Many point to vaccines as the epitome of how the response has gone wrong.
Mpox is a vaccine preventable disease and yet, to date, only about 886,000 people have been vaccinated in a dozen African countries. Just over 3 million doses have been delivered to the continent. That's according to Africa CDC, which had previously put the target at 10 million doses available by the end of 2025.
The challenges started early on: When WHO declared the public health emergency it still had not green lit the mpox vaccine.
"It's like: 'Well, you either have an emergency or you don't,'" says Beyrer. At the time, Tedros Adhanom Ghebreyesus, the director-general of WHO, pushed back on the notion that anyone was moving slowly, saying WHO experts didn't have complete information on which to assess the efficacy and safety of the vaccines. "We will not take shortcuts," he said.
The U.S. vaccine donation is an example of a pledge that failed to fully materialize. Former President Biden promised to send 1 million doses to Africa in September 2024. However, as of July 2025, only about 90,000 had made it to the continent. Of the remaining doses about half are now too close to their expiration date to ship, according to Yap Boum, the deputy head of Africa CDC's mpox response.
"They can no longer be sent to the continent, which is a huge loss, because that one dose of vaccine is $100," Boum says.
In Kenya, nurse Mugun -- who works for Doctors Without Borders -- says people want the mpox vaccine but the country has not yet launched an immunization program.
The U.S. Centers for Disease Control and Prevention as well as the Department of Health and Human Services did not respond to NPR's request for comment on the U.S. vaccine pledge.
Mpox researchers and doctors say the lackluster global response portends poorly for mpox's future potential as well as other disease threats.
Titanji of Emory University worries the lack of response may undercut the value of the WHO alert system. Same with Africa CDC's emergency declaration which marked the first time the body ever issued a Public Health Emergency of Continental Security. "If we have had the highest level of alert for 12 months on a particular emergency, and that hasn't really put a dent in the containment, how impactful is this lever?" she asks.
Dr. Jean Kaseya, director-general of Africa CDC, disagrees with the suggestion that not much has happened to contain mpox. "Africa didn't have this capacity. It's now that we are building capacity," he says.
He pointed out that a year ago no African country had granted regulatory approval for the mpox vaccine the U.S. was hoping to send. Now, 17 countries have approved it. Similarly, he says, the laboratory network used to test suspected mpox cases has grown significantly in the hot spots. For example, Burundi had 2 labs capable of testing mpox a year ago and now has 56.
Plus, he adds, this is the first time there's been coordination and collaboration across the continent with an African body helping to lead the charge and fairly allocate resources. Kaseya argues that without the emergency declaration, the resources that have been pledged would not have materialized. Still, he acknowledges, there is a lot more work to be done.
Titanji agrees there is more work to do. She warns that the world is watching in real time as the virus becomes entrenched in the human population. "The virus will evolve the more opportunities that it is given," she says.
Rimoin says, so far this mpox emergency the U.S. has been largely spared -- but that may not last. "Diseases we ignore abroad can quickly land on our doorstep," she says. "We've been lucky so far. I don't know how long our luck will hold out."