# Mpox: The Emergency After the Emergency
- Canonical dossier: [Web edition]()
- Markdown edition: [Plain-text edition]()
- Issue: Issue 012
- Rubric: Outbreak / Health-system magazine
- Byline: Totally Fine Foundation editorial desk
- Reading time: 9 min
- Last reviewed: 2026-07-06
> WHO closed the global alarm in September 2025. The virus answered by changing address — into households, into children, and onto an island now carrying the largest clade Ib outbreak on earth.
## Cover
- Kicker: Field dossier / Disease / graded emergency
- Cover lines: The emergency was called off. The outbreak was not. / Clade Ib moved house — to Madagascar / First read as a sexual-network disease. Then a children's one. / Falling counts, thinning eyes
#### Hero visual provenance
- Caption: Mpox virus particles under an electron microscope — generic MPXV morphology, not a clade-Ib-specific specimen.
- Alt text: Colorized transmission electron micrograph of monkeypox (mpox) virus particles.
- Credit: NIAID
- Rights / license: CC BY 2.0, via Wikimedia Commons
- Asset: [View image]()
- Original / provenance: [Open source]()
## Metrics
### 61,061 — Global confirmed cases (1 Jan 2025-31 May 2026)
- Category: outbreak scale
- Caveat: Surveillance-dependent; WHO says counts are falling partly because surveillance is thinning. Across 103 countries.
**Source trail:** [WHO — Multi-country mpox External Situation Report no. 67]() (`mpox-who-sitrep67`)
#### Visual provenance
- Caption: The global ledger, read as a floor.
- Alt text: Data surface: 61,061 confirmed mpox cases across 103 countries since the start of 2025.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### 244 — Global deaths (same window)
- Category: outbreak scale
- Caveat: Deaths among confirmed cases; case-fatality varies by clade and access to care.
**Source trail:** [WHO — Multi-country mpox External Situation Report no. 67]() (`mpox-who-sitrep67`)
#### Visual provenance
- Caption: Deaths among confirmed cases, in the same surveillance-dependent window.
- Alt text: Data surface: 244 mpox deaths since the start of 2025.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### 2,117 cases / 7 deaths — Madagascar — largest clade Ib outbreak worldwide
- Category: epicentre
- Caveat: To 14 Jun 2026; 65% test positivity in the latest week; WHO says the outbreak is not yet under control.
**Source trail:** [WHO — Multi-country mpox External Situation Report no. 67]() (`mpox-who-sitrep67`)
#### Visual provenance
- Caption: The island epicentre, not yet under control.
- Alt text: Data surface: Madagascar's 2,117 cases and seven deaths with 65 per cent test positivity.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### ~60% of cases / 80% of deaths — Children's share of the burden, DRC
- Category: who is hit
- Caveat: 12 Sep 2024 baseline; echoed by the Uvira cohort (median age 9). A historical baseline, not a live count.
**Source trail:** [UNICEF / WHO — UNICEF DR Congo mpox response (with WHO on the conflict nexus)]() (`mpox-unicef-drc`); [Eurosurveillance — Clade Ib transmission in Uvira (Bugeme et al.)]() (`mpox-eurosurveillance-uvira`)
#### Visual provenance
- Caption: A child-centred, household-driven epidemic.
- Alt text: Data surface: household transmission and a median patient age of nine.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### ~10M needed vs ~1M delivered early 2025 — Vaccine equity gap
- Category: response
- Caveat: Later passed 3M delivered; keep need / facilitated / funded / administered separate — only ~650k administered by Apr 2025.
**Source trail:** [Gavi / Oxfam — Vaccine access and equity (Gavi, Oxfam, WHO, Africa CDC)]() (`mpox-vaccine-equity`)
#### Visual provenance
- Caption: The dose gap, kept in separate columns.
- Alt text: Data surface: roughly ten million doses needed against about 650,000 administered.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### PHEIC ended 5 Sep 2025 — still a graded emergency — Emergency status
- Category: status signal
- Caveat: PHEIC declared 14 Aug 2024, ended 5 Sep 2025; standing recommendations to 20 Aug 2026. A status signal, not a count.
**Source trail:** [WHO — Mpox PHEIC / IHR Emergency Committee status]() (`mpox-who-pheic`)
#### Visual provenance
- Caption: The alarm was lowered, not switched off.
- Alt text: Data surface: WHO and Africa CDC emergency timelines with mpox still a graded emergency.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
## The emergency was called off. The outbreak was not.
### The emergency that was declared over
WHO ended the mpox public health emergency of international concern on 5 September 2025 — thirteen months after it had declared one over a new strain spreading out of eastern Congo. The wording of the all-clear is narrower than the headlines that carried it. The same decision kept mpox a graded emergency, kept the Director-General's standing recommendations in force until 20 August 2026, and sat on a plain admission: more than a thousand confirmed cases still surface every month.
Africa CDC, which had declared its own continental emergency a day before WHO in August 2024, held that emergency open four months longer, until 22 January 2026. Two institutions, two clocks, one outbreak that nobody was calling finished.
**Source trail:** [WHO — Mpox PHEIC / IHR Emergency Committee status]() (`mpox-who-pheic`); [Africa CDC — Continental response and PHECS transition]() (`mpox-africa-cdc`)
#### Visual provenance
- Caption: De-escalation, not termination: the alarm was lowered while the outbreak continued.
