The Democratic Republic of Congo (DRC) has become the focal point of the global mpox outbreak, with the majority of cases reported from this region. The situation in the DRC has escalated due to a combination of factors, including the endemic presence of the virus, inadequate healthcare infrastructure, socio-political challenges, and the subsequent regional spread of the disease.
Mpox has been endemic in the DRC for years, particularly affecting rural areas where access to healthcare and diagnostic facilities is severely limited. According to the World Health Organization (WHO), the DRC accounted for 96% of the confirmed mpox cases in the African region as of June 2024. The national positivity rate is around 65%, indicating that the actual burden of the disease is likely much higher than reported. Limited testing capacity, especially in rural areas, has resulted in a significant number of clinically compatible cases going unconfirmed.
Limited Access to Healthcare and Testing
One of the critical challenges in the DRC's fight against mpox has been the limited access to healthcare, particularly in remote regions. WHO reports that the majority of mpox cases in the DRC occur in areas with little to no access to laboratory testing, leading to underreporting and delayed diagnosis. This lack of infrastructure hampers the identification of new cases and restricts timely intervention, allowing the virus to spread unchecked.
Socio-Political Challenges
The socio-political landscape in the DRC further complicates the situation. Ongoing conflict, displacement, and poverty have severely disrupted public health initiatives and strained the already fragile healthcare system. These challenges have made it difficult to implement widespread vaccination campaigns, public health education, and other critical measures needed to contain the outbreak.
Geographic Expansion of the Outbreak
The outbreak in the DRC has not remained confined within its borders. Neighbouring countries such as Burundi, Kenya, Rwanda, and Uganda have reported their first mpox cases, all linked to the expanding outbreak in East and Central Africa. The presence of clade I MPXV has been confirmed in these countries, underscoring the regional implications of the DRC's outbreak and raising concerns about the potential for further international spread.
Insights from Africa CDC
The Africa CDC's recent epidemic intelligence report emphasises the high risk of mpox spread in the Eastern DRC and neighbouring countries, particularly among adults, predominantly through sexual contact. The report highlights the increasing number of cases in areas with limited healthcare access and the challenges posed by multiple modes of transmission, including human-to-human and zoonotic transmission.
Despite the expanding outbreak, significant gaps remain in the surveillance and reporting of mpox cases, particularly in regions with endemic mpox. These gaps hinder the ability to assess the true scale of the outbreak and to implement targeted public health interventions.
Global Response and WHO Actions
The escalating situation in the DRC has prompted the WHO to reclassify the mpox outbreak as an acute grade 3 emergency, the highest level of emergency in WHO's grading system. This reclassification has led to further international actions, including extending the WHO Director-General's Standing Recommendations for mpox and initiating processes for Emergency Use Listing for mpox vaccines. These measures underscore the global health threat posed by the outbreak in the DRC and highlight the urgent need for a coordinated international response.
The DRC's position as the epicenter of the mpox outbreak is the result of a complex interplay of factors, including the endemic presence of the virus, limited healthcare access, and socio-political instability. Addressing this outbreak requires a multifaceted approach that includes strengthening healthcare infrastructure, increasing access to testing and vaccines, and addressing the underlying socio-political challenges. The situation in the DRC serves as a stark reminder of the importance of global health solidarity in the fight against emerging infectious diseases. As the outbreak continues to spread across borders, the international community must rally to contain this public health threat before it escalates further.