Mpox in 2025: What we know, what we have and what needs to happen next
Mpox continues to present two realities. In Africa, the virus is surging with over 139,000 suspected cases since 2024, driven by clade I variants that are spreading beyond sexual networks to children, rural communities, and health workers. Weak health systems, poor diagnostics, and limited vaccine access leave millions unprotected. Outside Africa, transmission of clade IIb remains low, largely contained within sexual and social networks, though travel-linked clade I cases highlight the risk of spillover. While vaccines and antivirals exist, their impact is constrained. Equitable access, stronger surveillance, and stigma-free education remain critical to preventing mpox from becoming an entrenched global threat.
Three years after mpox captured global attention, the world faces starkly different realities. In Africa, the virus has escalated into a full-scale epidemic. Between January 2024 and May 2025, 26 countries reported more than 139,000 suspected cases, including nearly 35,000 confirmed infections and almost 1,800 deaths. The Democratic Republic of Congo, Sierra Leone, and Malawi are at the epicenter. The emergence of a new clade I variant carrying APOBEC3 mutations raises concerns about increased transmissibility and adaptability. Unlike the 2022–2023 clade IIb outbreak, clade I variants are spreading broadly among children, rural populations, and healthcare workers. Weak health systems, underfunding, and scarce diagnostic labs have left many cases undetected, while vaccination has reached only 700,000 people in 11 countries.
Outside Africa, transmission of clade IIb remains limited but persistent, largely in sexual and social networks. Public health campaigns and vaccination have reduced cases, but sporadic clade I infections linked to travel in the UK, United States, India, and other countries underscore the risk of international spread. For this reason, the World Health Organization continues close monitoring, even though mpox is no longer classified as a Public Health Emergency of International Concern.
Medical countermeasures remain limited. The Modified Vaccinia Ankara vaccine (JYNNEOS, Imvanex, Imvamune) is the cornerstone of prevention, while tecovirimat (TPOXX) remains the leading antiviral, though clinical trials suggest limited benefit in mild cases and greater potential in severe disease. Older vaccines and off-label antivirals are fallback options. Encouragingly, Moderna and others are developing next-generation vaccines and therapies.
The future of mpox control depends on equitable access to vaccines, stronger genomic surveillance, stigma-free education, and a One Health approach to prevent animal spillover. Sustainable investment and preparedness exercises are vital. Mpox has not disappeared; the world must act decisively to prevent the next orthopoxvirus crisis.