The Mpox Crisis Is Much Bigger Than Mpox

Nicaise Ndembi and others

It is not easy to witness people battling an mpox infection. Fear and stigma make it difficult for patients to seek medical attention soon after symptoms arise, which include a painful rash, fever, muscle aches and sore throat. Misinformation is spreading rapidly. Doctors and other health care workers are straining to fight not just the disease as it afflicts individual patients; they are also up against larger issues they have little control over.

The resurgence of mpox has reminded the world of how dangerous this disease is for personal and community health. But less focus has been placed on the profound crises that exacerbate outbreaks like these, particularly in Africa. They are made exponentially worse because of the broader sociopolitical and economic challenges that many African countries face, exposing vulnerabilities that extend far beyond the realm of public health. Mpox is simply the latest crisis, and this cycle will not abate without meaningful action to alleviate the larger plights affecting the continent.

The Democratic Republic of Congo stands as a stark example of how a health crisis can intertwine with ongoing emergencies. The country experienced outbreaks like cholera, Ebola and Covid-19. Now it is at the center of the mpox outbreak in Africa. This year Congo has reported over 17,000 cases and over 500 deaths — the most cases and deaths in the continent — particularly in provinces like Équateur and South Kivu. These regions, already burdened by conflict, displacement and health infrastructural collapse, are grappling with the additional strain of a widespread and deadly mpox outbreak.

The emergence of a new mpox strain has added a layer of complexity to a challenging situation. Although the disease has spread predominantly because of sexual contact between adults, any physical contact can cause transmission of the virus. This means the overcrowded camps housing hundreds of thousands of people displaced by armed conflict are potential breeding grounds for a large-scale outbreak of the disease. These displaced families are grappling with the trauma of conflict, and now they must navigate the additional burden of disease.

Throughout the country, health care workers, the frontline defenders in the battle against mpox, are struggling to provide care with limited resources. Conflicts between armed insurgents and the country’s military have destroyed infrastructure and severely compromised access to essential services. In South Kivu, a region plagued by displacement and human rights violations, the situation is especially dire.

Mpox is especially dangerous to young children, many of whom have lost access to education and the safety that regular schooling offers. In Congo, over 1.1 million children under 5 years of age and approximately 605,000 pregnant or breastfeeding women faced or were expected to face elevated levels of acute malnutrition between July 2023 and June 2024. Though some patients get access to antiviral treatments, many must rely on their immune systems to fight off infection; malnutrition makes this especially challenging.

The resilience of these communities is continuously tested, and without significant intervention, the cycle of vulnerability and disease will only be perpetuated. Mpox will be far from the last public health issue to affect the region unless the social, political and economic problems plaguing these populations are also addressed.

While the World Health Organization and the Africa C.D.C. have declared mpox a public health emergency, the measures taken so far have been insufficient to address the scale of the crisis in the continent. Mpox vaccine distribution has been inequitable. African countries that desperately need it to protect their populations have been afforded limited access. The high cost of vaccines may further hamper disease prevention efforts, particularly in regions like South Kivu where the need is greatest. The W.H.O. has allowed its partners like UNICEF and Gavi, the global vaccine alliance, to procure mpox vaccines before the W.H.O. can formally give an approval — a step in the right direction but still woefully falling short of the kind of aggressive response we need to see from the rest of the world.

More than that, there must be a coordinated international response that goes beyond short-term emergency measures and addresses the root causes that keep certain populations vulnerable to the disease. Foreign aid should focus not only on immediate relief but also on building resilient infrastructure, strengthening health systems and promoting peace and stability in affected regions.

The lessons from the mpox outbreak are clear: Health crises cannot be effectively managed without addressing the broader societal context. The world must recognize that in places like Congo, where conflict and disease intersect, public health interventions must be coupled with efforts to resolve conflict, rebuild communities and restore dignity to those affected. In the absence of such an intersectional response, conflict regions are likely to be hot spots of health crises once again. We want nothing more than for the memories of those suffering from this terrible disease to be just that: memories.