- Alt text: Data surface: WHO and Africa CDC emergency timelines with mpox still a graded emergency.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### Where the numbers actually live
By WHO's June 2026 ledger, 61,061 confirmed cases and 244 deaths had been recorded since the start of 2025 across 103 countries. The monthly line is falling — 1,142 cases in May 2026 — and WHO says plainly why that should not be read as recovery: the decline tracks declining surveillance as much as receding disease.
The clearest example sits inside the same report. The Democratic Republic of the Congo, the historical centre of this outbreak, reported only eight cases in the last six-week window — not because the disease left, but because the country's testing was diverted to a separate Bundibugyo virus outbreak. Read every count here as a floor, not a ceiling.
**Source trail:** [WHO — Multi-country mpox External Situation Report no. 67]() (`mpox-who-sitrep67`)
#### Visual provenance
- Caption: A falling line that tracks the gaze, not the disease.
- Alt text: Data surface: 61,061 confirmed mpox cases and 244 deaths across 103 countries since the start of 2025.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### The outbreak changed its address
Clade Ib was first identified in September 2023 in Kamituga, a remote South Kivu mining town, where it spread mainly through adult sexual networks. That is the version most readers met in 2024. It is no longer the whole picture. A peer-reviewed cohort downhill in Uvira found the same virus moving overwhelmingly through households — 67.9 percent of exposures — with sexual contact behind just 6.0 percent, and a median patient nine years old.
In DRC as a whole, UNICEF recorded children under fifteen as roughly 60 percent of suspected cases and 80 percent of deaths. The disease did not soften as it travelled; it found a younger, more domestic route, which is exactly why the response now turns on paediatric vaccines and household measures the early framing never planned for.
**Source trail:** [Eurosurveillance — Clade Ib transmission in Uvira (Bugeme et al.)]() (`mpox-eurosurveillance-uvira`); [UNICEF / WHO — UNICEF DR Congo mpox response (with WHO on the conflict nexus)]() (`mpox-unicef-drc`)
#### Visual provenance
- Caption: The same virus, a household and child-centred face.
- Alt text: Data surface: 67.9 per cent household exposure against 6.0 per cent sexual, median patient age nine.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### The island that became the epicentre
Since December 2025, Madagascar has carried the largest mpox outbreak of clade Ib in the world. WHO's count to 14 June 2026 was 2,117 confirmed cases and seven deaths, with test positivity in the latest week at 65 percent — a figure WHO reads as ongoing transmission and inadequate surveillance — and the blunt assessment that the outbreak is not yet under control.
Vaccination has been scaled up: 79,125 people had received a first dose of MVA-BN, though stockouts and cold-chain failures keep undercutting it. The African region as a whole still carried 63.9 percent of May's global cases. The map moved; the weight did not lift.
**Source trail:** [WHO — Multi-country mpox External Situation Report no. 67]() (`mpox-who-sitrep67`)
#### Visual provenance
- Caption: The centre of gravity moved offshore; the island now holds the largest clade Ib outbreak on earth.
- Alt text: Relief location map of Madagascar.
- Credit: Sadalmelik / ELEKHH
- Rights / license: Public domain, via Wikimedia Commons
- Asset: [View image]()
- Original / provenance: [Open source]()
### The ledger of doses
The vaccine story is a logistics ledger with a gap built into it. Gavi facilitated 1,215,460 donated doses and funded another 500,000 directly; deliveries reached DRC, Uganda, Sierra Leone, Kenya and others. Set against Africa CDC's estimate — relayed by Oxfam — that roughly ten million doses are needed to control the outbreak, early-2025 deliveries of about one million were a tenth of the need; the figure has since passed three million, still short.
Below the delivery line runs a quieter one: a little over 650,000 doses actually administered by April 2025. Price is a named bottleneck — MVA-BN is among the most expensive vaccines UNICEF distributes, at up to $65 a dose. Japan's three-million-dose donation arrived, and roughly a third was reportedly wasted in DRC for want of storage. In Europe, surveillance shows the same uptake gap from the other end: only about a fifth of confirmed cases had completed two doses.
**Source trail:** [Gavi / Oxfam — Vaccine access and equity (Gavi, Oxfam, WHO, Africa CDC)]() (`mpox-vaccine-equity`); [ECDC — Mpox worldwide overview and EU/EEA surveillance]() (`mpox-ecdc-overview`)
#### Visual provenance
- Caption: Need, delivered and administered, held in separate columns.
- Alt text: Data surface: roughly ten million doses needed against about 1.2 million facilitated and 650,000 administered.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### How to read the risk
The honest register here is neither alarm nor relief. WHO and ECDC both rate clade Ib's risk as moderate for higher-exposure groups and low for the general population. Outside Africa, clade Ib has surfaced as travel-linked cases and confined network transmission — Norway's first case, local clusters in Spain and Thailand — not generalised spread.
That undercuts the imminent-global-pandemic framing without licensing the opposite error, the it is over framing that the lifted emergencies invited. The outbreak is smaller in the headlines and larger in the places least able to measure it. That tension is the dossier.
**Source trail:** [ECDC — Mpox worldwide overview and EU/EEA surveillance]() (`mpox-ecdc-overview`); [US CDC — Mpox situation summary and clinical overview]() (`mpox-us-cdc`)
#### Visual provenance
- Caption: Neither alarm nor relief: risk read by exposure group.
- Alt text: Data surface: risk moderate for higher-exposure groups and low for the general population.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
## Actors and positions
### WHO
- Role: Declared and ended the mpox public health emergency of international concern.
