As Africa battles a relentless mpox outbreak, a sudden freeze in United States foreign aid is crippling containment efforts, threatening vaccine distribution, and leaving the hardest-hit regions scrambling for solutions, the Africa Centres for Disease Control and Prevention (Africa CDC) warned on Thursday.

In conflict-ridden Democratic Republic of Congo (DRC), the epicentre of the outbreak, mpox testing has plummeted due to the freeze in USAID activities.

In Uganda, an experimental new vaccine trial for the Sudan variant of Ebola offers a glimmer of hope of a means to prevent the deadly Sudan variant from spreading – one bright spot on the horizon.  

For years, US government funding—particularly through USAID and the President’s Emergency Plan for AIDS Relief (PEPFAR)—has been a cornerstone of Africa’s disease surveillance and outbreak response. However, the recent political shifts in Washington DC dealt a significant blow to Africa CDC’s ability to manage the ongoing mpox outbreak. However, with multiple outbreaks raging and resources dwindling, Africa CDC warns that without urgent intervention, the situation could “spiral out of control.”

Transport of mpox tests impacted due to USAID demise

Dr Ngashi Ngongo, head of Africa CDC’s Incident Management Support Team, described the situation as “a major setback for the continent’s health security.”

In the DRC, which is the epicentre of the ongoing mpox outbreak on the continent, the ability to transport samples from remote districts to laboratories has been severely impacted since the USAID had been responsible for transporting samples from hotspots to the central laboratory.

Without timely testing, he said it becomes harder to contain the outbreak. He noted that testing rates have dropped dramatically in some of the hardest-hit areas in the DRC where only 29% of suspected cases are now being tested due to logistical constraints.

Uganda, which has recorded 4,131 suspected mpox cases this year with a test positivity rate of 60%, is experiencing similar disruptions. Even so, DRC recorded a 34% increase in mpox cases reported in the past six weeks, as compared to the six previous ones. Meanwhile, mpox cases in Uganda nearly doubled to 1219 and the Republic of Congo, South Sudan, Zambie and Sierra Leone also saw increases.   

According to Africa CDC, the funding freeze could have further impacts on vaccine distribution and more severely hamper disease surveillance. With budget shortfalls, he argued that epidemiological field teams may not be able to swiftly respond to outbreaks, leading to delayed case detection and increased transmission risks.

Ability to quickly detect and respond to outbreaks weakened

“Without adequate funding, our ability to quickly detect and respond to outbreaks is significantly weakened. Epidemiological field teams are already facing disruptions, and delays in case detection will inevitably lead to more transmissions,” Ngongo said.

Africa CDC also warned that the inability to maintain robust surveillance efforts due to funding shortages could lead to spillover effects. Uganda’s Ebola cases pose a potential risk to the DRC, given the movement of populations between the two nations. Similarly, mpox cases in South Sudan have highlighted the vulnerability of border control measures. Ngongo noted that insecurity in eastern DRC has already complicated outbreak response, and further funding gaps could make containment even more difficult.

“The ongoing funding shortages are not just an issue of logistics; they are a matter of regional security. The movement of populations across borders, especially between Uganda and the DRC, increases the risk of Ebola and mpox spillover. If we cannot sustain robust surveillance, we will see these outbreaks spiral further out of control,” Ngongo warned.

With the withdrawal of U.S. financial support, Africa CDC is intensifying efforts to secure alternative funding sources. Ngongo revealed that China, Japan, and South Korea have stepped in with emergency contributions, but stressed the need for a long-term solution.

To address the funding crisis, the African Union has approved funds from the Africa Epidemics Fund, which aims to provide a financial safety net for health emergencies. Additionally, Rwanda’s President Paul Kagame is leading discussions on bolstering domestic health budgets across the continent. African leaders are also looking into utilizing COVID-19 fund reserves to support ongoing outbreak response efforts. In a bid to secure sustainable financing, officials are exploring private-sector partnerships and innovative financing mechanisms.

