Mpox in West Africa: Complexity Beyond the Global Alert Lift

African Security Analysis (ASA) Epidemiological Report

Strategic Overview

Despite the WHO’s September 2025 announcement ending the designation of Mpox as a “Public Health Emergency of International Concern,” West Africa continues to face a complex and deteriorating epidemiological situation. Multiple states are reporting fresh outbreaks, resurgent clusters, or evidence of local transmission. The region’s porous borders, high mobility, and fragile surveillance infrastructure are amplifying risks of transnational spread.

Continental Situation

• Total reported cases (2025, Africa-wide): 24,272
• Confirmed cases: 6,034
• Deaths: ~260
• Countries with active transmission: 15
• Countries officially in control phase: 7

Although aggregate numbers show decline compared to peak years, the persistence and reemergence of localized outbreaks indicate latent vulnerability in health systems across the continent.

National Focal Points

Sierra Leone – Epicentre of West African Surge

• >4,000 confirmed cases and 25 deaths (as of 17 June 2025).
• Primarily affecting young adults, raising fears of hidden community chains.
• Epidemiologists suspect either cross-border importation or cryptic sustained transmission.
• High migration flows and weak cross-border controls make the country a regional amplifier.

Guinea – New Major Outbreak Zone

• 271 confirmed cases (21 July 2025) across 15 districts.
• 55 recoveries, 1 death, and 241 contacts under surveillance.
• Rapid spread has triggered heightened surveillance in Mali, which shares a long frontier with Guinea.
• The outbreak risks creating a northward corridor of transmission into Sahel states.

Senegal – Emergence of Local Transmission

• First imported case in August 2025, fully recovered.
• Second case (22 September 2025): local resident of Dakar, no travel history.
• Confirms local transmission in the capital, with at least 20 contacts under monitoring.
• No link between the two confirmed cases → suggests diffuse, independent viral circulation.

Ghana – Unexpected Resurgence

• From two cases in 2024 to 21 new cases in 2025.
• Represents a failure of sustained control measures despite earlier international praise.
• Demonstrates how preventive frameworks can erode when vigilance drops.

Ivory Coast – Dual Clade Complexity

• First-time documented co-circulation of clades IIa and IIb.
• 28 confirmed cases, 1 death (as of 20 August 2025).
• Genomic sequencing underway to track clade evolution.
• While officially in “control phase,” this genetic diversity raises concern over mutation risks and epidemiological unpredictability.

WHO Announcement vs. Ground Reality

While the WHO decision to lift emergency status was based on falling continental averages, the localized flare-ups in West Africa show contradictory ground realities. Key concerns:

• Emergence of independent local transmission chains (Senegal).
• Rapid outbreak geographic expansion (Guinea).
• Resilience of epicentres (Sierra Leone).
• Genetic diversification of the virus (Ivory Coast).

These patterns underline the fragility of surveillance and the gap between official declarations and operational health realities.

Vaccination Progress

• 950,000+ doses administered continent-wide.
• DRC accounts for 69% of vaccinations delivered.
• Nine countries currently rolling out vaccination: DRC, Sierra Leone, Uganda, Angola, Liberia, Rwanda, Nigeria, Guinea, and Ivory Coast.
• Progress is uneven, with supply and logistical constraints limiting reach in rural or conflict-affected zones.

Strategic Implications

• Health Systems: Fragile national systems risk being overwhelmed by simultaneous outbreaks.
• Regional Security: Border spillovers may overlap with pre-existing instability (Sahel, Great Lakes).
• Economic Impact: Labor disruptions, trade slowdowns, and costs of emergency measures may accumulate.
• Global Perception: Prematurely lifting emergency status risks undermining trust if flare-ups escalate.

Strategic Advisory Note

West Africa is consolidating into a primary hotspot for Mpox resurgence, challenging the perception of global stabilization. The convergence of unseen community transmission, viral genetic diversification, and high regional mobility makes the region highly vulnerable to cross-border escalation. This reality demands reinforced surveillance, rapid-response deployments, and cross-sector preparedness.

ASA is positioned to provide decision-grade support through:

• Discrete Epidemiological Tracking — continuous monitoring at district and border levels to detect early spread.
• Impact and Exposure Assessments — tailored analysis for governments, investors, and humanitarian actors to manage operational risks.
• Scenario and Contingency Planning — structured forecasting and resource-allocation frameworks to anticipate outbreak trajectories and mitigate impact.