Madagascar
Indian Ocean island nation off south-East Africa, the world's fourth-largest island; capital Antananarivo.
Just over half of July 2026's confirmed mpox cases worldwide, 703 of 1,370, came from Madagascar, WHO said on 14 September, and its clade Ib outbreak had reached 75 of its 115 districts by 16 August.
Last refreshed: 4 October 2026 · Appears in 1 active topic
Timeline for Madagascar
Reported 703 of 1,370 confirmed cases worldwide in July
Pandemics and Biosecurity: Madagascar logs half July's mpox casesBackground
Madagascar is the centre of the world's mpox problem in 2026. Its clade Ib epidemic, the lineage first identified in eastern DR Congo in 2023, spreads through the general population rather than a narrow group, and WHO said in September that it was not yet under control. Madagascar depends on imported vaccine, and WHO names broken cold chains outside its cities among the reasons the outbreak is not under control.
The outbreak runs under a transitional government. Colonel Michael Randrianirina, whose CAPSAT unit backed the October 2025 uprising that drove President Andry Rajoelina from the country, was sworn in as president on 17 October 2025.
Madagascar has handled urban epidemics before. In 2017 pneumonic plague spread person to person in Antananarivo and Toamasina, and outside HELP, antibiotics and contact tracing ended it within about three months. Its disease burden also reaches its neighbours: with the Comoros, it is a main source of the Malaria cases imported into Mayotte, according to Santé publique France.
Madagascar carries half the world's mpox
By 16 August 2026 Madagascar had 3,436 confirmed clade Ib mpox cases and 22 deaths, WHO's situation report of 14 September said. The island had no recent mpox history, so its people had no immunity, and cases run across all ages and both sexes. Between 6 July and 16 August it supplied 785 of Africa's 1,153 cases.
Test positivity reached 67% in The Week to 16 August, which WHO read as surveillance too weak to catch any but the obvious cases, so the real count runs above 3,436. WHO also blamed vaccine stockouts and broken cold chains; 111,508 people have had at least one dose. Madagascar is the first big test of a permanent mpox vaccine stockpile launched on 27 August, procured by UNICEF and funded by GAVI, from which countries could request doses from September.