World paying a price with a disease that now counts humans as a reservoir. Continued neglect of diseases with epidemic potential leaves us all vulnerable
A new report from The Independent Panel for Pandemic Preparedness and Response traces how mpox, once a sporadic disease in West and Central Africa mainly caused by contact with infected animals, is now causing outbreaks in dozens of countries around the world and counts humans as a reservoir.
The Independent Panel’s latest report – Hiding in Plain Sight: Mpox and the Cost of Neglecting Known Threats – finds that the long-term neglect of mpox contributed to two preventable global health emergencies and made the disease a widespread public health risk.The report also shows how new variants of the monkeypox virus have emerged over a relatively short period of time, adding risks to people and burdens on already stretched health systems.
“We must stop ignoring sporadic diseases with epidemic potential,” said the Right Honourable Helen Clark, Co-Chair of The Independent Panel. “Mpox was neglected at our peril. Preventable health emergencies are a sign of failure. They happen when community health care is neglected, signals are missed, and pathogens are allowed to spread beyond their original habitats. These gaps leave us all vulnerable.”
Mpox is nowhere near as dangerous as smallpox, caused by the related variola virus, but it causes painful lesions that last weeks, may require hospitalisation, is more dangerous for people with advanced or untreated HIV, and has caused foetal and child deaths.
“There were earlier opportunities to control mpox, which was primarily a zoonotic illness in endemic countries in West and Central Africa,” said the report’s lead author, Dr Els Torreele. “With 145 countries reporting mpox in the last four years and many outbreaks of sustained human-to-human transmission, the opportunity to stop it locally was missed. We are all paying a price with a disease that now counts humans as a reservoir.”
The right tools were not in the right place at the right time
The report documents that prior to 2022, smallpox vaccines and treatments with potential against mpox existed because of health security investments and biodefence research. However, these were first used widely to support mpox control during the 2022 global emergency, when high-income countries were also affected. This was an opportunity to document the vaccine’s efficacy against mpox, but it was still not made available in the original endemic regions – particularly in the Democratic Republic of the Congo, which had been reporting around 2,000 suspected cases each year.
Vaccines against mpox were deployed on the African continent only after the emergence of a new viral subtype, a cross-border surge and the declaration of a second public health emergency of international concern in August 2024. When finally available, vaccines were provided to several countries experiencing outbreaks in a staggered manner. Ultimately, it is unclear how much impact they had on the 2024–2025 mpox outbreaks. An mpox vaccine stockpile was announced only in August 2026.
Further, tools like rapid diagnostic tests and therapies were not available where they were most needed. Only about one-third of suspected cases in the Democratic Republic of the Congo could be confirmed with testing.
“Many of the lessons of mpox are similar to those from the COVID-19 experience,” said Dr Joanne Liu, a member of The Independent Panel. “Tools like vaccines were not prioritised for the people who needed them most. And the one tool that would have made the biggest difference – an affordable, rapid diagnostic test that could be used in communities – still does not exist.”
Lessons must be applied and not only learned
Lessons from mpox are being relearned in 2026, Independent Panel Co-Chairs Helen Clark and Ellen Johnson Sirleaf write in the report’s foreword.
“The Ebola Bundibugyo virus has caused two prior outbreaks in this century. Yet it too surprised the world in 2026, and communities affected were stranded with no near point-of-care tests, no vaccines, no treatments, and eroded trust in government and institutions. A world that cannot manage known diseases will not be ready for Disease X, the next pandemic threat.”
Mpox is now global
The consequences are still unfolding. In 2026, 82 countries have confirmed more than 14,000 cases. Madagascar, which had never previously recorded an mpox case, now faces the world’s largest outbreak of 2026 with more than 3,400 cases and 22 deaths as of mid-August. In the EU/EEA in the last 12 months, almost 3,800 confirmed mpox cases were reported, and among people with known travel history, most had not travelled, indicating local transmission. People continue to be affected in the Democratic Republic of the Congo, where health workers must manage multiple health challenges, including Ebola.
Focus on community systems to avoid emergencies
The report concludes that diseases like mpox must be integrated into broader community-based health programmes in endemic regions, backed by diagnostic and prevention tools, livelihood support, and a One Health approach.
“Instead of parachuting in emergency funds for community engagement, leaving behind posters that fade on clinic walls, communities must be supported through sustained investment that builds lasting resilience,” said Dr Torreele. “A response should not only be evaluated through numbers of cases, countries affected, or doses of vaccines deployed, but also by how it leaves communities at risk better prepared and able to stay healthy.”
The report is the result of a review of literature and in-depth conversations with people directly involved in the two mpox emergencies and in ongoing mpox research. The lessons explained in the report are considered in the context of the main recommendations of The Independent Panel to address gaps in pandemic prevention, preparedness, and response as set out in its 2021 report, COVID-19: Make it the Last Pandemic.