- Confidence: high
- Position: Frames the 5 September 2025 decision as de-escalation of alert level, not of the outbreak: mpox stays a graded emergency with standing recommendations to 20 August 2026.
- Supporter framing: WHO stresses that ending the PHEIC reflects a lowered global alert, while grading and recommendations keep the response funded and coordinated.
- Opposing account: Some public-health voices questioned ending the PHEIC while outbreaks — later Madagascar — were still expanding.
- Independent assessment: The decision is a de-escalation, not a termination; the graded-emergency status and monthly case load are consistent with WHO's own framing, and Madagascar's outbreak began after the PHEIC ended.
**Source trail:** [WHO — Mpox PHEIC / IHR Emergency Committee status]() (`mpox-who-pheic`); [WHO — Multi-country mpox External Situation Report no. 67]() (`mpox-who-sitrep67`)
#### Portrait provenance
- Caption: WHO lowered the alarm while keeping the outbreak graded.
- Alt text: Data surface: WHO and Africa CDC emergency timelines.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### Africa CDC and affected states
- Role: Declared the first-ever Public Health Emergency of Continental Security and led the continental response.
- Confidence: high
- Position: Held its emergency open four months longer than WHO, then transitioned on 22 January 2026 to a country-led Mpox Transition Roadmap — a de-escalation, not an end to operations.
- Supporter framing: Africa CDC frames the staggered timing as regional thresholds differing from global ones, and points to more than US$1.1 billion mobilised and over five million doses deployed by April 2026.
- Opposing account: The staggered lifting invited a reading of institutional disagreement; Africa CDC frames it instead as different thresholds for a continental versus a global emergency.
- Independent assessment: The four-month gap reflects regional versus global thresholds rather than contradiction; Africa CDC's continental cumulative counts on a different window from WHO's and must not be merged with it.
**Source trail:** [Africa CDC — Continental response and PHECS transition]() (`mpox-africa-cdc`)
#### Portrait provenance
- Caption: Africa CDC counts on its own clock and its own window.
- Alt text: Data surface: Africa CDC and WHO counting windows kept apart.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### National authorities and affected communities (DRC, Madagascar)
- Role: The front line: origin, historical epicentre and current epicentre of the outbreak.
- Confidence: high
- Position: DRC is the origin and historical epicentre, its reporting now slowed by a parallel Bundibugyo outbreak; Madagascar carries the current largest clade Ib outbreak.
- Supporter framing: National responders stress that falling counts can reflect diverted testing and thin surveillance rather than control, and that the burden has shifted toward children.
- Opposing account: Falling DRC case numbers were sometimes read externally as recovery; the sources attribute them instead to diverted testing and thinning surveillance.
- Independent assessment: The hardest-hit shifted by setting — from adults in Kamituga's sexual networks to children in Uvira's households — and the outbreak shares eastern Congo's geography with armed conflict. Individuals and communities are described by setting, without stigma.
**Source trail:** [WHO — Multi-country mpox External Situation Report no. 67]() (`mpox-who-sitrep67`); [Eurosurveillance — Clade Ib transmission in Uvira (Bugeme et al.)]() (`mpox-eurosurveillance-uvira`); [UNICEF / WHO — UNICEF DR Congo mpox response (with WHO on the conflict nexus)]() (`mpox-unicef-drc`)
#### Portrait provenance
- Caption: The front line moved by setting, from the Congolese mainland to an island.
- Alt text: Relief location map of Madagascar.
- Credit: Sadalmelik / ELEKHH
- Rights / license: Public domain, via Wikimedia Commons
- Asset: [View image]()
- Original / provenance: [Open source]()
### Vaccine makers and donors (Gavi, Bavarian Nordic, UNICEF, Japan)
- Role: Supply and financing of vaccine via advance-purchase deals, donations and a stockpile.
- Confidence: high
- Position: Frame the response as doses facilitated, funded and delivered at growing scale across affected countries.
- Supporter framing: Donors point to more than a million doses facilitated early and over three million later, plus direct funding and country-by-country delivery.
- Opposing account: Critics note doses arrived months into the outbreak, fell short of the roughly ten million estimated as needed, and that uptake is constrained by surveillance, cold-chain and stigma — necessary but not sufficient.
- Independent assessment: Vaccine supply is necessary but not sufficient: large outbreaks emerged after major DRC deliveries, administered doses lag delivered ones, and price and storage remain named bottlenecks.
**Source trail:** [Gavi / Oxfam — Vaccine access and equity (Gavi, Oxfam, WHO, Africa CDC)]() (`mpox-vaccine-equity`)
#### Portrait provenance
- Caption: The donors' ledger: doses facilitated, funded and — far fewer — administered.
- Alt text: Data surface: the dose ledger's separate columns.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
## Claims and evidence
### The mpox emergency is over.
- Claimant: Headline reading of the lifted emergencies
- Evidence status: disputed
- Counterclaim: Both WHO and Africa CDC framed the change as de-escalation; WHO keeps mpox a graded emergency with standing recommendations to 20 August 2026.
- Independent assessment: False as stated. The emergencies were lowered, not the outbreak; Madagascar's outbreak began after the PHEIC ended, and over a thousand cases still surface monthly.
**Source trail:** [WHO — Multi-country mpox External Situation Report no. 67]() (`mpox-who-sitrep67`); [WHO — Mpox PHEIC / IHR Emergency Committee status]() (`mpox-who-pheic`)
#### Visual provenance
- Caption: 'Over' collapses against the graded-emergency status and the monthly case load.
