Women today are more likely than ever to survive pregnancy and childbirth according to a major new report released today, but United Nations (UN) agencies highlight the threat of major backsliding as unprecedented aid cuts take effect around the world.

Released on World Health Day, the UN report, Trends in maternal mortality, shows a 40% global decline in maternal deaths between 2000 and 2023 – largely due to improved access to essential health services. Still, the report reveals that the pace of improvement has slowed significantly since 2016, and that an estimated 260 000 women died in 2023 as a result of complications from pregnancy or childbirth – roughly equivalent to one maternal death every two minutes.

The report comes as humanitarian funding cuts are having severe impacts on essential health care in many parts of the world, forcing countries to roll back vital services for maternal, newborn and child health. These cuts have led to facility closures and loss of health workers, while also disrupting supply chains for lifesaving supplies and medicines such as treatments for haemorrhage, pre-eclampsia and malaria – all leading causes of maternal deaths.

Without urgent action, the agencies warn that pregnant women in multiple countries will face severe repercussions – particularly those in humanitarian settings where maternal deaths are already alarmingly high.

“While this report shows glimmers of hope, the data also highlights how dangerous pregnancy still is in much of the world today despite the fact that solutions exist to prevent and treat the complications that cause the vast majority of maternal deaths,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO). “In addition to ensuring access to quality maternity care, it will be critical to strengthen the underlying health and reproductive rights of women and girls – factors that underpin their prospects of healthy outcomes during pregnancy and beyond.”

The report also provides the first global account of the COVID-19 pandemic’s impact on maternal survival. In 2021, an estimated 40 000 more women died due to pregnancy or childbirth – increasing to 322 000 from 282 000 the previous year. This upsurge was linked not only to direct complications caused by COVID-19, but also widespread interruptions to maternity services. This highlights the importance of ensuring such care during pandemics and other emergencies, noting that pregnant women need reliable access to routine services and checks as well as round-the-clock urgent care.

“When a mother dies in pregnancy or childbirth, her baby’s life is also at risk. Too often, both are lost to causes we know how to prevent,” said UNICEF Executive Director Catherine Russell. “Global funding cuts to health services are putting more pregnant women at risk, especially in the most fragile settings, by limiting their access to essential care during pregnancy and the support they need when giving birth. The world must urgently invest in midwives, nurses, and community health workers to ensure every mother and baby has a chance to survive and thrive.”

The report highlights persistent inequalities between regions and countries, as well as uneven progress. With maternal mortality declining by around 40% between 2000 and 2023, sub-Saharan Africa achieved significant gains – and was one of just three UN regions alongside Australia and New Zealand, and Central and Southern Asia, to see significant drops after 2015. However, confronting high rates of poverty and multiple conflicts, the sub-Saharan Africa region still counted for approximately 70% of the global burden of maternal deaths in 2023.

Indicating slowing progress, maternal mortality stagnated in five regions after 2015: Northern Africa and Western Asia, Eastern and South-Eastern Asia, Oceania (excluding Australia and New Zealand), Europe and North America, and Latin America and the Caribbean.

“Access to quality maternal health services is a right, not a privilege, and we all share the urgent responsibility to build well-resourced health systems that safeguard the life of every pregnant woman and newborn,” said Dr Natalia Kanem, UNFPA’s Executive Director. “By boosting supply chains, the midwifery workforce, and the disaggregated data needed to pinpoint those most at risk, we can and must end the tragedy of preventable maternal deaths and their enormous toll on families and societies.”

Pregnant women living in humanitarian emergencies face some of the highest risks globally, according to the report.Nearly two-thirds of global maternal deaths now occur in countries affected by fragility or conflict. For women in these settings, the risks are staggering: a 15-year-old girl faces a 1 in 51 risk of dying from a maternal cause at some point over her lifetime compared to 1 in 593 in more stable countries. The highest risks are in Chad and the Central African Republic (1 in 24), followed by Nigeria (1 in 25), Somalia (1 in 30), and Afghanistan (1 in 40).

Beyond ensuring critical services during pregnancy, childbirth and the postnatal period, the report notes the importance of efforts to enhance women’s overall health by improving access to family planning services, as well as preventing underlying health conditions like anaemias, malaria and noncommunicable diseases that increase risks. It will also be critical to ensure girls stay in school and that women and girls have the knowledge and resources to protect their health.

Urgent investment is needed to prevent maternal deaths. The world is currently off-track to meet the UN’s Sustainable Development Goal target for maternal survival. Globally, the maternal mortality ratio would need to fall by around 15% each year to meet the 2030 target – significantly increasing from current annual rates of decline of around 1.5%.

