Mpox global emergency: strengthening African leadership The resurgence of mpox during 2024 has been declared a continental emergency by the Africa Centres for Disease Control and Prevention (Africa CDC) and a Public Health Emergency of International Concern (PHEIC) by WHO and now affects 15 African countries.1,2 In Africa between Jan 1, 2024 and Sept 16, 2024, there were 6201 confirmed mpox cases and 32 confirmed deaths, among a much larger number of suspected cases and deaths.2 Cases of clade 1b mpox causing the current sustained human-tohuman transmission are concentrated in Burundi, Central African Republic, Republic of the Congo, DR Congo, Kenya, Rwanda, and Uganda, while cases of clade 1a mpox have been reported from multiple countries across Central Africa associated with spillover events from animal reservoirs.2 Cases of clade 2 have been reported from Cote d’Ivoire, Liberia, Nigeria, and South Africa.2 The majority of cases and deaths have been reported in DR Congo, with an outsize toll on children.2 The epidemiology of mpox continues to evolve and gaps remain in our knowledge; evidence suggests there might be potential transmission from mother to fetus in utero and during breastfeeding.3,4 Further cases of clade 1 mpox have been reported beyond Africa including single cases in Sweden and Thailand.5 Calls for global action and response are important, especially for equity and solidarity in sharing countermeasures such as diagnostics and vaccines. However, the mpox outbreak is still at a stage amenable to control and elimination within Africa. African leadership is pivotal in shaping a coordinated and effective response to the mpox outbreak. We strongly support the ambitions of the single plan and single budget in the Mpox Continental Preparedness and Response Plan for Africa co-led by WHO and Africa CDC.6 This ambitious plan sets out ten pillars of action with a budget of about US$0.6 billion over 6 months, excluding vaccine costs, and an implementation framework. However, strategic plans are only as good as the speed and extent to which they can be implemented and they require leadership, accountability, and financing. There is already a plethora of generic and mpox specific guidance to inform the response.7 Strategic and accountable leadership can ensure that responses are contextually relevant, prompt, culturally appropriate, and sustainable. African leaders at the head of state level must spearhead the implementation of the joint Africa CDC and WHO Mpox Continental Preparedness and Response Plan for Africa6 and bring all member states, local civil society, industry, public and private sector actors, and international partners together, fostering collaboration across borders and sectors. Health leaders at the ministerial level should prioritise transparent communication, coordinated efforts in resource allocation, and a unified message that emphasises the importance of collective action. All too often, despite public statements, African health systems disproportionately depend on donor funding.8 Domestic funding should underpin the core of the mpox response complemented by donor assistance. Historically, when African leadership has been empowered by national leaders and international partners, the continent has seen progress in managing health crises, as evidenced during the west African outbreak of Ebola virus disease in 2014–16, when leadership from affected countries and regional bodies had a crucial role in eventually controlling the epidemic.9 Challenges, lessons, and actions that must be taken to ensure success in the response to mpox in Africa are numerous and some of them are summarised in the table. Furthermore, there is a need to strengthen discovery and operational research based on inclusive collaborations,10 including research to understand transmission informed by epidemiology undertaken by local researchers in affected areas and genomic epidemiology in collaboration with specialised laboratories to trace the evolution and spread of mpox. Examples of African-led epidemiological research to understand transmission include the elucidation of the emergence of clade 1 with predominance of APOBEC3-type mutations associated with a propensity for human-to-human transmission11 and previous work on the clade 2b outbreak in Nigeria that helped identify the sexual spread of mpox.12,13 A One Health approach, which considers the interconnectedness of human, animal, and environmental health, is also important.12 Integrating data across African health systems14 and ensuring real-time information sharing will be vital to advance understanding of transmission patterns. A data-driven approach will enable more timely and effective interventions, reducing transmission and morbidity. Strengthening health systems to support integrated research is essential, as highlighted by the Published Online September 20, 2024 https://doi.org/10.1016/ S0140-6736(24)02068-3 Doctopic: Analysis and Interpretation [THELANCET-D-24-05518] S0140-6736(24)02068-3 Embargo: September 20, 2024—23:30 Comment 2 www.thelancet.com Published online September 20, 2024 https://doi.org/10.1016/S0140-6736(24)02068-3 successes seen in similar approaches during the COVID-19 pandemic.15