Mireille Efonge fell ill several months ago with a fever and painful blisters on her groin. As her condition worsened, she became too weak to move, prompting neighbors to carry her to a health center in Pakadjuma, a densely populated, impoverished area in Kinshasa, the capital of the Democratic Republic of Congo (DRC). There, she was transferred to a hospital after the onset of lesions that spread across her body, each new bump a painful reminder of the illness taking hold.
Her diagnosis: mpox.
“I had never heard of it,” she shared, a sentiment echoed by many in Kinshasa when the disease first began to spread within the city’s 17 million residents. At that time, the mpox virus, closely related to smallpox, was largely unknown to the people living in the capital.
That was August. Since then, the outbreak has grown at an alarming rate. A new and highly contagious strain of the virus has emerged, spreading rapidly through the country and now threatening global efforts to contain it. Researchers now fear that the virus has likely moved beyond the point where containment is possible.
In August, the World Health Organization declared mpox a global public health emergency, following reports of the fast-spreading virus in a remote mining town in eastern Congo. Since then, mpox cases have skyrocketed, particularly in refugee camps where displaced Congolese live in overcrowded conditions with limited access to basic necessities like water. The virus is now reaching the urban heart of Congo — Kinshasa itself.
Efforts to control the outbreak in the city have been inconsistent, with delays in isolating infected individuals and vaccinating those who may have come into contact with them. Despite posters plastered throughout Kinshasa warning residents about the virus and educating them on how to identify symptoms, response efforts have been hindered by bureaucratic infighting over access to international aid.
While vaccination efforts have begun, progress has been painfully slow. Hundreds of thousands of vaccines are sitting unused in freezers, with only a fraction of the population having received a dose. Even worse, half of those infected by the virus are children, yet none have been vaccinated. The country’s healthcare infrastructure, already weak, has been stretched to its limits, and widespread contact tracing is virtually nonexistent.
In the tight alleyways of Pakadjuma, where the virus is now rampant, vulnerable communities, including sex workers, have become prime vectors for transmission. For these residents, the risk of contracting the virus is exacerbated by their lack of access to medical care and the difficulty of reaching health centers.
Historically, mpox has been a rural disease in Congo, causing isolated outbreaks, particularly in children in remote areas. However, the current epidemic is different. In 2023, researchers identified a new strain of the virus, called Clade Ib, which has shown a particular tendency to spread through heterosexual contact. This strain has since spread to several other African countries and even appeared in travelers to the United States, Canada, and Europe.
In Congo, this new strain has helped push the number of mpox cases to unprecedented levels, with over 53,000 reported this year — more than triple the number from 2023. Tragically, the virus has claimed around 1,250 lives this year alone.
Pakadjuma, in particular, has emerged as a hotspot for both Clade Ia and the newer, more contagious Clade Ib. The neighborhood’s high population density and the mobility of its residents have made it an ideal breeding ground for the virus. Yet, despite the urgency of the situation, the response has been woefully inadequate, with few resources reaching the area.
A lack of effective vaccination campaigns, poor infrastructure, and inadequate healthcare facilities are contributing to the crisis. While more than 385,000 doses of mpox vaccine have arrived in Congo, only 53,000 doses have been administered as of late December. This slow pace of vaccination and the absence of proper contact tracing are major obstacles in controlling the virus’s spread.
In Pakadjuma, vaccination efforts only began in December, months after the United States donated 50,000 vaccine doses. However, only a small number of residents, including sex workers and healthcare workers, have received their shots. Meanwhile, the virus continues to spread rapidly, with residents fearful of leaving their community to seek medical treatment, further hindering the effectiveness of the response efforts.
Local healthcare centers are overwhelmed, with patients being crammed into small, overcrowded rooms. Doctors and nurses struggle to implement basic infection control measures, and some healthcare workers have contracted the virus themselves.
One of the more concerning aspects of the outbreak is its impact on children, with more than half of the cases being among minors. Despite this, no children have been vaccinated, and the arrival of a special vaccine for children, LC16, has been delayed by bureaucratic hurdles.
Pakadjuma remains at the forefront of Congo’s response to the epidemic. The area is now the focus of the country’s health authorities, as they work to contain the spread of both the new Clade Ib and the endemic Clade Ia strains.
The situation in Congo highlights the broader global risk of mpox, as the virus continues to spread in a region with weak healthcare infrastructure. Although international aid has begun to flow, it is clear that the response is too slow, and the consequences could be catastrophic not just for Congo but for the world.