Note to editors

About the United Nations Maternal Mortality Estimation Inter-Agency Group
The report was produced by WHO on behalf of the United Nations Maternal Mortality Estimation Inter-Agency Group comprising WHO, UNICEF, UNFPA, the World Bank Group and the Population Division of the United Nations Department of Economic and Social Affairs. It uses national data to estimate levels and trends of maternal mortality from 2000–2023. The data in this new publication covers 195 countries and territories. It supersedes all previous estimates published by WHO and the United Nations Maternal Mortality Estimation Inter-Agency Group.

About the data
The SDG target for maternal deaths is for a global maternal mortality ratio (MMR) of less than 70 maternal deaths per 100 000 live births by 2030. The global MMR in 2023 was estimated at 197 maternal deaths per 100 000 live births, down from 211 in 2020 and from 328 in 2000.

The report includes data disaggregated by the following regions, used for SDG reporting: Central Asia and Southern Asia; Sub-Saharan Africa; Northern America and Europe; Latin America & the Caribbean; Western Asia and Northern Africa; Australia and New Zealand; Eastern Asia and South-eastern Asia, and Oceania excluding Australia and New Zealand.

A maternal death is a death due to complications related to pregnancy or childbirth, occurring when a woman is pregnant, or within six weeks of the end of the pregnancy.

About World Health Day
World Health Day is marked around the world on 7 April. Each year, it draws attention to a specific health topic of concern to people all over the world. The World Health Day 2025 campaign focuses on improving maternal and newborn health and survival with the theme “Healthy beginnings, hopeful futures”. The campaign urges governments and the health community to ramp up efforts to end preventable maternal and newborn deaths, and to prioritize women’s longer-term health and well-being.

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The number of children dying globally before their fifth birthday declined to 4.8 million in 2023, while stillbirths declined modestly, still remaining around 1.9 million, according to two new reports released today by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME).

Since 2000, child deaths have dropped by more than half and stillbirths by over a third, fuelled by sustained investments in child survival worldwide. In 2022, the world reached a historic milestone when child deaths dropped slightly below 5 million for the first time. However, progress has slowed and too many children are still being lost to preventable causes.

“Millions of children are alive today because of the global commitment to proven interventions, such as vaccines, nutrition, and access to safe water and basic sanitation,” said UNICEF Executive Director Catherine Russell. “Bringing preventable child deaths to a record low is a remarkable achievement. But without the right policy choices and adequate investment, we risk reversing these hard-earned gains, with millions more children dying from preventable causes. We cannot allow that to happen.”

Decades of progress in child survival are now at risk as major donors have announced or indicated significant funding cuts to aid ahead. Reduced global funding for life-saving child survival programmes is causing health-care worker shortages, clinic closures, vaccination programme disruptions, and a lack of essential supplies, such as malaria treatments. These cuts are severely impacting regions in humanitarian crises, debt-stricken countries, and areas with already high child mortality rates. Global funding cuts could also undermine monitoring and tracking efforts, making it harder to reach the most vulnerable children, the Inter-agency Group warned.

“From tackling malaria to preventing stillbirths and ensuring evidence-based care for the tiniest babies, we can make a difference for millions of families,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “In the face of global funding cuts, there is a need more than ever to step up collaboration to protect and improve children’s health.”

Even before the current funding crisis, the pace of progress on child survival had already slowed. Since 2015, the annual rate of reduction of under-five mortality has slowed by 42%, and stillbirth reduction has slowed by 53%, compared to 2000–2015.

Almost half of under-five deaths happen within the first month of life, mostly due to premature birth and complications during labour. Beyond the newborn period, infectious diseases, including acute respiratory infections such as pneumonia, malaria, and diarrhoea, are the leading causes of preventable child death. Meanwhile, 45% of late stillbirths occur during labour, often due to maternal infections, prolonged or obstructed labour, and lack of timely medical intervention.

Better access to quality maternal, newborn, and child health care at all levels of the health system will save many more lives, according to the reports. This includes promotive and preventive care in communities, timely visits to health facilities and health professionals at birth, high-quality antenatal and postnatal care, well-child preventive care such as routine vaccinations and comprehensive nutrition programmes, diagnosis and treatment for common childhood illnesses, and specialized care for small and sick newborns.

“Most preventable child deaths occur in low-income countries, where essential services, vaccines, and treatments are often inaccessible”, said Juan Pablo Uribe, World Bank Global Director for Health and Director of the Global Financing Facility. “Investing in children’s health ensures their survival, education, and future contributions to the workforce. With strategic investments and strong political will, we can continue to reduce child mortality, unlocking economic growth and employment opportunities that benefit the entire world.”

