This brief presents social and political considerations for the design and implementation of vaccination-related risk communication and community engagement (RCCE) strategies for mpox in the eastern Democratic Republic of the Congo (DRC). A nationwide outbreak of mpox (clade I) was declared in late 2022 and now affects 23 of its 26 provinces. Notably, the outbreak is characterised by widespread human-to-human transmission unlike previous outbreaks primarily involving animal-human contact.
While mpox hotspots are emerging around the country, this brief focuses on eastern DRC where complex political history and ongoing armed conflict – on top of poor infrastructure and rural isolation of many communities – present significant challenges. These challenges demand carefully designed and tailored strategies. Furthermore, a mutated, more virulent mpox strain has also emerged in the eastern province of South Kivu. Although little remains known about transmission dynamics in the outbreak overall, sexual transmission of the new strain is of concern, putting stigmatised populations such as sex workers and others at risk. Overall, however, children are the most affected population, with transmission driven by close physical contact. Along with pregnant women and people with compromised immunity (e.g., people with HIV/AIDS), children are also at higher risk of complications and death.
The World Health Organization (WHO) recommends targeted vaccination approaches in the context of mpox outbreaks, including as postexposure prophylaxis for these populations. The DRC Ministry of Public Health has announced intentions to vaccinate both children and adults with the LC16 and MVA-BN mpox vaccines, respectively, under a temporary emergency use authorisation as these vaccines are not yet approved in the country. Efforts are now mobilising to design vaccine and related RCCE interventions.
This brief draws on a SSHAP roundtable discussion on mpox in the DRC (May 2024), consultation with social science experts and health and humanitarian actors active in or knowledgeable about the region and outbreak, and academic and grey literature.
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