The World Health Organization (WHO) today ended the global health emergency for mpox, 10 months after it was declared, as cases have fallen dramatically in Europe and the Americas. Caused by the monkeypox virus (MPXV), the painful and occasionally fatal disease is endemic in Africa, but a new strain surged in other locations last year, sparking WHO to invoke a Public Health Emergency of International Concern (PHEIC), the same type of worldwide alarm that was lifted last week for COVID-19.

The agency’s director-general, Tedros Adhanom Ghebreyesus, said at a press conference today in Geneva that WHO’s emergency committee monitoring the mpox outbreak recommended ending the PHEIC at a meeting yesterday, and that he has accepted its advice.

“That does not mean that the work is over,” Tedros said. “Mpox continues to pose significant public health challenges that need a robust, active, and sustainable response.”

Tedros noted that nearly 90% fewer mpox cases were reported to WHO in the past 3 months compared with the preceding 3 months. In total, WHO has received reports of more than 87,000 mpox cases and 140 deaths from 111 countries, but natural immunities and changes in behavior appear to have curtailed the disease’s spread.

At the height of the outbreak in the summer of 2022, when the disease was still commonly called monkeypox, more than 7000 weekly cases were being reported in the Americas and Europe alone. MPXV, a member of the poxvirus family, is spread by intimate personal contact. In the current outbreak, men who have sex with men (MSM) have been particularly affected. It commonly causes a rash and flulike symptoms and is rarely fatal, but people with severely weakened immune systems are at particular risk of poor outcomes.

Nicola Low, an infectious disease epidemiologist at the University of Bern and the vice-chair of WHO’s emergency committee on mpox, said the committee had “intense” deliberations over lifting the PHEIC, but decided that long-term efforts rather than emergency measures are now the best way to control MPXV. The challenges are many, however, including a scarcity of vaccines and a lack of data that show how well they work, uncertainty about the modes of transmission in some places, and stigma that imperils those most vulnerable to the disease, especially people living with untreated HIV. Small outbreaks in specific countries also continue, Low noted. “So there is understandable uncertainty about the probability of a large resurgence of infection.”

Several WHO officials pleaded for countries and international groups to make financial commitments to monitor, treat, and understand the disease going forward. “It is clear the recommendation to lift the [PHEIC] in no way means that mpox is no longer an infectious disease threat,” Low said. “What it means is we need to have the international commitments that will enable us to reach the long-terms goals of control and elimination of human-to-human transmission.”

So far such commitments have been lacking, said Michael Ryan, executive director of WHO’s Health Emergencies Programme. Mpox “has been totally neglected during this outbreak [during which] not one dollar was received from donors” to support WHO’s response, he said. He suggested donors slighted the disease because it was largely confined to Africa in the past and predominantly affected MSM in the current global outbreak. “Maybe it’s an issue of the continued prejudice in this world. … It will continue to be a neglected disease. And it may come back. And it may shock us in the future.”

Anne Rimoin, an infectious disease epidemiologist at the University of California, Los Angeles, urged more intense surveillance for all emerging pathogens. The mpox outbreak with its broad and speedy global spread “should be a big red flag that there are probably many other pathogens that are spilling over and traveling down this same road undetected,” says Rimoin, who is a member of WHO’s emergency committee. “If you aren’t looking for something, you won’t see it. We need better global surveillance. And we need it now.”