The reports also show that where a child is born greatly influences their chances of survival. The risk of death before age five is 80 times higher in the highest-mortality country than the lowest-mortality country, for example, while a child born in sub-Saharan Africa is on average 18 times more likely to die before turning five than one born in Australia and New Zealand. Within countries, the poorest children, those living in rural areas, and those with less-educated mothers face the higher risks.

Stillbirth disparities are just as severe, with nearly 80% occurring in sub-Saharan Africa and Southern Asia, where women are six to eight times more likely to experience a stillbirth than women in Europe or North America. Meanwhile, women in low-income countries are eight times more likely to experience a stillbirth than those in high-income countries.

“Disparities in child mortality across and within nations remain one of the greatest challenges of our time,” said the UN DESA Under-Secretary-General, Li Junhua. “Reducing such differences is not just a moral imperative but also a fundamental step towards sustainable development and global equity. Every child deserves a fair chance at life, and it is our collective responsibility to ensure that no child is left behind.”

UN IGME members call on governments, donors, and partners across the private and public sectors to protect the hard-won gains in saving children’s lives and accelerate efforts. Increased investments, service integration, and innovations are urgently needed to scale up access to proven life-saving health, nutrition, and social protection services for children and pregnant mothers.    

Notes to editors

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The UN IGME child mortality report

The UN IGME stillbirth report

The two reports – Levels & Trends in Child Mortality and Counting Every Stillbirth – are the first of a series of important global data sets released in 2025. UN maternal mortality figures will be published in the coming weeks.

About UN IGME

The United Nations Inter-agency Group for Child Mortality Estimation or UN IGME was formed in 2004 to share data on child mortality, improve methods for child mortality estimation, report on progress towards child survival goals and enhance the capacity of countries to produce timely and properly evaluated estimates of child mortality. UN IGME is led by UNICEF and includes the World Health Organization, the World Bank Group and the Population Division of the United Nations Department of Economic and Social Affairs.

 For more information: http://www.childmortality.org/

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The World Health Organization (WHO) today published its first-ever reports addressing the critical lack of medicines and diagnostic tools for invasive fungal diseases, showing the urgent need for innovative research and development (R&D) to close these gaps.

Fungal diseases are an increasing public health concern, with common infections – such as candida, which causes oral and vaginal thrush – growing increasingly resistant to treatment. These infections disproportionately impact severely ill patients and those with weakened immune systems, including individuals undergoing cancer chemotherapy, living with HIV, and who have had organ transplants.

“Invasive fungal infections threaten the lives of the most vulnerable but countries lack the treatments needed to save lives,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Antimicrobial Resistance ad interim. “Not only is the pipeline of new antifungal drugs and diagnostics insufficient, there is a void in fungal testing in low- and middle-income countries, even in district hospitals. This diagnostic gap means the cause of people’s suffering remains unknown, making it difficult to get them the right treatments.”

The fungi in the top ‘critical priority’ category of the WHO’s fungal priority pathogens list (FPPL) are deadly, with mortality rates reaching as high as 88%. Advancements in treatments mean that more people are likely to be living with immunocompromised conditions, which also could mean increases in cases of invasive fungal diseases. This is a complex challenge to manage due to inaccessibility of diagnostic tools, limited availability of antifungal medicines, and a slow and complex R&D process for new treatments.

Constrained process in developing treatments against deadly fungal infections

WHO’s report on antifungal drugs highlights that, in the past decade, only four new antifungal drugs have been approved by regulatory authorities in the United States of America, the European Union or China. Currently, nine antifungal medicines are in clinical development to use against the most health-threatening fungi, as detailed in the FPPL.

However, only three candidates are in phase 3, the final stage of clinical development, meaning few approvals are expected within the next decade. Twenty-two drugs are in preclinical development, an insufficient number to feed a clinical pipeline considering the dropout rates, risks and challenges associated with earlier development stages.

Issues with current antifungal treatments include serious side effects, frequent drug-drug interactions, limited dosage forms and the need for prolonged hospital stays. The report highlights the urgent need for safer antifungal medicines, possibly reducing requirements for continuous drug monitoring.

Antifungal medicines that work against a wide range of severe infections caused by fungal priority pathogens are also needed. Children are particularly underserved with few clinical trials exploring paediatric dosing and age-appropriate formulations.

WHO recommends investing in global surveillance, expanding financial incentives for drug discovery and development, funding basic research to help identify new and unexploited targets on fungi for medicines, and investigating treatments that work by enhancing patients’ immune responses.

Landscape report of diagnostics for fungal priority pathogens

The new diagnostics report shows that while commercially available tests exist for fungal priority pathogens, these rely on well-equipped laboratories and trained staff, which means that most people in in low- and middle-income countries (LMICs) do not benefit from them. All countries, but particularly LMICs, need faster, more accurate, cheaper and easier testing for a broad range of fungal priority pathogens, including diagnostic tools that can be used at or near point-of-care.