- Alt text: Data surface: mpox remains a graded emergency after the PHEIC ended.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### Clade Ib is an imminent global pandemic.
- Claimant: Alarm-driven framing
- Evidence status: disputed
- Counterclaim: WHO and ECDC rate the risk moderate for higher-exposure groups and low for the general population; spread outside Africa is travel-linked or network-confined, not generalised.
- Independent assessment: Overstated. The risk tiers and the travel-linked pattern outside Africa do not support an imminent global pandemic — while equally not supporting the opposite 'it is over' claim.
**Source trail:** [ECDC — Mpox worldwide overview and EU/EEA surveillance]() (`mpox-ecdc-overview`)
#### Visual provenance
- Caption: The risk tiers undercut the 'imminent pandemic' framing without endorsing 'it is over'.
- Alt text: Data surface: risk moderate for higher-exposure groups, low for the general population.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### Vaccines alone will end the outbreak.
- Claimant: Vaccine-centred optimism
- Evidence status: disputed
- Counterclaim: WHO stresses surveillance, rapid containment, stigma reduction and reaching the most-affected; large outbreaks emerged after major DRC deliveries.
- Independent assessment: False as stated. Vaccines are necessary but not sufficient: administered doses lag deliveries, and Madagascar's outbreak grew after significant regional vaccine roll-out.
**Source trail:** [Gavi / Oxfam — Vaccine access and equity (Gavi, Oxfam, WHO, Africa CDC)]() (`mpox-vaccine-equity`)
#### Visual provenance
- Caption: Doses are necessary but not sufficient; the administered column is the smallest.
- Alt text: Data surface: administered doses far below delivered and needed.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
## Language record
### WHO
- Role: Multi-country mpox situation report no. 67
- Context: The report's own framing of a falling count that is not recovery.
Quotation text is available in the web edition and the cited original source; it is not republished in this machine-readable edition.
**Source:** [WHO — Multi-country mpox External Situation Report no. 67]() (`mpox-who-sitrep67`)
### WHO Director-General
- Role: Emergency determination, 5 September 2025
- Context: The determination that ended the global alarm while keeping mpox a graded emergency.
Quotation text is available in the web edition and the cited original source; it is not republished in this machine-readable edition.
**Source:** [WHO — Mpox PHEIC / IHR Emergency Committee status]() (`mpox-who-pheic`)
### WHO
- Role: On the Goma isolation units, 7 February 2025
- Context: Where outbreak control and armed conflict occupy one geography.
Quotation text is available in the web edition and the cited original source; it is not republished in this machine-readable edition.
**Source:** [UNICEF / WHO — UNICEF DR Congo mpox response (with WHO on the conflict nexus)]() (`mpox-unicef-drc`)
### Eurosurveillance (Bugeme et al.)
- Role: Uvira cohort study, 18 December 2025
- Context: The study's own conclusion on a setting-dependent transmission route.
Quotation text is available in the web edition and the cited original source; it is not republished in this machine-readable edition.
**Source:** [Eurosurveillance — Clade Ib transmission in Uvira (Bugeme et al.)]() (`mpox-eurosurveillance-uvira`)
## Timeline
### 2024-08-14 — WHO declares mpox PHEIC — Clade Ib spreading beyond DRC
- Event type: outbreak\_start
- Confidence: high
WHO Director-General declared mpox a Public Health Emergency of International Concern (PHEIC) for the second time, citing the rapid spread of the new Clade Ib variant from eastern DRC to neighboring countries including Burundi, Rwanda, Uganda, and Kenya.
**Source trail:** [WHO — WHO Mpox Outbreak — Disease Outbreak News]() (`src-mpox-who`)
### 2024-09-15 — First Clade Ib case confirmed in Sweden — intercontinental spread
- Event type: outbreak\_update
- Confidence: high
Sweden confirmed the first Clade Ib mpox case outside Africa, in a traveler returning from an affected country. WHO urged enhanced surveillance at points of entry globally.
**Source trail:** [ECDC — Mpox Surveillance — ECDC]() (`src-mpox-ecdc`); [WHO — WHO Mpox Outbreak — Disease Outbreak News]() (`src-mpox-who`)
### 2026-05-01 — Vaccine deliveries resume to East Africa after supply gap
- Event type: treatment\_update
- Confidence: high
WHO and GAVI confirmed resumption of Bavarian Nordic and LC16m8 vaccine shipments to DRC, Burundi, Uganda, and Rwanda after a 6-week supply gap. Total doses committed: 3.5 million for 2026.
**Source trail:** [WHO — WHO Mpox Outbreak — Disease Outbreak News]() (`src-mpox-who`); [ReliefWeb — Mpox Response in DRC — ReliefWeb]() (`src-mpox-reliefweb`)
## Visual essay
### Gallery image 01
#### Visual provenance
- Caption: Madagascar, the current epicentre: since December 2025 it has carried the world's largest clade Ib outbreak.
- Alt text: Relief location map of Madagascar.
- Credit: Sadalmelik / ELEKHH
- Rights / license: Public domain, via Wikimedia Commons
- Asset: [View image]()
- Original / provenance: [Open source]()
### Gallery image 02
#### Visual provenance
- Caption: The Democratic Republic of the Congo, the historical epicentre, where reporting has slowed as testing was diverted to a separate outbreak.
- Alt text: Relief location map of the Democratic Republic of the Congo.
