Democratic Republic of the Congo and monkeypox, what's going on?

Translated by Giulia Maffeis

In the African continent, especially in the central region, an unprecedented and significant monkeypox (mpox) epidemic is taking place. As this viral infection has been associated with specific African countries in the past, what makes this situation unique is the scale of the recorded outbreak. According to a World Health Organization (WHO) press release from August 8, and the declaration of a Public Health Emergency of International Concern (PHEIC) on August 14—the highest alert level in international health law—fifteen African countries are currently experiencing a monkeypox epidemic. Among these, four countries—Burundi, Kenya, Rwanda, and Uganda—had never reported cases before, signaling a worrying spread. The rapid transmission, from an epidemiological perspective, is linked to a highly aggressive strain (Clade 1b), first identified in 2013, and now particularly prevalent in Central Africa, with the Democratic Republic of the Congo (DRC) becoming the hardest-hit country.

News of the epidemic and the potential pandemic risks have also drawn attention from the European Union and the West, especially given the fresh memory of the two-year-long pandemic from 2020 to 2022. At the moment, there are no concrete risks indicating a similar situation. Apart from the African continent, confirmed cases of the variant severely affecting the DRC include 49 in Mexico and 8 in Argentina, while only one case has been found in Europe, specifically in Sweden, linked to travel from one of the hardest-hit African regions. However, the European Centre for Disease Prevention and Control (ECDC) has stated that more imported cases of mpox are likely.

As the epidemiological situation remains controlled outside Africa, in the hardest-hit regions, the situation is becoming increasingly tragic and complex. Mohammed Omer Mukhier, Regional Director of the International Red Cross, highlighted that the mpox outbreak in Africa "is not just a local problem but a continental threat that needs an immediate and coordinated response." As mentioned earlier, the most critical situation is in the Democratic Republic of the Congo, where over 96% of cases have been confirmed. Between January and August, more than 17,000 suspected cases were reported, with a devastating toll of over 500 deaths and 23 provinces hit, including previously spared southern provinces and North Kivu. This is a significant increase compared to the previous epidemic declared in 2022, when the WHO also declared a PHEIC emergency. For reference, 7,146 cases were recorded in 2022 and 14,857 in 2023. Worries in recent months have risen due to the virus's transmission road, shifting from zoonotic vectors to human-to-human contagion. This is particularly worrying given the growing number of displaced people in the country, which has long been embroiled in an internal war with increasingly difficult-to-control terrorist factions for the government.

The ongoing internal geopolitical situation, according to the latest United Nations report on the current war in the eastern provinces of the DRC, is that of a full-scale insurgency fought by fragile factions that are exerting significant pressure on Kinshasa, so much so that contingents from neighboring countries like Rwanda and Uganda have been deployed, clashing repeatedly with the Armed Forces of the Democratic Republic of the Congo. The M23 rebel group now controls the Goma area, the capital of North Kivu, keeping it as a strategic point to dominate the entire region. Surely, control and containment activities in such a fragmented and volatile context are of primary importance, although likely not entirely feasible. This has made the request and supply of vaccines an immediate and critical priority.

The World Health Organization's response has been an initial funding of 15 million dollars to support the surveillance, the preparing, and the response activities, along with an appeal for the Emergency Use Listing (EUL) for two recommended and approved vaccines. This will allow agencies like UNICEF and the United Nations Fund to gather vaccines to support an already at-risk population. The Africa Centre for Disease Control (ACDC) has highlighted the need for a massive mobilization in this direction, confirming initial partnership agreements with the European Commission's Health Emergency Preparedness and Response Authority (HERA) and Bavarian Nordic for the initial supply of more than 215,000 doses of the MVA-BN® vaccine—far from covering the region's or the continent's needs.

The mpox epidemic, quickly growing in the Democratic Republic of the Congo should not be seen as a global threat such as COVID-19, but rather as an urgent call to action for the international community. The epidemic, worsened by geopolitical tensions and internal instability in the country, stresses the need for a coordinated global response that goes beyond simple virus containment. Efforts must focus not only on delivering healthcare resources but also on assuring stability and security in the region. The deep and tragic internal instability in the country is exacerbating the health crisis dramatically, with displaced peoples' camps and forced displacement for tens of thousands of people.