There are many challenges with existing antifungal diagnostics; they work only for a limited range of fungi, are insufficiently accurate and take a long time to obtain results. Most of the tests are not well suited to primary and secondary health facilities as certain diagnostics require stable electricity supplies within suitable and equipped laboratories.

Health workers often have insufficient knowledge about fungal infections as well as the impact of fungi growing more resistant to treatments, resulting in limited ability to perform the testing needed to determine the appropriate treatment. WHO calls for strengthening the global response against invasive fungal diseases and antifungal resistance, and is also developing an implementation blueprint for the FPPL.

Sourced from WHO

Sourced from WHO

On the occasion on World Tuberculosis (TB) Day, marked on 24 March, the World Health Organization (WHO) is calling for an urgent investment of resources to protect and maintain tuberculosis (TB) care and support services for people in need across regions and countries. TB remains the world’s deadliest infectious disease, responsible for over 1 million deaths annually bringing devastating impacts on families and communities.

Global efforts to combat TB have saved an estimated 79 million lives since 2000. However, the drastic and abrupt cuts in global health funding happening now are threatening to reverse these gains. Rising drug resistance especially across Europe and the ongoing conflicts across the Middle-East, Africa and Eastern Europe, are further exacerbating the situation for the most vulnerable.

 Under the theme Yes! We Can End TB: Commit, Invest, Deliver, World Tuberculosis Day 2025 campaign highlights a rallying cry for urgency, and accountability and hope. “The huge gains the world has made against TB over the past 20 years are now at risk as cuts to funding start to disrupt access to services for prevention, screening, and treatment for people with TB,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But we cannot give up on the concrete commitments that world leaders made at the UN General Assembly just 18 months ago to accelerate work to end TB. WHO is committed to working with all donors, partners and affected countries to mitigate the impact of funding cuts and find innovative solutions.”

Funding: threat to global TB efforts

Early reports to WHO reveal that severe disruptions in the TB response are seen across several of the highest-burden countries following the funding cuts. Countries in the WHO African Region are experiencing the greatest impact, followed by countries in the WHO South-East Asian and Western Pacific Regions. Twenty seven countries are facing crippling breakdowns in their TB response, with devastating consequences, such as:

Nine countries report failing TB drug procurement and supply chains, jeopardizing treatment continuity and patient outcomes.

The 2025 funding cuts further exacerbate an already existing underfunding for global TB response. In 2023, only 26% of the US$ 22 billion annually needed for TB prevention and care was available, leaving a massive shortfall. TB research is in crisis, receiving just one-fifth of the US$ 5 billion annual target in 2022 – severely delaying advancements in diagnostics, treatments, and vaccines. WHO is leading efforts to accelerate TB vaccine development through the TB Vaccine Accelerator Council, but progress remains at risk without urgent financial commitments.

Joint statement with civil society

In response to the urgent challenges threatening TB services worldwide, WHO’s Director-General and Civil Society Task Force on Tuberculosis have issued a decisive statement. The joint statement released this week, demands immediate, coordinated efforts from governments, global health leaders, donors, and policymakers to prevent further disruptions. The statement outlines five critical priorities:

“This urgent call is timely and underscores the necessity of swift, decisive action to sustain global TB progress and prevent setbacks that could cost lives,” said Dr Tereza Kasaeva, Director of WHO’s Global Programme on TB and Lung Health. “Investing in ending TB is not only a moral imperative but also an economic necessity – every dollar spent on prevention and treatment yields an estimated US$ 43 in economic returns.”

New guidance on TB and lung health

As one of the solutions to combating growing resource constraints, WHO is driving the integration of TB and lung health within primary healthcare as a sustainable solution. New technical guidance released by WHO outlines critical actions across the care continuum, focusing on prevention, early detection of TB and comorbidities, optimized management at first contact and improved patient follow-up. The guidance also promotes better use of existing health systems, addressing shared risk factors such as overcrowding, tobacco, undernutrition and environmental pollutants.

By tackling TB determinants alongside communicable and non-communicable diseases, lung conditions, and disabilities through a unified strategy, WHO aims to reinforce the global response and drive lasting improvements in health outcomes.

On World TB Day, WHO calls on everyone: individuals, communities, societies, donors and governments, to do their part to end TB. Without concerted action from all stakeholders, the TB response will be decimated, reversing decades of progress, putting millions of lives at risk and threatening health security.

Editor’s note

On 24 March 2025, a correction was made to the second sentence in the first paragraph of this news release as noted below.