- Credit: Uwe Dedering
- Rights / license: CC BY-SA 3.0, via Wikimedia Commons
- Asset: [View image]()
- Original / provenance: [Open source]()
### Gallery image 03
#### Visual provenance
- Caption: The vaccine ledger: MVA-BN, a smallpox vaccine, is the front-line dose. Context image, not a clade-Ib-specific product.
- Alt text: A vial of smallpox vaccine with a bifurcated needle.
- Credit: James Gathany / CDC
- Rights / license: Public domain, via Wikimedia Commons
- Asset: [View image]()
- Original / provenance: [Open source]()
## Linked visual references
### Clade Ib transmission in Uvira (open-access figures)
- Photographer: Bugeme et al.
- Publisher: Eurosurveillance
- Recognition: Open access, CC BY 4.0
- Why it matters: The peer-reviewed Uvira cohort is the evidence that clade Ib's transmission route is setting-dependent, turning a sexual-network story into a household, child-centred one.
- Original: [Open reference]()
#### The virus wears a different face by setting.
The dossier reads clade Ib through the peer-reviewed record rather than clinical imagery. The Uvira study is the exhibit that reframes the outbreak from adult sexual networks to households and children.
This is a disease with no scene to photograph responsibly — the dossier avoids clinical lesion imagery entirely and leans on the virus micrograph, locator maps and re-typeset data surfaces instead.
The Uvira cohort matters because it measures what changed. The same virus that spread through adults in Kamituga moved through households in Uvira, with a median patient nine years old. That single finding is why the response now turns on paediatric vaccines the early framing never planned for.
## Media desk
### The new epicentre
- Publisher: Wikimedia Commons
- Creator: Sadalmelik / ELEKHH
- Date: Relief locator
- Media type: map
- Rights mode: direct\_image
- Placement: Geography / current epicentre
- Caption: The outbreak's centre of gravity moved offshore: since December 2025 Madagascar has held the largest clade Ib outbreak on earth.
- Why it matters: It orients the reader to the epicentre shift without treating any single map as a case count.
The map belongs in the visual desk because the mpox story is partly a story of address changes — from Kamituga to Uvira to an island. A locator keeps geography honest: it says where the weight sits now without pretending to certify how many cases live in each district. The numbers stay in the WHO data surface beside it.
- Original: [Open media record]()
#### Visual provenance
- Caption: Madagascar carries the largest clade Ib outbreak in the world; the map anchors the shift from the African mainland to an island.
- Alt text: Relief location map of Madagascar.
- Credit: Sadalmelik / ELEKHH
- Rights / license: Public domain, via Wikimedia Commons
- Asset: [View image]()
- Original / provenance: [Open source]()
### The historical epicentre
- Publisher: Wikimedia Commons
- Creator: Uwe Dedering
- Date: Relief locator
- Media type: map
- Rights mode: direct\_image
- Placement: Geography / origin and conflict nexus
- Caption: The response shares a map with a war: WHO documented that 128 of 143 mpox patients fled Goma's isolation units as fighting closed in.
- Why it matters: It keeps the origin country visible even as its reported numbers fall for reasons that have nothing to do with recovery.
The DRC map is the reminder that a falling count can mean a thinning gaze rather than a receding disease. Here the outbreak and an armed conflict occupy one geography, and testing was pulled toward a separate emergency. The locator holds the place steady while the surveillance around it wavers.
- Original: [Open media record]()
#### Visual provenance
- Caption: The DRC is the origin and historical epicentre; its falling case count reflects diverted testing, not a departed disease.
- Alt text: Relief location map of the Democratic Republic of the Congo.
- Credit: Uwe Dedering
- Rights / license: CC BY-SA 3.0, via Wikimedia Commons
- Asset: [View image]()
- Original / provenance: [Open source]()
### The dose ledger
- Publisher: Wikimedia Commons
- Creator: James Gathany / CDC
- Date: Context image
- Media type: photo
- Rights mode: direct\_image
- Placement: Vaccine access / logistics
- Caption: The vaccine is a logistics ledger with a gap built in: doses arrived months late, fell short of need, and uptake lagged delivery.
- Why it matters: It anchors the dose figures visually while the four-column discipline lives in the data surface beside it.
A vaccine vial is the honest image for a story that is really about supply chains. The dossier keeps need, delivered and administered as separate columns because collapsing them would flatter the response; the photograph is the object, and the data surface is the arithmetic of scarcity.
- Original: [Open media record]()
#### Visual provenance
- Caption: MVA-BN, a smallpox vaccine, is the front-line mpox dose; this is a context image, not a clade-Ib-specific product.
- Alt text: A vial of smallpox vaccine with a bifurcated needle.
- Credit: James Gathany / CDC
- Rights / license: Public domain, via Wikimedia Commons
- Asset: [View image]()
- Original / provenance: [Open source]()
### Multi-country mpox external situation report
- Publisher: WHO
- Creator: World Health Organization
- Date: Report no. 67, 26 Jun 2026
- Media type: report\_pdf
- Rights mode: linked\_reference\_only
- Placement: Global ledger / primary source
- Caption: WHO's situation report is the anchor for current figures; it is re-fetched at publication because the numbers roll.
- Why it matters: It is the authoritative global count, linked rather than re-hosted, with figures dated to the report edition.
The WHO report belongs in the visual desk as the primary source the reader can open, not an image the dossier re-hosts. The dossier rebuilds its figures as a re-typeset surface and dates them to report no. 67, because a mpox count is only meaningful with the surveillance caveat attached.
