approved two vaccines but hasn't launched an immunization plan. Why would a country approve something and then not use it?
Partly logistics—Congo is in the middle of a humanitarian crisis with internal conflict. But also, there simply aren't enough vaccines in the world. Even if Congo wanted to vaccinate everyone, the global supply couldn't support it. So the question becomes: who do you vaccinate first? Healthcare workers? High-risk groups? That requires planning and resources Congo doesn't have right now.
Is there any reason to think this outbreak will be contained, or are we looking at something that spreads globally like 2022?
The difference is that in 2022, wealthy countries had access to vaccines and people had the ability to isolate. Here, you have a deadlier strain, no vaccine supply, and populations living in conditions where isolation is impossible. The CDC warning to the United States suggests they're already thinking about global spread as a real possibility.
What would actually need to happen to slow this down?
Honestly, the experts quoted in this story don't have a clear answer. Dr. Jonckheere said they don't know how to control it. You'd need a massive vaccine manufacturing effort, which takes time. You'd need to address the humanitarian crisis in Congo so people aren't living in displacement camps. You'd need surveillance systems in neighboring countries. None of that is happening at the speed the virus is moving.