IEarly one morning in Burundi, one of our patients set off for the hospital with a baby strapped to her back and her sick four-year-old son in her arms. When her little boy’s itchy sores began to water and he wouldn’t stop crying, she knew she had to get him there as soon as possible. They walked for miles along a dusty red trail, past palm groves and rice paddies. When she finally arrived, doctors told her they would have to move her son to a separate building. “He has mpox,” they said.
Scenes like these are playing out daily across Burundi and other Central African countries as thousands of people fall ill with the new strain of mpox that is ravaging the region. August 14, 2024 World Health Organization (WHO) stated that the multiple mpox outbreaks occurring on the African continent were a public health emergency of international concern. Although mpox has been around for decades, a new strain known as clade Ib has led to thousands of infections and hundreds of deaths in countries such as the Democratic Republic of the Congo (DRC), Burundi, Rwanda and the Central African Republic.
The WHO declaration was intended to spur an international response. But what did it look like on the ground? As doctors who have treated dozens of mpox patients in Burundi over the past four weeks, trust us: the response has been passive at best. People are in desperate need of both medical care and basic resources.
Read more: What You Need to Know About Mpox in 2024
Limited funding is primarily directed toward improving diagnosis and surveillance of mpox, leaving little to care for patients or to prevent further spread of mpox in the communities most at risk. This is especially heartbreaking because the outbreak appears to be disproportionately affecting vulnerable groups, including women, children, people with HIV, and those facing food insecurity. This gap in mpox prevention and treatment is particularly acute in countries like Burundi, where the health system is already strained by decades of civil war and where diseases like cholera, measles, malaria, and malnutrition are all too common.
One of our other patients came to the hospital with her newborn, whom she was breastfeeding. She walked to us for hours, asking for help because of the numerous painful lesions that now covered most of her skin. She was diagnosed with mpox, and we recommended that she stop breastfeeding to avoid the skin-to-skin contact that mpox spreads. With no other way to feed her baby, she was distraught when asked to choose between a starving baby and a baby developing mpox. There were no vaccines to protect the baby, and no other resources that could provide a safe feeding alternative for this family.
Read more: It's Time to Take Mpox and Bird Flu Seriously
This lack of resources focused on caring for people with mpox is not a failure of science. Mpox is not a new disease, and there are vaccines and medications that can significantly alter its course. But these tools are not available in hospitals and health centers that are having to care for more and more people with mpox every day. The DRC has only been allocated 250,000 courses of the only effective vaccine, while tens of millions of doses are actually needed to contain the spread of mpox. And smaller countries like Burundi have no access at all. In contrast, when a patient with the clade Ib strain was diagnosed in Sweden, the European Centers for Disease Control and Prevention decided recommend that travelers to Africa now consult their doctors about vaccinations.
Governments in the region are valiantly trying to respond to the mpox crisis. In Burundi, the government has developed a comprehensive national plan to manage mpox. But they should not bear the burden alone — and these regions desperately need partners who can step up immediately and provide:
- Decent services those already sick with mpox, including care in the community for people who are stable and in hospital for those who have severe disease or are at high risk. Such care will include access to proven strategies to reduce the illness and suffering associated with mpox, such as antiviral drugs, antibiotics, and anti-inflammatory eye drops to prevent the blindness that sometimes occurs when mpox affects the eyes. It will also address the socioeconomic needs of families: hunger, housing, child care, and management of common co-morbidities, including HIV.
- Localized preventive care. This works best when it comes from the community and may involve adapting standard health education messages to make them relevant to those at risk. Epidemics exploit fault lines in society and can exacerbate existing tensions. Mpox mitigation efforts should be combined with activities to promote collaboration and address other community needs.
- Immediate vaccination in areas where the epidemic is concentrated. Since most of the affected regions face problems of overcrowding and limited access to water, other preventive measures will be less effective. Releasing existing vaccines for use in Central Africa and ensuring their safe import, storage and administration must be a priority.
- Investing in Strengthening Health Systemsbecause infectious diseases will always prey on those whose health is most vulnerable. Rather than providing the bare minimum needed to respond to mpox, donors should see this outbreak as a call to support solid, long-term investment in building resilient health systems.
Models of mpox care that encompass these pillars have been developed in countries like Burundi. When the first mpox patients began showing up in rural areas, our team at Village Health Works—an organization founded by a Burundian to provide high-quality health care to those with limited access—launched a comprehensive response program called Stop the Mpox Outbreak with Justice (HOME) We are ready to support the government at the regional and national levels, but this requires mobilizing resources.
There is a global sense of fatigue when it comes to outbreaks, and mpox is no exception. What is happening to families in central Africa can feel very distant. People who reach for their smartphones or laptops to Google countries like Burundi should understand that they already have a connection to central Africa. The minerals that fuel these technologies were extracted from the area by companies which have made billions of dollars in profits. Very little of that capital has been reinvested in improving the lives of the people living there.
mpox’s weak local response shows that governments and their international cooperation are powerless in the face of such an outbreak. And in fact, it should not be their sole responsibility: the companies that profit from exporting materials from this region of the world should reinvest in building resilient health systems.
We are accustomed to hearing the word “outbreak” in connection with the spread of an infectious disease. But an alternative meaning is “a sudden increase in activity.” We urgently need an outbreak of solidarity and a mobilization of resources to end mpox in Central Africa.