The Democratic Republic of Congo (DRC) is well known for decades of armed conflicts, gender-based violence, food insecurity and increasing poverty among the local population. This situation has weakened its healthcare system, providing the breeding ground for recurrent epidemics including measles, cholera, polio and most recently, mpox. 80% of these epidemics are vaccine-preventable.
The DRC has recorded 15,664 suspected cases and 548 deaths since the start of 2024, according to the latest epidemiological report published on August 15th. A few days earlier, the World Health Organization (WHO) had already activated its highest level of international alert in response to the resurgence of mpox cases in Africa, while Africa CDC, the African Union's public health agency, had declared a state of “public health emergency”.
In addition, the DRC is home to over seven million internally displaced people, many of whom live in camps with limited access to drinking water, putting them at increased risk of catching the disease.
South Kivu, one of the worst-affected regions
The South Kivu province is the second hardest to be hit by this epidemic. The first cases of mpox were recorded in September 2023 in the town of Kamituga, 160 kilometres from Bukavu, capital of this eastern province of the DRC. Little known locally, nor with the right preventive measures in place, the epidemic rose rapidly, prompting the World Health Organization to declare mpox a global health emergency in August 2024.
Mpox is transmitted by direct contact with infected animals, by eating infected uncooked meat, by direct contact from one infected person to another, by sexual contact, or by objects contaminated with infected body fluids (blood, urine, sweat). Dr Claude Bahizire, Head of Communications for the South Kivu Provincial Health Division, reported that since the outbreak of the disease, 5,944 cases have been documented and 5,000 cured. The health zones of Miti, Kamituga and Uvira are the most affected, with the largest number of reported cases.
In a press release, provincial governor Jean-Jacques Purusi revealed that 32 deaths had been recorded in 10 health zones and 912 active cases were hospitalised in free mpox treatment centres. Health facilities are reporting an average of 350 new cases per week.
According to the health authorities, the people most affected are those aged between 15 and 49, including children, especially in the Miti-Murhesa Health Zone.
They fear that sexual transmission represents a high risk, potentially accelerating the spread of the disease and complicating efforts to contain, control and eliminate mpox.
Challenges in patient care
In the Miti health zone, mpox patients, who had been starving for several days, had escaped from the hospitals where they were quarantined. Dr Vincent Sanvura, who coordinates the zoonosis prevention project in the Kahuzi-Biega Park region, fears that this situation could exacerbate the risk of contamination.
“The rapid spread of the disease raises concerns. Medical facilities could become sources of contamination due to the lack of means for holistic care of patients. Patients' families are responsible for providing food, which can lead to transmission from the family to the hospital. The lack of food encourages some patients to flee their quarantine areas,” he adds.
The government of South Kivu province has received a large consignment of medicines to treat the sick free of charge. Nonetheless, enormous challenges remain for the response teams in the field. The drugs were handed over to the provincial health minister, who in turn gave responsibility to the provincial health division, which is the technical department.
Clearly, children aged 0 to 15 are the most affected by this mpox disease in South Kivu province.
However, access to emergency care remains limited, as does case identification. Vaccines, which are in short supply worldwide, are not yet being used in the DRC epidemic, although organisations such as Gavi, the Vaccine Alliance, and WHO have taken steps to accelerate their deployment.
Awareness campaigns: the crucial role of all players
A mass vaccination program is planned by the Congolese government for October 2024, in order to halt the galloping epidemic of the mpox virus. However, even once the country has obtained sufficient vaccines for a nationwide roll-out, considerable efforts will be needed to combat vaccine-sceptic communities' hesitancy.
Indeed, many rumors about the ineffectiveness of vaccines, the use of vaccines as a chemical weapon, or the effectiveness of traditional treatments against epidemics, lead local populations to resist being vaccinated. As a result, a rapid, coordinated response to the outbreak of mpox is essential. The mobilisation of health authorities, civil society and international partners is crucial to containing the epidemic and protecting the most vulnerable populations.
Civil society is playing a crucial role in the fight against this epidemic, carrying out daily awareness-raising campaigns to inform people about the means of prevention. “Many people are still unaware of this disease, which is why we are conducting awareness campaigns through the media, word-of-mouth in public places, and calling on opinion leaders to spread the message,” explains a member of a local organisation.
In South Kivu, the political and health authorities have put in place a series of measures to treat and limit the spread of the disease. These include free medical care in several treatment centres. They have also launched campaigns to raise awareness of hygienic measures, including avoiding close contact with suspected cases, shaking hands and hugging, washing hands regularly and cooking meat properly before consumption.