Unlock the White House Watch newsletter for free
Your guide to what Trump’s second term means for Washington, business and the world
More than a dozen African countries are struggling to contain an outbreak of mpox after cuts to US and European aid left fragile health systems ill-prepared to fight the spreading virus.
More than 21,000 cases have been recorded in at least 13 countries this year — already more than the 19,738 diagnoses across all of 2024, according to the Africa Centres for Disease Control and Prevention. By the end of 2025, it could be double last year’s tally, said Africa CDC’s mpox manager Ngashi Ngongo.
Health workers in Malawi, Sierra Leone and several other countries said losing US and European support had severely compromised their ability to deal with such outbreaks. The US Agency for International Development was in effect shut down in February under Elon Musk’s cost-cutting drive, while several big European economies have slashed their aid budgets.
“On one side we hear about the health financing crisis that is going on but at the same time we also have the outbreaks that continue on the continent,” said Ngongo. “We’re called to deliver results but at the same time with much greater efficiency to manage more than one outbreak with limited resources.”
Mpox, a so-called zoonotic disease that has jumped from animals to humans, causes skin rashes and mouth sores. In severe cases, it can lead to brain inflammation, sepsis and even death. There are two types of the virus, both of which can be spread through sex and other forms of close contact.
There have been 200 confirmed fatalities in Africa since the start of 2024 and more than 1,000 other suspected deaths, according to the Africa CDC. Cases have been detected in more than 120 countries worldwide since May 2022, including four people in the US this year who had recently travelled to affected African countries.
The risk of further mpox transmission is “high” within Africa and the risk of “international spread outside of Africa” is “moderate particularly through travel-linked transmission”, according to a paper by the World Health Organization and Africa CDC.
Sierra Leone has been hit particularly hard, with more than 3,000 cases since January and making up 41 per cent of all new infections in the past week, according to Africa CDC.
Some patients have been asked to stay at home given the limited capacity at state-run centres, although the government recently opened a 400-bed facility in the capital.
The cash-strapped administration of President Julius Maada Bio in Sierra Leone, a country of 9mn people, says it needs more external help to stop the epidemic spreading. The US supported Sierra Leone during the Ebola crisis more than a decade ago and was helping to pay for mpox monitoring before the USAID was abruptly dismantled.
Charles Senessie, deputy health minister, told the AFP news agency that his government was working “round the clock”, but said “we will continue to ask [foreign donors] for their assistance for the necessary resources to respond to the rising cases”.
The Democratic Republic of Congo is at the epicentre of the crisis, with more than 24,000 cases detected since the start of last year, while Malawi is the latest country to record an outbreak.
About 60 per cent of Malawi’s health budget is funded by foreign aid, said Peter Phiri, Water Aid’s country head in Malawi, leaving it vulnerable to cuts.
“We have a weak health system,” said Phiri, adding that the loss of US aid had particularly affected HIV programmes. “People who are immunocompromised can be targets of this virus.”
Uganda, Sierra Leone and DR Congo account for 87 per cent of all new confirmed mpox cases in the past week, with monitoring in these countries described as “passive”, suggesting there could be more cases going unreported.
Eleven African countries have received vaccines and seven are now vaccinating residents, with almost 700,000 people receiving at least one dose of the jabs. But supply remains tight, and Sierra Leone has received only 50,000 of the 280,000 vaccines it requested. DR Congo made a donation of 75,000 vaccines to Sierra Leone in the past week, the Africa CDC said.