Clinical trial underway in Uganda

Clinical trials to evaluate new vaccines and therapeutics are also underway in Uganda to assess the effectiveness of a recombinant vesicular stomatitis virus (VSV) vaccine candidate. The trial, which builds on pre-existing vaccine research, involves 2,160 doses that were already in-country before an additional 10,000 doses were secured for expanded testing. Since the outbreak declaration on January 30, Sudan Ebola Virus in Uganda has led to nine confirmed cases, including five among healthcare workers. One patient has died, while eight remain in treatment.

Mosoka Fallah, Acting Director of the Science and Innovation Directorate at Africa CDC, noted that 214 close contacts of confirmed Ebola cases have been identified and enrolled in the study, with researchers establishing eight vaccination rings to test immediate and delayed immunization strategies. The study aims to determine whether ring vaccination—an approach successfully used to combat Ebola—can effectively contain mpox outbreaks in Africa. The goal is to see how well this vaccine works in real-world settings where mpox is actively spreading. If successful, Africa CDC believes it could be a game-changer in controlling the outbreak, especially in high-risk populations.

“We have already established eight vaccination rings, and seven of them have begun immunization. The strategy follows both immediate and delayed vaccination models to assess how effectively the vaccine can contain further spread,” said Fallah.

The trial is being conducted in collaboration with global health organizations, with researchers closely monitoring vaccine safety, immune responses, and potential side effects. Experts hope that the results will inform broader vaccination strategies across Africa and strengthen the continent’s long-term epidemic preparedness.

Mpox rages on

The mpox outbreak itself continues to spread. In 2025 alone, 16,291 cases have been reported across Africa, with 4,203 confirmed cases and 143 deaths among suspected cases. The outbreak remains active in 13 out of 22 affected countries, with Uganda and the DRC experiencing the highest case burdens.

The DRC remains the hardest-hit country, with 71,704 total notified cases, 15,539 confirmed infections, and 1,443 deaths. The ongoing conflict in the region makes tracking and containing cases even more challenging. Uganda has emerged as a growing hotspot, where young adults aged 18–39 account for 80% of cases.

Urban centers such as Kampala and Wakiso have been identified as key transmission zones. Meanwhile, South Sudan recently reported its first confirmed case of mpox, raising concerns over cross-border spread. In contrast, Burundi is one of the few countries seeing a decline in cases, with a 51% drop in new infections over the past six weeks.

“The numbers speak for themselves—this outbreak is far from over. The Democratic Republic of Congo remains the epicenter, with conflict further complicating response efforts. Uganda is also seeing a sharp increase, particularly among young adults in urban centers. Meanwhile, South Sudan’s first confirmed case is a stark reminder that without urgent intervention, mpox will continue spreading across borders,” Ngongo said.

While the pace of mpox vaccine delivery and distribution had picked up since last October when vaccination began, rollout efforts remain uneven due to logistical challenges. Rwanda received 5,800 doses in early February, while the DRC took delivery of 200,000 doses, though delays in distribution have slowed immunization efforts. Uganda has prioritized sex workers and other high-risk groups, successfully administering 9,000 doses in one week. Liberia, however, is still preparing for vaccine deployment, meaning not all affected countries have begun immunizing at-risk populations.

Despite logistical hurdles, Ngashi noted that public acceptance of mpox vaccination has been overwhelmingly positive. In Uganda, 86% of vaccine recipients are young adults aged 20–49, indicating strong demand for immunization in the most affected demographic.

“The demand for mpox vaccines is high, and we are seeing strong acceptance across affected populations. In Uganda, young adults have responded particularly well to the immunization campaign. However, logistical challenges, especially in the DRC and Liberia, are slowing down the rollout, and we must address these gaps urgently to prevent further spread,” he said.

Beyond mpox, Africa is grappling with multiple concurrent health emergencies, further stretching already limited resources. Among those, Angola is facing a worsening cholera outbreak, with 2,259 cases reported and 75 deaths. Children under 15 account for 40% of all cases and 35% of fatalities. In Tanzania, the Marburg virus continues to pose a threat. Although no new cases have been reported since January 21, 2025, all ten confirmed cases resulted in fatalities, marking a 100% case fatality rate.

Image Credits: Africa CDC .