In the Democratic Republic of Congo (DRC), efforts to combat the ongoing mpox outbreak, the largest ever recorded in the country, are entering a critical phase. With over 4,500 cases reported this year, containing the outbreak remains a challenge as there are currently no vaccines or treatments available in the country. Additionally, the testing capacity is severely limited.

Dr. Jennifer McQuiston of the U.S. Centers for Disease Control and Prevention (CDC) expressed hope that the situation is reaching a turning point. Over the next three weeks, experts expect to gain a better understanding of the ground situation through extensive groundwork and support-building efforts.

The CDC and the World Health Organization (WHO) have been working closely with the DRC for several years, but have intensified their efforts in response to the mpox outbreak. Testing capacity has been expanded, with the opening of labs in remote and heavily affected areas, and local epidemiological teams have been funded to provide detailed insights into mpox cases.

The mpox outbreak in the DRC stands out not only due to its scale but also because of changes in the nature of the virus. While 11 African countries have reported mpox cases, the DRC serves as the epicenter with a caseload three times higher than it was at the same time last year. The current strain, known as Clade I, is ten times deadlier than the one responsible for the global outbreak in 2022. Approximately 10% of Clade I cases are fatal, with the DRC confirming 311 mpox-related deaths this year. Alarmingly, there are indications of a new strain circulating in the eastern part of the country, specifically among sex workers, and it appears to be sexually transmitted, which is unusual for Clade I.

The country faces the challenge of balancing its fight against mpox with other pressing health issues, including measles, cholera, and plague. Dr. Mandy Cohen, director of the CDC, acknowledged the need to support the DRC's overall health response and emphasized the importance of working with a sovereign country facing multiple health threats.

In an effort to address the mpox outbreak, the DRC recently announced its intention to use mpox vaccines pending approval and the development of a delivery strategy. While mpox vaccines have been utilized in other parts of the world, they are not yet approved for widespread use in most African nations. One major challenge is the limited data on how the vaccines work in children, who represent the majority of mpox cases in the DRC. There is also a lack of research on administering the vaccine to populations dealing with health issues like malnutrition. The WHO's vaccine advisory committee recommended the off-label use of mpox vaccines in children but emphasized the need for further study.

Implementing an mpox vaccination campaign poses logistical challenges due to the remote areas where most cases are located, as well as the presence of violent unrest in some parts of the country. While the availability of mpox vaccines is still months away, the DRC's acknowledgment of the scale of the problem and its intention to use vaccines is seen as significant progress.

Nicaise Ndembi, a virologist and senior advisor to the director-general of the Africa CDC, believes that the potential declaring of a health emergency is justified based on scientific evidence. Given that the DRC shares borders with nine other countries, swift action is crucial to avoid the spread of the virus through travel, as was the case in 2022.

Although an official declaration of a health emergency has not yet been made, interim measures such as disease surveillance, emergency response communication, infection prevention control, and improved clinical care can be implemented, according to Dr. Rosamund Lewis, the WHO's technical lead for mpox. Basic medical care, particularly for children with mpox, is essential to prevent severe disease and reduce the risk of death.

The global community is called upon to support and stand alongside the DRC in its efforts to combat the mpox outbreak. Dr. Michael Ryan, executive director of the WHO's Health Emergencies Programme, emphasized the need for increased financial resources to effectively contain the virus, highlighting the lack of donor funding thus far.

As the mpox outbreak continues to pose a public health emergency in the DRC, efforts are underway to better understand the situation on the ground and establish strategies for containment and treatment. International support and collaboration are crucial to combat this evolving health crisis.

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