The sentence in the original news release read:

TB remains the world’s deadliest infectious disease, responsible for over 1 million people annually bringing devastating impacts on families and communities.

This was changed to:

TB remains the world’s deadliest infectious disease, responsible for over 1 million deaths annually bringing devastating impacts on families and communities.

Sourced from WHO

Sourced from WHO

Sourced from WHO

The Director-General of the World Health Organization (WHO) is hereby transmitting the report of the third meeting of the International Health Regulations (2005) (IHR) Emergency Committee (Committee) regarding the upsurge of mpox 2024, held on Tuesday, 25 February 2025, from 12:00 to 17:00 CET.

Concurring with the advice unanimously expressed by the Committee during the meeting, the WHO Director-General determined that the upsurge of mpox 2024 continues to meet the criteria of a public health emergency of international concern (PHEIC) and, accordingly, on 27 February 2025, issued temporary recommendations to States Parties.

The WHO Director-General expresses his most sincere gratitude to the Chair, Members, and Advisors of the Committee.

Proceedings of the meeting

Sixteen (16) Members of, and two Advisors to, the International Health Regulations (2005) (IHR) Emergency Committee (Committee) were convened by teleconference, via Zoom, on Tuesday, 25 February 2025, from 12:00 to 17:00 CET. Fourteen (14) of the 16 Committee Members, and one of the two Advisors to the Committee participated in the meeting.

On behalf of the Director-General of the World Health Organization (WHO), the Deputy Director-General welcomed Members of and Advisors to the Committee, as well as Government Officials designated to present their views to the Committee on behalf of the ten invited States Parties – Burundi, Canada, China, the Democratic Republic of the Congo (DRC), Nepal, Nigeria, Sierra Leone, Uganda, United Arab Emirates and United Kingdom of Great Britain and Northern Ireland (United Kingdom).

In his opening remarks, the WHO Deputy Director-General recalled that, on 14 August 2024, the upsurge of mpox was determined to constitute a public health emergency of international concern (PHEIC). He noted that, over the three years from 1 January 2022 through 31 January 2025, almost 130 000 confirmed cases of mpox, including over 280 deaths, were reported to WHO from 130 countries and territories in all six WHO Regions, including seven countries and territories that had reported their first mpox cases since the previous meeting of the Committee on 22 November 2024. The WHO African Region, where some States Parties are continuing to experience sustained community transmission, accounts for 61% of the cases and 72% of the deaths reported globally over the past 12 months.

The WHO Deputy Director-General highlighted that, since the last meeting of the Committee, the epidemiological situation continues to be volatile. Despite observed improvements pertaining to several aspects of the response – emergency coordination, surveillance, laboratory diagnostics, empowerment of communities, furthering equitable access to medical countermeasures and tools – several critical challenges had emerged, including: (a) rising geopolitical instability in the DRC due to escalating conflict affecting mpox response operations resulting in temporary pauses in operation, relocation of staff and restricted access to affected populations; (b) concurrent health emergencies requiring States Parties and partners to respond (e.g. Sudan virus disease outbreak in Uganda); and (c) uncertainties related to the pause in financial support from the United States of America (United States) occurring in the broader landscape of declining foreign assistance. To date, globally, one-third of the funds supporting the response to mpox had been pledged by the United States. Without sufficient funds, the ability of States Parties, WHO and partners to maintain, sustain, and expand the response to mpox would be compromised.

The Representative of the Office of Legal Counsel then briefed the Members and Advisors on their roles and responsibilities and identified the mandate of the Committee under the relevant articles of the IHR. The Ethics Officer from the Department of Compliance, Risk Management, and Ethics provided the Members and Advisors with an overview of the WHO Declaration of Interests process. The Members and Advisors were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or actual conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and the work of the Committee. Each Member and Advisor was surveyed, with no conflicts of interest identified.

The meeting was handed over to the Chair who introduced the objectives of the meeting, which were to provide views to the WHO Director-General on whether the event continues to constitute a PHEIC, and if so, to provide views on the potential proposed temporary recommendations.

Session open to representatives of States Parties invited to present their views

The WHO Secretariat presented an overview of the global epidemiological situation of mpox, including all circulating clades of monkeypox virus (MPXV). Outside the WHO African Region, cases of mpox reported to WHO are associated with the spread of MPXV clade IIb, with a decline in the number of cases reported in recent months. In the WHO African Region, amid the circulation of multiple MPXV clades, the still growing number of cases reported monthly is driven by the spread of MPXV clade Ib. Since the Committee last met, on 22 November 2024, exported travel-related cases of confirmed MPXV clade Ib infection have been detected in eight additional countries outside the WHO African Region.

