The United States is taking a bold stand against a growing public health threat emerging from Africa: a virulent outbreak of mpox in the Democratic Republic of Congo (DRC) and its neighboring countries. While media coverage may be scant, the implications of this crisis are vast, especially as the mpox strain spreads beyond African borders. In response, the U.S. government (USG) has launched a comprehensive intervention, mobilizing key resources from its acclaimed global health initiative, the President’s Emergency Plan for AIDS Relief (PEPFAR). This billion-dollar program, primarily focused on HIV/AIDS, now stands at the forefront of U.S. efforts to tackle the mpox threat in Africa. Here’s a look at how PEPFAR’s established infrastructure and partnerships are being leveraged to respond to this latest health emergency.
Mpox Outbreak in Africa: Why It’s a Global Concern
Declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) in July 2022, and reiterated in 2024, the mpox outbreak in Africa, particularly in the DRC, has escalated into an international crisis. The DRC has seen over 40,000 suspected cases reported in 2024 alone, with the strain spreading to nations as far as Germany, Sweden, and India. Amid these circumstances, the U.S. has increased its support to assist the African region in managing and containing the virus.
Though treatable with existing vaccines, mpox response in the DRC faces immense challenges. Weak health infrastructure, limited access to healthcare, misinformation, and stigma further complicate control efforts. The circulation of a highly contagious mpox strain among communities has spurred international organizations into action. The WHO, alongside Gavi’s First Response Fund, recently allocated over 500,000 vaccine doses to the region, a vital step to curb transmission.
Vaccine Distribution Hurdles in the DRC
Vaccine distribution in the DRC, while promising, has met with significant logistical challenges. Distribution systems in rural and conflict-ridden areas lack the reliability needed to reach vulnerable populations. Public trust in vaccines is fragile due to misinformation and lingering distrust rooted in colonial history. As vaccination began in October 2024, the focus shifted to building awareness, fostering public trust, and addressing distribution inefficiencies.
A Historical Link: Mpox, Smallpox, and Immunity
One interesting factor worsening the mpox crisis is a side effect of the global victory over smallpox. Smallpox vaccination, which concluded in the 1980s, provided incidental immunity to mpox due to their shared viral family. Now, with smallpox long eradicated, millions globally lack immunity to mpox, leaving a vast population susceptible to outbreaks. This immunological gap is of particular concern for African nations where mpox is endemic, adding urgency to vaccination efforts.
The Critical Intersection of Mpox and HIV
The overlap between mpox and HIV infection presents a uniquely dangerous scenario. Coinfection with uncontrolled HIV can heighten mpox severity and lethality. Mpox, like HIV, often impacts marginalized populations, such as men who have sex with men and sex workers, adding a layer of stigma and complicating public health outreach.
As with HIV, stigma associated with mpox leads many to avoid testing and treatment, potentially driving undetected transmission. Lessons learned from HIV response efforts—including those focused on human rights, community engagement, and infectious disease management—are now critical to an effective response to mpox. International organizations such as the Joint United Nations Programme on HIV/AIDS (UNAIDS) have highlighted the need for a stigma-free response to the mpox outbreak, urging the global community to adopt a strategy rooted in compassion and inclusion.
U.S. Response and PEPFAR’s Expanding Role
The U.S. has significantly stepped up its involvement in the DRC’s mpox response, guided by a commitment to support health security in regions at risk of severe health threats. In recent months, John Nkengasong, U.S. Global AIDS Coordinator and former head of the Africa CDC, has led sessions with key health partners—including the WHO, Africa CDC, and DRC government—to coordinate response efforts.
The U.S. government has pledged $500 million for immediate mpox interventions in the DRC, including provision of 1 million vaccine doses. These resources will be distributed bilaterally and multilaterally, with support from key global health entities such as WHO, Gavi, UNICEF, and the Coalition for Epidemic Preparedness Innovations (CEPI).
PEPFAR’s Unique Advantages in Addressing Mpox
A major pillar of the U.S. response is the integration of PEPFAR’s extensive HIV/AIDS infrastructure into the fight against mpox. Established in 2003, PEPFAR has poured billions into HIV-related efforts in the DRC and surrounding regions. This deep-rooted presence in Africa offers a strategic advantage, with pre-existing channels for laboratory testing, community outreach, and healthcare delivery. According to the White House, PEPFAR platforms will be repurposed to support mpox prevention, diagnosis, and vaccination efforts, ensuring continuous access to healthcare for people living with HIV in the DRC and beyond.
PEPFAR’s established relationships with African health agencies offer a well-equipped foundation for the U.S. to mobilize resources in response to mpox. Surveillance, risk communication, and diagnostic support can swiftly transition to support mpox interventions. The $800 million invested in HIV efforts over the last decade has laid the groundwork for today’s multifaceted response.
An Opportunity for Global Health Collaboration
The mpox crisis has revealed the potential to harness global HIV/AIDS funding mechanisms, such as The Global Fund, to fight emergent diseases. This fund, which has invested over $3 billion in grants for the DRC’s health infrastructure, has adjusted its strategy to include mpox support. Repurposed resources now target essential needs in surveillance, laboratory testing, and community education in high-risk areas.
As countries neighboring the DRC report new mpox cases, U.S. assistance extends beyond national borders, aiding at-risk populations in Zambia, Burundi, and elsewhere. This regional approach demonstrates the broader utility of PEPFAR’s existing resources and partnerships, creating a framework for how global health initiatives can pivot to manage emergent diseases while maintaining ongoing services for established health concerns like HIV/AIDS.
U.S. Health Leadership Tested Amid Uncertain Times
The U.S. response to mpox presents an opportunity for the country to reinforce its commitment to global health security. However, the complexity of the crisis may test the resilience of current health strategies. Stakeholders, from the DRC’s Ministry of Health to global health advocates, have noted both progress and ongoing challenges. Missteps in early containment strategies highlight the need for greater coordination among international partners.
The Political Backdrop: PEPFAR Reauthorization in 2025
Amid its response to mpox, PEPFAR faces an uncertain future as its reauthorization approaches in March 2025. Political debates surrounding PEPFAR’s funding and scope have intensified, particularly in light of previous controversies, including abortion-related disputes. The reauthorization process in 2024 nearly stalled due to partisan divides, indicating a challenging road ahead as the program faces potential reshaping in a politically polarized Congress. Given the program’s impact on global health security, the outcome of this reauthorization will have lasting consequences for U.S. efforts to respond to public health crises worldwide.
PEPFAR’s success in battling HIV/AIDS has positioned it as a critical component in U.S. global health security strategy, now expanded to combat other health threats such as mpox. With the looming reauthorization, advocates are calling on policymakers to consider the program’s long-term benefits, not just in reducing HIV-related suffering, but in bolstering health infrastructure capable of responding to diverse and emergent health crises.
This re-envisioned content aims to engage and rank well by balancing detailed information on the U.S. mpox response with a humanized narrative, emphasizing PEPFAR’s central role in strengthening health security across Africa.