- Original: [Open media record]()
#### Visual provenance
- Caption: Our re-typeset reading of WHO's ledger, with the falling monthly line marked as thinning surveillance rather than recovery.
- Alt text: Data surface: 61,061 confirmed mpox cases and 244 deaths across 103 countries since the start of 2025.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
## Source readings
### A ledger with a warning folded into it.
- Registry ID: `mpox-who-sitrep67`
- Publisher: WHO
- Source type: humanitarian
- Published: 2026-06-26
- Registry title: Multi-country mpox External Situation Report no. 67
- Editorial note: Anchor source for current global and Madagascar figures; counts are surveillance-dependent floors.
- Original: [Open source]()
WHO's 67th report anchors the current figures — and says plainly why falling counts are not recovery.
By WHO's June 2026 ledger, 61,061 confirmed cases and 244 deaths had been recorded since the start of 2025 across 103 countries. The monthly line is falling — 1,142 cases in May 2026 — and WHO says why that should not be read as recovery: the decline tracks declining surveillance as much as receding disease.
The clearest example sits inside the same report. The Democratic Republic of the Congo, the historical centre of this outbreak, reported only eight cases in the last six-week window — not because the disease left, but because the country's testing was diverted to a separate Bundibugyo virus outbreak. Read every count here as a floor, not a ceiling.
#### Takeaways
- Anchor source for current global and Madagascar figures.
- Counts are a floor; the fall reflects thinning surveillance.
- The outbreak remains a WHO graded emergency.
#### Visual provenance
- Caption: The global ledger, with its falling monthly line read as thinning surveillance, not recovery.
- Alt text: Data surface: 61,061 confirmed mpox cases and 244 deaths across 103 countries since the start of 2025.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### Two clocks, not one.
- Registry ID: `mpox-who-pheic`
- Publisher: WHO
- Source type: official\_position
- Published: 2025-10-30
- Registry title: Mpox PHEIC / IHR Emergency Committee status
- Editorial note: Emergency-status source; the 'all clear' is de-escalation, not termination.
- Original: [Open source]()
WHO ended the global alarm; the recommendations, the grading and the monthly cases stayed.
WHO ended the mpox public health emergency of international concern on 5 September 2025, thirteen months after declaring one over a new strain spreading out of eastern Congo. The wording of the all-clear is narrower than the headlines that carried it: the same decision kept mpox a graded emergency, kept standing recommendations in force until 20 August 2026, and sat on a plain admission that more than a thousand confirmed cases still surface every month.
Africa CDC, which had declared its own continental emergency a day before WHO in August 2024, held that emergency open four months longer, until 22 January 2026. Two institutions, two clocks, one outbreak that nobody was calling finished.
#### Takeaways
- De-escalation of alert level, not termination of the outbreak.
- Standing recommendations run to 20 August 2026.
- Madagascar's outbreak began after the PHEIC ended.
#### Visual provenance
- Caption: Two institutions, two clocks, one outbreak nobody was calling finished.
- Alt text: Data surface: WHO ended its emergency in September 2025 and Africa CDC in January 2026, while mpox stays a graded emergency.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### Risk by group, not by headline.
- Registry ID: `mpox-ecdc-overview`
- Publisher: ECDC
- Source type: official\_position
- Published: 2026-06-26
- Registry title: Mpox worldwide overview and EU/EEA surveillance
- Editorial note: Risk-tier source; general-population risk low, moderate for higher-exposure groups.
- Original: [Open source]()
ECDC keeps clade Ib's general-population risk low and rates it moderate only for higher-exposure groups.
ECDC rates clade Ib's general-population risk low and moderate for men who have sex with men, with clade IIb lower still. Beneath the wording sits a year's count and a coverage gap: nine in ten EU cases in the same group, and only about a fifth of confirmed cases vaccinated with two doses.
Clade I now circulates in Europe via travel and confined local transmission rather than generalised spread. That undercuts the imminent-global-pandemic framing without licensing the opposite error — the it is over framing that the lifted emergencies invited.
#### Takeaways
- Group-specific risk tiers, not one blanket number.
- Clade I in Europe is travel-linked and network-confined.
- A two-dose coverage gap sits under the risk wording.
#### Visual provenance
- Caption: The risk read the way the agencies write it: by exposure group, not by headline.
- Alt text: Data surface: risk moderate for higher-exposure groups and low for the general population.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### The weight rests on the youngest.
- Registry ID: `mpox-unicef-drc`
- Publisher: UNICEF / WHO
- Source type: humanitarian
- Published: 2025-02-07
- Registry title: UNICEF DR Congo mpox response (with WHO on the conflict nexus)
- Editorial note: Child-centred burden and the conflict nexus; 2024 figures are a historical baseline.
- Original: [Open source]()
UNICEF records children carrying most of DRC's mpox burden, in a response that shares a map with a war.
UNICEF reports that children under fifteen carry roughly 60 percent of DRC's suspected mpox cases and 80 percent of its deaths — the outbreak's weight resting on the youngest. These are September 2024 figures, best read as a historical baseline rather than a live count.
The response shares a map with a war. WHO documented that 128 of 143 mpox patients fled Goma's isolation units as fighting closed in — a reminder that outbreak control and armed conflict occupy one geography in eastern Congo.
#### Takeaways
- Child-centred burden: ~60% of cases, ~80% of deaths.