The WHO Secretariat then focused on the three countries reporting most cases of MPXV clade Ib since January 2024 – the DRC (over 15 000 cases, including cases in areas where MPXV clade Ia is circulating); Burundi (over 3000 cases, with a sustained decrease reported weekly and a geographic shift to the administrative capital Gitega since the Committee last met); and Uganda (nearly 3000 cases, with an exponential increase in and around the capital Kampala since the Committee last met). Notwithstanding changes in the case definition of mpox cases, uneven surveillance coverage (including due to the conflict in the eastern provinces of the country), and limited laboratory testing capacity in the DRC introducing some challenges in the interpretation of data , the number of mpox cases reported weekly is plateauing and the geographic distribution of cases, in all provinces in the country, remained very similar to the situation presented at the previous meeting of the Committee. Mathematical modelling work suggests that, since the PHEIC was determined in mid-August 2024 in the DRC, the transmission rate has decreased in certain health zones of the North Kivu and South Kivu Provinces, as well as in some health zones of the capital Kinshasa where vaccination efforts are underway.

The spread of MPXV clade Ia and Ib, in North Kivu, South Kivu, and Kinshasa Provinces of the DRC, as well as in Burundi and Uganda, appears to have started among adults, including through sexual networks involving commercial sex workers and their clients, disproportionately affecting the 20–39 years age group. Since then, in North Kivu and South Kivu Provinces of the DRC, more age group became affected reflecting community transmission through close contact, including household, whereas, in the capital Kinshasa, the spread has remained within the adult population. In Burundi and Uganda, the age distribution of mpox cases shows a bimodal pattern, with high incidence observed among young adults and younger children. This pattern reflects both ongoing sexual transmission and close contact transmission in household settings. The strikingly high proportion of cases among younger children (0-9 age group) observed in Burundi is possibly attributable to transmission occurring within health care facilities settings.

In addition to the three aforementioned countries, community transmission of MPXV clade Ib is also observed in Kenya, Rwanda, and Zambia, while travel-related imported cases have been reported both, by countries in the WHO African Region (Angola, Zimbabwe, with cases in Tanzania being under investigation), and by 14 countries in the five remaining WHO Regions. Most travel-related imported cases are male and, in instances where limited secondary transmission in the country of importation has occurred, a few children have been infected through household contact, including child-to-child transmission on one occasion. The five imported cases with sole travel history to the United Arab Emirates may signal wider mpox transmission in that country.

Mortality associated with the different MPXV clades in the WHO African Region, and notwithstanding the limitation of surveillance and laboratory diagnostics in the DRC, clade Ia accounts for the majority of fatal cases (1345), corresponding to an average case fatality rate (CFR%) of 2.5-3%, being highest in children under 1 year of age (4–5%). The CFR attributed with clade Ib infection remains very low at around 0.2%, and similar to the that attributed to clade IIb, with recorded deaths associated with specific risk factors such as uncontrolled HIV and other comorbidities.

The WHO Secretariat also noted an increase in mpox cases reported in West African countries since the PHEIC was determined in mid-August 2024, including the first cases of mpox, due to MPXV clade IIa, reported by Sierra Leone.

The WHO Secretariat presented the assessed risk by MPXV clades and further expressed in terms of overall public health risk where any given clade/s is/are circulating, as: Clade Ib – high public health risk in the DRC and neighbouring countries; Clade Ia – moderate public health risk in the DRC; Clade II – moderate public health risk in Nigeria and countries of West and Central Africa where mpox is endemic; and lade IIb – moderate public health risk globally.

The WHO Secretariat subsequently provided an update on response actions taken together with States Parties and partners since the Committee last met. In addition to the overview provided by the WHO Deputy Director-General, and in the epidemiological overview, the WHO Secretariat provided details on progress and challenges focusing on the aspects of the response outlined below.

The coordination of emergency operations by the WHO Secretariat was readjusted – including based on action reviews and leveraging the comparative advantages of WHO, State Parties, and partners –prioritizing a flexible, agile, and delivery-focused response. However, while decentralized field operations have intensified, such shifts take time, particularly in specific settings in the DRC and amid changes in geopolitical partnerships. The operational decentralization continues to emphasize increased laboratory diagnostic support, increased dissemination of standards and guidance to deliver safe clinical care, and empowering communities to enhance their efforts to protect themselves from risks associated with mpox.

Additionally, through the Access and Allocation Mechanism (AAM), WHO and partners (Africa Centres for Disease Control and Prevention (Africa CDC), the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, The Vaccine Alliance (Gavi), and the United Nations Children’s Fund (UNICEF)) are continuing coordinated and multifaceted efforts to prioritize access to and roll out mpox vaccines in an equitable manner.

