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The World Health Organization’s decision in May 2023 to lift the status of Public Health Emergency of International Concern (PHEIC) for monkeypox — now more commonly referred to as mpox — was, at first glance, presented as the culmination of a successful response: a sustained drop in cases across many countries, strengthened tracing capacities, and the availability of vaccines and public information that helped contain transmission chains which, at their 2022 peak, had crossed continents. Formally, the Emergency Committee pointed to a significant reduction in reported cases and to the absence of changes in the clinical severity of the disease, factors that justified the recommendation that the situation no longer met the legal criteria for a PHEIC. But looking only at the numerical decline in cases is to oversimplify the complexity of what the removal of the status reveals. First, it highlighted a tension between immediate metrics and structural risks. While the epidemic curve retreated in high-income countries — where testing, targeted vaccination, and communication campaigns were rapidly deployed — deep gaps persisted in surveillance capacity, laboratory diagnosis, and access to vaccines and therapies in African countries where the virus has been endemic for decades. Several analyses published after the end of the PHEIC noted that the decision rested on an optimistic reading of the global situation, without a clear, equitable operational plan to strengthen surveillance and response in the most vulnerable settings. The removal of the PHEIC also laid bare, starkly, the problem of inequality in access to health resources. The distribution of vaccines and the prioritization of prevention campaigns followed geographic and geopolitical lines long familiar: where political risk and public pressure were highest, measures arrived early; where the disease had long existed or re-emerged more intensely, resources remained scarce. This is not only an ethical injustice — it is an epidemiological weakness. Failing to suppress viral circulation in areas of high transmission creates reservoirs that can fuel new waves, generate variants, or simply maintain the disease as a latent threat to broader populations. Reports and scientific reviews emerging after May 2023 signaled the absence of a long-term management plan comparable to what was outlined for COVID-19, and argued that lifting the emergency should have been paired with binding commitments to strengthen laboratories, surveillance, and vaccine equity. There is also a sociocultural and political dimension that the decision exposed: the risk of a false sense of security and the politicization of risk. In 2022, the predominant transmission within networks of men who have sex with men showed how social patterns and stigma shape public health responses. At the same time, the decision to “normalize” the international situation may have reduced political visibility and dedicated funding for research and community interventions. What appeared — and was — a tactical victory in many contexts proved potentially fragile if not accompanied by sustained public policy, community engagement, and communication that avoided stigma while keeping active surveillance. The months that followed confirmed this fragility in practice. New outbreaks and rising cases in parts of sub-Saharan Africa prompted reassessments by WHO itself and, in August 2024, the declaration of an emergency for outbreaks in the African region — an acknowledgment that without sustained and equitable response, danger does not disappear with an administrative act. This back-and-forth between “emergency” and “non-emergency” reveals the limitations of the PHEIC as a legal instrument: it is useful for mobilizing immediate attention, but insufficient to secure lasting commitment to building local capacities, research, and equitable access to vaccines and treatments. An investigative reading of what the removal of the emergency status reveals is therefore two-fold. On the one hand, it celebrates the capacities the world does possess to control outbreaks: international coordination, rapid science, and the production and implementation of technological and behavioral interventions. On the other, it exposes systemic weaknesses: persistent inequalities, fragmented surveillance, the absence of long-term strategies, and the ease with which attention and investment shift toward newer, more visible crises. The practical lesson is blunt: decisions about international legal status cannot replace — and must not be used as a pretext to delay — structural investments in public health, especially in endemic regions. Keeping the threat under control requires turning the tactical gains of 2022–2023 into sustainable capacity, ongoing research, and justice in the distribution of resources. In concrete terms, what should have followed the removal of the PHEIC is as obvious as it is rarely implemented: programs to strengthen laboratory capacity, integrated surveillance networks, stable funds for rapid response, clear supply chains and technology transfer routes for vaccines and diagnostics, and — perhaps most difficult — a long-term political commitment not dependent on media visibility. If the lifting of the emergency status taught anything, it is that declaring the end of a crisis is not the same as solving it. The true measure of success will not be found in decrees, but in the global ability to detect outbreaks early, protect vulnerable populations, and, above all, ensure that prevention and treatment are not the privilege of a few countries but rights accessible to all.
