The DRC, with a long history of health crises, is the African country most affected by the mpox virus
Since the beginning of 2024, cases of mpox, a virus better known as monkeypox, have increased significantly in Africa. From the Democratic Republic of the Congo (DRC), the epicenter of the epidemic outbreak, it has spread, with moderate risk, inside and outside the continent.
Gilbert, Thérèse and Jeannot are infected. They are located in Bukavu, the capital of the province of South Kivu, the most affected. From the Kavumu hospital they tell us by phone that they have some kind of blisters spread over their face, hands, back and feet. One of them, also on the genitals. Two have sore throats and have bouts of fever. They tell us the injuries don’t look good. They are treating them with anti-inflammatories and antibiotics. They are waiting for the vaccine.
Endemic for decades
Monkeypox was first detected in Denmark in 1958 in laboratory monkeys. In 1970, it was diagnosed in a nine-year-old boy in the DRC. Since then, several human outbreaks have been reported in central and western Africa, where mpox is endemic. In the 20th century, especially between 1970 and 1980, the disease especially affected children. Monkeypox is from the same family as smallpox, eradicated 40 years ago after killing more than 300 million people. The suppression of vaccination against the disease after its disappearance could have favored the appearance of the different outbreaks of monkeypox that have a particularly relevant incidence in children: 40% of the cases have been diagnosed in minors.
From January 1, 2022 to September 8, 2024, around twenty African countries, some in Europe and the United States have reported cases to the World Health Organization (WHO). In the DRC alone, 4,901 cases have been recorded and 629 deaths have occurred, as confirmed on its website by the African Center for Disease Control and Prevention (CDC-Africa) at the beginning of September. In the Congolese province of South Kivu, 31 people have died, according to Radio Okapi. According to the WHO, a considerable number of suspected cases, clinically compatible with mpox, have not been analyzed due to lack of means to diagnose the disease. Burundi and Nigeria, along with the DRC, are the countries with the highest incidence.
On August 14, 2024, Tedros Adhanom Ghebreyesus, Secretary General of the WHO, declared an international public health emergency due to the spread of a new variant of the virus, more deadly than previous ones. At the end of August, Ghebreyesus announced the shipment of some 230,000 doses of the JYNNEOS vaccine, produced by the Danish pharmaceutical company Bavarian Nordic. The first part of this consignment arrived in Congolese territory on September 5. The shipment was carried out by the European Health Emergency Preparedness and Response Authority (HERA), of the European Commission.
The CDC-Africa and WHO have funded the 14 affected African countries with $600 million to stop the spread of the epidemic. WHO has also sent a team of more than 400 experts and 14 tons of medical supplies and equipment to the DRC to support infection prevention and control. On October 2, vaccination began in the most affected provinces.
Conflicts, epidemics and mistrust
However, it must not be ignored that the sociopolitical context of the DRC favors the spread of mpox. In the two Kivus, North and South, conflicts proliferate. Since spring 2022, the Rwandan-backed rebel group M23 has been active in the area and has caused the death of thousands of people and the displacement of at least seven million citizens who now live in displacement camps. Many families occupy small houses or tents in extremely precarious situations. Without work and in a situation of instability, they often have to sell and eat wild animals to survive. This exponentially increases the risk of contracting zoonotic diseases such as mpox. Furthermore, poverty encourages prostitution, which is one of the main ways the virus spreads. To this, we must add malnutrition. In these regions, the virus threatens to further aggravate the already difficult situation of the population, hit by decades of conflict, forced displacement, human rights violations and lack of international aid.
With all these elements, questions are resurfacing in Congolese public opinion about the care of the sick or the management of funds intended for the eradication of the epidemic. The population is skeptical and has expressed its distrust of the political and health authorities. The measures established to stop the spread of the virus are not respected on the streets, in the markets or on public transport, making it difficult to control. Some consider that mpox is a lie from the Government, while others do not believe in its existence because, they say, they have not seen anyone who suffers from it.
The DRC has not learned from the epidemics it has suffered previously: cholera, measles, smallpox, Ebola or the most recent coronavirus. In this country, improvisation is chronic, which explains in some way that it always depends on international aid to face epidemics or any emergency. Structures and a parallel health system are created that serve only to respond to the health crisis of the moment, without promoting the development of better management or the implementation of structures that respond more effectively to these challenges.
Poor staff management, embezzlement of funds, misinformation, lack of patient care or corruption generate distrust and skepticism in the population and make it difficult to raise awareness. Here, many see epidemics as a well-planned business from outside and inside the country. The memory of the bad practices that were evident in the management of Ebola and the coronavirus could make it difficult to eradicate a virus that, for weeks now, has stopped being talked about in the West.