With the WHO Mpox global strategic preparedness and response plan, September 2024-February 2025 (SPRP) reaching the end of its initial timeframe, and considering the response strategy it outlines as still fit for purpose, the WHO Secretariat is planning to release an extension of the plan in the coming weeks.

In September 2024, the WHO Secretariat launched an appeal for US$ 87.4 million to support mpox response efforts WHO appeal: mpox public health emergency 2024 with US$ 65.5 million raised by the time of this meeting. The contribution from the United States had accounted for 33% of the funds raised, of which US$ 7.5 million is currently inaccessible due to the freeze of funds from the United States. As part of planning for the extension of the SPRP, the WHO Secretariat is conducting a review of available resources to address priority needs and mitigate potential future gaps in the delivery of the response. While the above-mentioned freeze is expected to primarily impact operations in Burundi, the Central African Republic, the DRC, the Republic of the Congo, and Rwanda, broader challenges are anticipated for the second and third quarters of 2025. Given the evolving epidemiological situation and challenges noted above, the reduction in predictable and flexible funding throughout 2025 will put at risk the progress of the mpox response to date.

Representatives of Burundi, the DRC, Nigeria, Sierra Leone, and Uganda updated the Committee on the mpox epidemiological situation in their countries and their current control and response efforts, needs and challenges, including those related to the freeze of the funds from the United States. The use of mpox vaccine is contemplated in the response plans of the DRC, Nigeria, Sierra Leone, and Uganda. In Burundi, following action review, community-based interventions that are being strengthened in areas experiencing high incident of mpox include risk communication and awareness raising.

Members of, and the Advisor to, the Committee then engaged in questions and answers, revolving around the issues and challenges enumerated below, with the presenters from States Parties and the WHO Secretariat, as well as with representatives of States Parties invited to submit a written statement to the Committee ahead of the meeting – Canada, China, Nepal, the United Arab Emirates, and the United Kingdom.

Funding – The Committee reiterated the importance of efforts to mobilize domestic financial resources to support mpox response activities. Burundi and the DRC indicated the funds allocated to the response by their respective Governments, also providing details of specific activities supported. The DRC indicated that, at present, the freeze of the funds from the United States is impacting the transportation of clinical specimens and laboratory diagnostics, with a decline in the testing rate, and that the Government is exploring solutions with other partners. The WHO Secretariat added that alternative funding sources are being explored with non-traditional donors.

Age distribution of mpox cases – The WHO Secretariat indicated that (a) there are studies ongoing to determine the secondary attack rate by age group and type of exposure; (b) at least in Burundi, there is no evidence of large outbreaks in settings where children are congregating and, hence, supporting evidence of child-to-child transmission; and (c) in the South Kivu Proving of the DRC, it remains unknown the extent to which transmission to children is occurring beyond the household setting.

Impact of vaccination on transmission – The DRC indicated that, at present, there is no information about whether the use of the limited amount of mpox vaccine available is being effective in interrupting mpox transmission.

The DRC – The DRC indicated that, due to insecurity and to decrease in laboratory testing rate, any apparent decrease of the number of reported mpox cases may represent an artifact and should be interpreted with caution. The WHO Secretariat highlighted that, being mpox a relatively mild illness, the rate of underreporting is unknown and that the trends of mpox surveillance data are critical to monitor the evolution of the situation. With respect to detection of a new MPXV clade Ia lineage in Kinshasa, the WHO Secretariat indicated that the strain, similarly to clade Ib, has increased human-to-human transmission potential.

Uganda – Uganda elaborated on the shift of the dynamics of mpox transmission from lower to higher income groups. The initial spread of MPXV clade Ib initiated long-distance truck drivers, it continued in fishing communities, and then within commercial sex networks in the capital Kampala. The fact that more affluent individuals are now affected poses a public health risk both, nationally and internationally. Therefore, the use of mpox vaccine is focused among sex workers in Kampala.

Nigeria – Nigeria indicated that, in the context of the mpox response, the human health and animal health sectors are working very closely and that, despite the numerous research initiatives, to date, there is no evidence of animal involvement in sustaining the mpox outbreak in the human population. Nigeria, with a population of 200 million persons, indicated that 20 000 doses of mpox vaccine have been used in the country, targeting health care workers, female sex workers, and men who have sex with men.

The United Arab Emirates – Considering that, in five instances, travel-related imported cases of MPXV clade Ib infection had sole travel history to the United Arab Emirates, the representative of the country (a) indicated that the National IHR Focal Point reported to WHO the first case of MPXV clade Ib infection; (b) briefly described the surveillance, laboratory diagnostic, case management, and risk communication approaches in place; (c) indicated that mpox vaccine is available to health care workers and as a post-exposure measure; and (d) recalled that the country is bilaterally supporting the response efforts of some African countries.

