Mpox outbreak: one more reason we need a strong pandemic agreement

As the world grapples with strengthening health systems in the aftermath of COVID-19, the recent re-emergence of mpox (formerly known as monkeypox) and its declaration as a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) should serve as a wake-up call for all global health leaders.

Despite efforts to rebuild capacity and initiatives to improve health security, our collective response to emerging infectious diseases remains alarmingly fragile. The mpox outbreak signals an urgent need for the international community to bolster pandemic prevention, preparedness, and response capacities, and serves as critical reminder of why we must push forward with negotiating a robust Pandemic Agreement.

Gavi, the Vaccine Alliance has long been at the forefront of global immunisation efforts, supporting countries in protecting their populations against vaccine-preventable diseases. Our work in routine immunisation over the last two decades and the more recent role in the COVID-19 pandemic response demonstrated that health security and strong pandemic responses are not just about having the right vaccines available – though they remain a crucial tool in outbreak responses – but that it is also about having the right systems and structures in place to enable collaboration for rapid action. The re-emergence of mpox provides a clear lesson for why a new Pandemic Agreement will prove essential for future responses and help address the global gaps we continue to face.

Mpox demonstrates the need to speed up global PPPR collaboration

When mpox began spreading across non-endemic countries in 2022, it was apparent that there were still gaps in essential tools and systems for agile responses – inadequate surveillance, insufficient vaccines available for key target populations in low- and middle-income countries, and limited diagnostic capacity in many countries with significant numbers of infected persons. Since the first public health emergency of international concern was declared over in 2023, little about the situation has changed – many of these gaps remain over a year later.

We must commend Africa CDC and the WHO for quickly declaring a Public Health Emergency of Continental Security and a Public Health Emergency of International Concern, respectively, in response to the recent expansion of the mpox outbreak. Their swift declarations allow the global health community to unlock key resources and capacity for the response. However, uncertainties remain in the process to get key doses in arms –potential weaknesses that a Pandemic Agreement, and related investments in PPPR, could help to address.

How the Pandemic Agreement can help

The global health community has been actively engaged in negotiations for a Pandemic Agreement – a comprehensive, binding framework under the WHO constitution intended to better prevent, prepare for, and respond to future pandemics. The Agreement presents a unique opportunity to take the lessons learned from past outbreaks like COVID-19, and the current mpox outbreak, to ensure the world is better equipped for future health security threats. The Agreement, once adopted, could lead to significant health security improvements on several fronts:

1. Increasing equitable access to vaccines, therapeutics and diagnostics: The COVID-19 pandemic underscored the dangers of uneven access to vaccines and other essential medical countermeasures. This inequity is precisely what the Pandemic Agreement seeks to address through the Pathogen Access and Benefit Sharing system – establishing an equitable system for access and distribution from the outset in real time, regardless of income level. Gavi’s experience with COVID-19 and other outbreaks show that an equitable system agreed upon by all Member States is and will continue to be critical for stopping the spread of infectious diseases worldwide.
2. Strengthened surveillance and early warning systems: One of the most significant factors in addressing the mpox outbreak is, and will continue to be, strong surveillance and early warning systems. Effective pandemic preparedness requires real-time data sharing, coordinated responses, and the ability to rapidly detect and track emerging pathogens, particularly as they spread across borders. The Pandemic Agreement could play a key role in increasing investments in global surveillance infrastructure, including sharing of pathogen information and genomic sequencing. Such measures, alongside strong investments in the health workforce that are a pivotal part of the Agreement, are critical for stopping outbreaks before they spread into global health emergencies.
3. Sustainable financing for prevention, preparedness, and response: Sustainable, long-term investment and a well-coordinated global governance structure are critical to successfully limiting the chances of an outbreak, and being sufficiently responsive when a pandemic occurs. The proposed Pandemic Agreement establishes dedicated coordinating financial mechanisms and frameworks that would help countries to prioritize investments in key capacities.

Learning lessons from this outbreak

The resurgence of mpox serves as a stark reminder that infectious diseases do not respect borders, and neither should our pandemic prevention, preparedness, and response efforts. Many of the challenges from the last mpox outbreak remain and we must better equip ourselves for these moments – this begins with a strong Pandemic Agreement that has equity and solidarity at its core.

The path to a successful Pandemic Agreement will not be without challenges. We know that negotiators will need to balance national interests with global public goods, and the agreement must be flexible enough to adapt to future unknowns. However, the stakes are too high to settle for anything less than an ambitious and binding framework. Gavi’s experience in mobilizing global cooperation to deliver vaccines to the most vulnerable populations demonstrates that when countries come together in solidarity, we can achieve remarkable outcomes.

If we are to prevent future health crises and save lives, we need a system that prioritizes equity, invests in prevention and preparedness, and fosters global cooperation. We have the tools, knowledge, and experience; now we need the political will and collective action to make it a reality.