Gabrielle Emanuel

In early 2025, reports emerged suggesting a decline in mpox cases within the Democratic Republic of Congo (DRC). At first glance, this appeared to be a positive development in the battle against the virus. However, health officials and experts caution that this perceived downturn may not reflect the true situation on the ground. Instead, it could be a consequence of escalating violence and instability in the region, which have severely hindered disease surveillance and reporting efforts.

The Complex Reality Behind Declining Case Numbers

The DRC has long grappled with mpox outbreaks, with the virus becoming endemic in several provinces. In recent years, the emergence of the more virulent clade Ib variant has exacerbated the situation, leading to increased transmission rates and fatalities. Despite these challenges, the reported decrease in case numbers in early 2025 raised hopes of a turning tide.

However, the World Health Organization (WHO) and other health agencies have expressed concerns that these figures may not accurately represent the epidemic’s trajectory. The DRC’s eastern regions, particularly North Kivu and Ituri provinces, have been plagued by armed conflict, making it perilous for health workers to operate effectively. This insecurity has led to the suspension of surveillance activities, closure of health facilities, and displacement of communities, all of which contribute to underreporting of mpox cases.

Dr. Matshidiso Moeti, WHO’s Regional Director for Africa, emphasized the gravity of the situation: “The apparent decline in reported mpox cases is likely a reflection of our diminished capacity to detect and respond to the outbreak due to the ongoing conflict. We must not be lulled into a false sense of security.”

Impact of Violence on Health Infrastructure

The intertwining of armed conflict and disease outbreaks creates a vicious cycle. Insecurity hampers public health responses, while the spread of disease further destabilizes communities. In the DRC, attacks on health centers and threats to medical personnel have become alarmingly frequent. These assaults not only disrupt mpox vaccination campaigns and treatment efforts but also deter patients from seeking care, fearing for their safety.

Moreover, the displacement of populations fleeing violence complicates contact tracing and containment measures. Internally displaced persons often find refuge in overcrowded camps with inadequate sanitation, conditions ripe for the spread of infectious diseases like mpox. The lack of reliable communication channels in these areas further impedes the reporting and monitoring of new cases.

Global Health Implications

The situation in the DRC has far-reaching implications beyond its borders. The disruption of surveillance and response systems increases the risk of mpox spreading to neighboring countries and potentially beyond. In August 2024, the WHO declared the mpox outbreak a Public Health Emergency of International Concern (PHEIC), underscoring the global threat posed by the virus. This declaration aimed to mobilize international resources and attention to contain the outbreak.

However, the effectiveness of global interventions is compromised when accurate data is unavailable. Underreporting in the DRC means that international health organizations may not fully grasp the outbreak’s scale, leading to potential misallocation of resources and delayed responses in other regions. Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, stated, “Without precise data, our efforts to combat mpox are akin to navigating without a map. We need unimpeded access and security for health workers to obtain the information necessary for an effective response.”

The Role of International Aid and Policy Decisions

Compounding the challenges in managing the mpox outbreak are recent policy shifts affecting international aid. In February 2025, reports indicated that the dismantling of the United States Agency for International Development (USAID) under the Trump administration led to a significant reduction in support for global health initiatives, including those targeting mpox. The withdrawal of funding and personnel has disrupted vaccination drives and surveillance programs in the DRC and other affected regions.

Professor Stephen Morse of Columbia University criticized this move, stating, “It’s a grave mistake to withdraw support at a critical juncture. Infectious diseases do not recognize borders, and neglecting an outbreak in one region can have catastrophic consequences globally.”

The Necessity for Sustained Vigilance and Support

While the reported decline in mpox cases might seem encouraging, it is imperative to approach this data with caution. The underlying issues of conflict, underreporting, and reduced international support paint a more concerning picture. To effectively combat the mpox outbreak, a multifaceted approach is required:

• Ensuring Security for Health Workers: International organizations and governments must collaborate to provide safe environments for medical personnel. This could involve negotiating ceasefires or establishing humanitarian corridors to allow uninterrupted health services.
• Strengthening Surveillance Systems: Investing in robust disease monitoring infrastructure is crucial. Utilizing technology, such as mobile health platforms, can aid in real-time data collection even in hard-to-reach areas.
• Reinstating and Increasing Funding: Reversing cuts to global health funding and ensuring sustained financial support for outbreak response initiatives are vital steps. This includes not only government aid but also contributions from private sectors and non-governmental organizations.
• Community Engagement and Education: Empowering local communities with knowledge about mpox prevention and treatment can enhance early detection and reduce transmission. Culturally sensitive education campaigns can address misconceptions and encourage cooperation with health authorities.