The United Kingdom – The United Kingdom (a) described the detection, investigation, and clinical and public health management of the travel-related imported mpox cases; and (b) highlighted that the countries of origin of the imported cases are systematically informed about the occurrences.

Deliberative session

Following the session open to invited States Parties, the Committee reconvened in a closed session to examine the questions in relation to whether the event constitutes a PHEIC or not, and if so, to consider the temporary recommendations drafted by the WHO Secretariat in accordance with IHR provisions.

The Chair reminded the Committee Members of their mandate and recalled that a PHEIC is defined in the IHR as an “extraordinary event, which constitutes a public health risk to other States through the international spread of disease, and potentially requires a coordinated international response”.

The Committee was unanimous in expressing the views that the ongoing upsurge of mpox still meets the criteria of a PHEIC and that the Director-General be advised accordingly

The overarching considerations underpinning the advice of the Committee are (a) the insecurity in the eastern provinces and in the capital of the DRC – the State Party epicenter of the MPXV clade Ib outbreak –, hampering mpox response field operations and with the potential to morph into a larger scale humanitarian response; (b) the freeze of funding by the United States both, of specific mpox response activities as well as of other, directly or indirectly related, aid interventions; and (c) the continuing detection of travel-related imported mpox cases in States Parties within and outside the WHO African Region.

On that basis, the Committee considered that:

The event is “extraordinary” because of (a) the persistent, if not increasing, challenges in gauging the actual magnitude and trend of the MPXV clade Ib outbreak, especially in the DRC. This is thwarting the ability to assess progress, if any, towards controlling the spread of mpox and to adjust response interventions. The Committee’s reading is that, overall, the epidemiological situation is worryingly similar to that observed in November 2024; (b) the unfolding dynamics of MPXV clade Ib transmission, resulting in the shift in age groups affected and, hence, posing challenges in timely targeting response interventions; (c) the co-circulation and the risk of mutations of MPXV clades in the context of sustained community transmission; and (d) the possibility of change in the severity of disease resulting from food insecurity and interruption in the delivery of HIV-related care due to the freeze of aid.

The event “constitutes a public health risk to other States through the international spread of disease” because of (a) the doubling of the number of States Parties having detected travel-related imported cases of MPXV clade Ib infection since the Committee last met, both in the WHO African Region and in all five other WHO Regions; (b) the possible influx of refugees from the eastern provinces of the DRC into neighbouring countries.

The event “requires a coordinated international response” because of the needs (a) to mobilize, and optimize the use, of financial and other resources to sustain response efforts, at the required level, in the medium term, following the freeze of funding by the United States; and (b) to continue facilitating and increasing equitable access to mpox vaccines and diagnostics.

The Committee subsequently considered the draft of the temporary recommendations proposed by the WHO Secretariat

Anticipating the possibility that the WHO Director-General may determine that the event continues to constitute a PHEIC, the Committee had received a proposed set of revised temporary recommendations ahead of the meeting. This reflected the proposal to extend most of the temporary recommendations issued on 27 November 2024. The Committee indicated that it would be giving them further consideration with a view to share its advice in that regard with the WHO Director-General as soon as possible. In such a way, should the WHO Director-General determine that the event continues to constitute a PHEIC, he could proceed, without delay, with issuing such communication together with a prospective revised set of temporary recommendations.

The Committee agreed to finalize the report of its third meeting during the week of 3 March 2025.

Conclusions

The Committee reiterated its concern regarding the continuing spread of MPXV in and beyond Africa, considering global geopolitical developments, the humanitarian situation in the DRC, as well as the foreseeable options and opportunities to secure sustainable funding to support response efforts. The Committee considered that the determination by the WHO Director-General that the upsurge of mpox still constitutes a PHEIC would be warranted. However, the Committee cautioned about the possible unintended consequences of determining an event to constitute a PHEIC for extended periods of time, since this could undermine the global public health alert function intrinsic to such a determination and reduce the leverage of a PHEIC in boosting domestic and international response efforts for future events. To that effect, the Committee reiterated the need to elaborate on considerations, related to the three criteria defining a PHEIC, that would inform its future advice to the WHO Director-General as to the termination of this PHEIC.

The Incident Manager for mpox at WHO headquarters, on behalf of the WHO Deputy Director-General, expressed his gratitude to the Committee’s Officers, its Members and Advisor and closed the meeting.

Editor’s note

On 24 March 2025, a correction was made to the fifth paragraph as noted below.

The original paragraph mistakenly listed Rwanda as an invited State Party. This was corrected and Rwanda is no longer mentioned.

Sourced from WHO