The New Face of an Old Threat
Mpox virus (MPXV), once largely contained to Central and West Africa, has re-emerged as a serious global health challenge. A recent review published in Frontiers in Public Health outlines how ecological disruption, waning population immunity, and shifting transmission patterns have enabled MPXV to spread across more than 100 countries in recent years.
What’s Driving the Global Resurgence?
The global mpox outbreaks of 2022–2023 revealed fundamental changes in how the virus spreads and whom it affects. Once driven primarily by zoonotic spillover from wildlife to humans, mpox is now increasingly sustained by human-to-human transmission, especially in dense urban environments.
Key drivers of this shift include:
- Waning immunity after the cessation of smallpox vaccination
- Superspreading events and close-contact transmission networks
- Genomic mutations suggesting adaptation under human transmission pressure
- Deforestation and urban encroachment increasing spillover risk
Although the Modified Vaccinia Ankara (MVA-BN) vaccine and antivirals like tecovirimat offer strong tools for prevention and treatment, global access remains highly inequitable. Endemic regions in Africa continue to face critical shortages, even as higher-income countries have secured stockpiles.
Clinical Variability and At-Risk Populations
Mpox symptoms have diversified significantly since the virus began spreading globally. In contrast to the classic presentation of fever, widespread rash, and lymphadenopathy, many recent cases have shown genital- or perianal-localized lesions, mild systemic symptoms, or even asymptomatic transmission.
While most cases are self-limiting, severe disease—including encephalitis, sepsis, ocular complications, and fetal loss—can occur, especially in:
- Immunocompromised individuals, including those with advanced HIV
- Pregnant individuals
- Young children in regions where more virulent clades circulate
Data from recent outbreaks indicate much higher case fatality rates among these groups, with hospital-based mortality exceeding 20% in severely immunosuppressed patients.
Why Mpox Matters for National Health Security
The resurgence of mpox is not just a clinical challenge—it’s a signal of broader system failure. Just as a city ignoring infrastructure warnings can be overwhelmed by preventable disasters, neglecting zoonotic surveillance, vaccination programs, and outbreak response systems puts nations at risk.
For the public, mpox may seem distant. But its spread illustrates how underinvestment in disease prevention anywhere can pose a threat everywhere. With climate change and ecological degradation increasing the frequency of spillover events, mpox offers a timely warning for future preparedness.
Closing the Gaps: From Research to Equity
The authors identify several critical priorities to mitigate the risk of mpox becoming entrenched:
- Clarifying MPXV ecology: The virus’s natural reservoir remains unidentified, complicating targeted spillover prevention.
- Understanding respiratory transmission: Evidence remains inconclusive on the extent of airborne spread in real-world conditions, especially in healthcare settings.
- Closing vaccine access gaps: While MVA-BN shows 85–90% protection, endemic regions face ongoing shortages due to high costs and infrastructure barriers.
- Improving diagnostic reach: Decentralized, rapid diagnostics are essential, particularly in areas with limited lab capacity.
- Combating stigma and misinformation: Outbreaks have disproportionately affected marginalized communities, and stigma continues to hinder early detection and care-seeking.
Mpox serves as a barometer of global pandemic readiness. The tools to control it exist—effective vaccines, antiviral therapies, and proven public health interventions—but their reach is uneven and unsustained. The 2022–23 outbreaks should be seen not as isolated anomalies, but as signals of how quickly regional pathogens can become global risks in the absence of equity and coordination.
Addressing mpox will require not only short-term outbreak control, but long-term investments in One Health systems, vaccine manufacturing, and international solidarity. The virus has changed—and so must our response.
Malla A, Saleh FM. The resurgence of monkeypox virus: a critical global health challenge and the need for vigilant intervention. Frontiers in Public Health, 29 May 2025