Sustaining Mpox Surveillance, Research, and Care Integration in a Post-PHEIC, Resource-Constrained World

In August 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared mpox a Public Health Emergency of Continental Security (PHECS), and the World Health Organization (WHO) followed with a second Public Health Emergency of International Concern (PHEIC), in response to the rapid expansion of clade Ib monkeypox virus (MPXV) across eastern Democratic Republic of the Congo (DRC) and neighboring countries. Both declarations have since been lifted (September 2025 and January 2026), yet clade Ib transmission and severe outcomes in pregnant women and children persist. We argue that closing these emergency mechanisms marks not the end of the epidemic but the start of a harder phase: sustaining surveillance, care, and research amid shrinking donor support, including the dissolution of the United States Agency for International Development (USAID). We contend that integrating mpox into existing HIV, sexually transmitted infection (STI), and reproductive health platforms is the most realistic route to durable routine care, while pregnancy, paediatric disease, severe cases, and zoonotic spillover still need dedicated pathways. Sustainable management ultimately depends on domesticated financing, stronger institutions, genuine community engagement, and action on the ecological drivers of spillover.