Why is the Democratic Republic of the Congo struggling to contain mpox?

The Democratic Republic of the Congo (DRC), a large central African country, is currently struggling to contain an outbreak of mpox.

More than 21,000 of the roughly 25,000 suspected mpox cases in Africa are in Congo, according to the most recent update from the World Health Organization (WHO). Outbreaks there also account for around 90 per cent of confirmed mpox cases.

The situation prompted the WHO last month to declare mpox a global health emergency, especially as a new strain of the virus spreads.

What is the situation in the DRC?

Mpox has been endemic for decades in the DRC, with the first human case of the virus reported there in 1970. Since then, there have been mostly small household and community outbreaks, according to WHO.

Formerly known as monkeypox, it's from the same family of viruses as smallpox but causes milder symptoms such as fever. People may also get a rash and skin lesions.

It can be spread through direct contact with infected animals or close contact with an infected person.

Mpox spread to the eastern province of South Kivu in September 2023 and scientists identified a new strain that could be more infectious. It also spread to the neighbouring North Kivu.

Both eastern provinces face escalating violence and a humanitarian crisis.

What are the problems in eastern Congo?

More than 120 armed groups have been fighting each other and the Congolese army for years in the eastern part of the country over the control of minerals. That has forced millions of people fleeing violence into refugee camps or nearby towns.

With more than six million displaced people in the east, authorities and aid agencies were already struggling to provide food and healthcare, while fighting other diseases such as cholera. Many people have no access to soap, clean water or other basics.

Some eastern Congo communities are also out of reach of health clinics. Roads are unreliable and hourslong risky boat trips are sometimes the only means of transport, said Mercy Muthee Lake of the International Federation of Red Cross and Red Crescent.

People can be more susceptible to severe mpox cases because of malnutrition and undiagnosed HIV, she said.

She also said health workers in eastern Congo have requested more mpox training as medications to treat fever and ease pain run out.

What about vaccines?

Vaccines are desperately needed, but they're just "an additional tool," said Emmanuel Lampaert, the Congo representative for Doctors Without Borders.

The key, Lampaert said, is still identifying cases, isolating patients, and executing grassroots health and education campaigns.

Africa still has no capacity to produce vaccines and the vaccine is also approved only for adults.

Around 250,000 doses have arrived in Congo from the European Union and the United States, and more are expected, with authorities saying they need around three million there.

Slow response criticised

Critics also say the mpox response has been sluggish compared to the funding to address Ebola and COVID-19.

Health experts say the sharp contrast is due to a lack of both funds and international interest.

"Ebola is the most dangerous virus in the world, and COVID wiped out the world economy," said Ali Bulabula, who works on infectious diseases in the medical department at Congo’s University of Kindu.

"While mpox is a public health emergency of international concern, there is a lack of in-depth research and interest in the virus, as it’s still seen as a tropical disease, localised to Africa with no major impact on Western economies".