- Outbreak and conflict occupy one geography.
- 2024 figures are a baseline, not a current total.
#### Visual provenance
- Caption: The DRC, where the outbreak and an armed conflict occupy one geography and children carry most of the burden.
- Alt text: Relief location map of the Democratic Republic of the Congo.
- Credit: Uwe Dedering
- Rights / license: CC BY-SA 3.0, via Wikimedia Commons
- Asset: [View image]()
- Original / provenance: [Open source]()
### A logistics ledger with a gap built in.
- Registry ID: `mpox-vaccine-equity`
- Publisher: Gavi / Oxfam
- Source type: humanitarian
- Published: 2025-05-01
- Registry title: Vaccine access and equity (Gavi, Oxfam, WHO, Africa CDC)
- Editorial note: Dose logistics; keep need, delivered and administered as separate columns.
- Original: [Open source]()
Gavi accounts for the response as doses facilitated and funded; the arithmetic of scarcity sits beneath.
Gavi facilitated 1,215,460 donated doses and funded another 500,000 directly, with deliveries reaching DRC, Uganda, Sierra Leone, Kenya and others. Set against Africa CDC's estimate of roughly ten million doses needed to control the outbreak, early-2025 deliveries of about one million were a tenth of the need; the figure later passed three million, still short.
Below the delivery line runs a quieter one: a little over 650,000 doses actually administered by April 2025. Price is a named bottleneck — MVA-BN is among the most expensive vaccines UNICEF distributes, at up to $65 a dose — and Japan's three-million-dose donation arrived with roughly a third reportedly wasted in DRC for want of storage.
#### Takeaways
- Keep need, delivered and administered as separate columns.
- $65-a-dose price is a named bottleneck.
- Doses arrived, fell short, and uptake lagged delivery.
#### Visual provenance
- Caption: The dose ledger, with need, delivered and administered kept in separate columns.
- Alt text: Data surface: roughly ten million doses needed against about 1.2 million facilitated and 650,000 administered.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### The same virus, a different face.
- Registry ID: `mpox-eurosurveillance-uvira`
- Publisher: Eurosurveillance
- Source type: research
- Published: 2025-12-18
- Registry title: Clade Ib transmission in Uvira (Bugeme et al.)
- Editorial note: Peer-reviewed cohort showing setting-dependent transmission; open access, CC BY 4.0.
- Original: [Open source]()
Eurosurveillance measures how clade Ib's transmission route changed with its setting.
Clade Ib was first identified in September 2023 in Kamituga, a remote South Kivu mining town, where it spread mainly through adult sexual networks. That is the version most readers met in 2024. A peer-reviewed cohort downhill in Uvira found the same virus moving overwhelmingly through households — 67.9 percent of exposures — with sexual contact behind just 6.0 percent, and a median patient nine years old.
The case-fatality ratio held at 0.7 percent. The disease did not soften as it travelled; it found a younger, more domestic route, which is exactly why the response now turns on paediatric vaccines and household measures the early framing never planned for.
#### Takeaways
- Transmission route is setting-dependent, not fixed.
- A child-centred, household-driven epidemic in Uvira.
- The finding argues for paediatric vaccines.
#### Visual provenance
- Caption: The route the study measured: a household, child-centred epidemic, not the sexual-network one of 2023.
- Alt text: Data surface: 67.9 per cent household exposure against 6.0 per cent sexual, median patient age nine.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### A clean clade explainer.
- Registry ID: `mpox-us-cdc`
- Publisher: US CDC
- Source type: official\_position
- Published: 2026-06-01
- Registry title: Mpox situation summary and clinical overview
- Editorial note: US clade explainer and case count; US public risk low; a rolling 'more than 20' count.
- Original: [Open source]()
CDC defines the virus's two clades and four subclades and keeps the US risk low.
CDC reports more than 20 laboratory-confirmed clade I mpox cases in the United States since November 2024 — almost all subclade Ib, with no deaths and mostly mild illness — and defines clade I and clade II as the virus's two types, each with two subclades (Ia, Ib, IIa, IIb). Its assessment holds that the outbreak's risk to most people in the US remains low, even as it watches suspected community transmission in Southern California.
The US count is a rolling more than 20 — a figure to date rather than inflate, and not to be replaced by higher secondary-press totals. Clade Ib mortality under 0.5 percent is a figure about Central and Eastern Africa, the source region, not about the United States.
#### Takeaways
- A clean clade explainer: two clades, four subclades.
- US public risk low; the count is a dated 'more than 20'.
- Mortality figures are about the source region, not the US.
#### Visual provenance
- Caption: The clades kept straight, and the US count dated: more than twenty clade I cases since November 2024, no deaths.
- Alt text: Data surface: clade I (Ia, Ib) and clade II (IIa, IIb), with clade Ib driving this outbreak.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### A continental clock, and its own arithmetic.
- Registry ID: `mpox-africa-cdc`
- Publisher: Africa CDC
- Source type: official\_position
- Published: 2026-01-22
- Registry title: Continental response and PHECS transition
- Editorial note: Continental de-escalation and response tally; a different counting window from WHO's.
- Original: [Open source]()
Africa CDC lifted its emergency four months after WHO's, and counts on a different window.
Africa CDC lifted the continental Public Health Emergency of Continental Security in January 2026, on its Emergency Consultative Group's recommendation, moving to a country-led Mpox Transition Roadmap — a de-escalation, not an end to operations. Its response tally by April 2026: more than US$1.1 billion mobilised, over five million vaccine doses deployed, and risk communication reaching 50 million people across 33 countries.
Its continental cumulative, reported near 70,000 cases, counts since 2024 — a different window from WHO's count since 1 January 2025 (49,176 at the comparison date, 61,061 by situation report no. 67). The two windows must not be merged into a single figure.
#### Takeaways
- Continental emergency lifted four months after WHO's PHEIC ended.
- Response figures are Africa CDC's own.
- Do not merge the ~70,000 continental cumulative with WHO's since-2025 count.
#### Visual provenance
- Caption: Two counting windows kept apart: a continental cumulative and a global since-2025 count are not one total.
- Alt text: Data surface: Africa CDC's ~70,000 continental cumulative since 2024 versus WHO's 49,176 since January 2025.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
## Analysis shelf
### Multi-country mpox External Situation Report no. 67
- Publisher: WHO
- Type: report
- Why it matters: The anchor source for current global and Madagascar figures, with the surveillance caveat built in.
- Position note: Official global surveillance; counts are floors, and the outbreak stays a graded emergency.
- Original: [Open source]()
#### Visual provenance
- Caption: The global ledger, read as a floor.
- Alt text: Data surface: 61,061 confirmed mpox cases and 244 deaths since the start of 2025.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### Mpox worldwide overview and EU/EEA surveillance
- Publisher: ECDC
- Type: dataset
- Why it matters: The risk-tier source that keeps general-population risk low and higher-exposure risk moderate, with a live dashboard.
- Position note: Official EU public-health agency; group-specific tiers, not one blanket number.
- Original: [Open source]()
#### Visual provenance
- Caption: Risk by exposure group.
- Alt text: Data surface: risk moderate for higher-exposure groups, low for the general population.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### Clade Ib transmission in Uvira
- Publisher: Eurosurveillance (Bugeme et al.)
- Type: investigation
- Why it matters: The peer-reviewed evidence that clade Ib's transmission route is setting-dependent and child-centred in Uvira.
- Position note: Open-access research, CC BY 4.0; the strongest single evidence exhibit in the file.
- Original: [Open source]()
#### Visual provenance
- Caption: The evidence for a household, child-centred epidemic.
- Alt text: Data surface: household transmission and a median patient age of nine.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original source linked
- Asset: [View image]()
- Original / provenance: [Open source]()
## Media shelf
### Continental response and PHECS transition
- Publisher: Africa CDC
- Type: official page
- Why it matters: The continental response tally and the counting window that must be kept separate from WHO's.
- Position note: Official continental agency; a country-led transition, not an end to operations.
- Original: [Open source]()
#### Visual provenance
- Caption: Two windows, not one total.
- Alt text: Data surface: Africa CDC and WHO counting windows kept apart.
- Credit: Totally Fine Foundation
- Rights / license: Project editorial graphic; original sources linked
- Asset: [View image]()
- Original / provenance: [Open source]()
### Vaccine delivery and equity
- Publisher: Gavi
- Type: report
- Why it matters: The logistics record behind the dose figures, and the gap between doses delivered and doses given.
- Position note: Alliance financing source; necessary but not sufficient for control.
- Original: [Open source]()
#### Visual provenance
- Caption: MVA-BN is the front-line dose; the ledger behind it is one of scarcity and lag.
- Alt text: A vial of smallpox vaccine with a bifurcated needle.
- Credit: James Gathany / CDC
- Rights / license: Public domain, via Wikimedia Commons
- Asset: [View image]()
- Original / provenance: [Open source]()
## Open questions
- Add a Madagascar country panel — now the epicentre — and a DRC conflict-nexus lane covering the Goma isolation-unit flight.
- Refresh the WHO situation report and ECDC dashboard at publication day: global cases (61,061 / 244), Madagascar (2,117 / 7), monthly line and test positivity all roll — re-fetch and re-date each.
- Keep the two counting windows explicitly separate: Africa CDC's continental cumulative since 2024 must never be merged with WHO's count since 1 January 2025.
- Keep every dose figure in its own column — need, facilitated, funded, administered — and avoid presenting delivered doses as protection achieved.
- Preserve the 'ended emergency, not ended outbreak' nuance in headline and deck, avoid stigma cues, and use no clinical lesion imagery.
## Source registry
- `mpox-who-sitrep67` — [WHO — Multi-country mpox External Situation Report no. 67](); humanitarian; 2026-06-26
- `mpox-who-pheic` — [WHO — Mpox PHEIC / IHR Emergency Committee status](); official\_position; 2025-10-30
- `mpox-ecdc-overview` — [ECDC — Mpox worldwide overview and EU/EEA surveillance](); official\_position; 2026-06-26
- `mpox-unicef-drc` — [UNICEF / WHO — UNICEF DR Congo mpox response (with WHO on the conflict nexus)](); humanitarian; 2025-02-07
- `mpox-vaccine-equity` — [Gavi / Oxfam — Vaccine access and equity (Gavi, Oxfam, WHO, Africa CDC)](); humanitarian; 2025-05-01
- `mpox-eurosurveillance-uvira` — [Eurosurveillance — Clade Ib transmission in Uvira (Bugeme et al.)](); research; 2025-12-18
- `mpox-us-cdc` — [US CDC — Mpox situation summary and clinical overview](); official\_position; 2026-06-01
- `mpox-africa-cdc` — [Africa CDC — Continental response and PHECS transition](); official\_position; 2026-01-22