Slumped on the ground over a mound of dirt, Divine Wisoba pulled weeds from her daughter’s grave. The 1-month-old died from mpox in eastern Congo in August, but Ms. Wisoba, 21, was too traumatized to attend the funeral.

In her first visit to the cemetery, she wept into her shirt for the child she lost and worried about the rest of her family. “When she was born, it was as if God had answered our prayers — we wanted a girl,” Wisoba said of little Maombi Katengey. “But our biggest joy was transformed into devastation.”

In Congo’s Kamituga children are the worst sufferers

Her daughter is one of more than 6,000 people officials suspect have contracted the disease in South Kivu province, the epicenter of the world’s latest mpox outbreak, in what the World Health Organization has labeled a global health emergency. A new strain of the virus is spreading, largely through skin-to-skin contact, including but not limited to sex. A lack of funds, vaccines and information is making it difficult to stem the spread, according to alarmed disease experts.

Mpox — which causes mostly mild symptoms like fever and body aches, but can trigger serious cases with prominent blisters on the face, hands, chest and genitals — had been spreading mostly undetected for years in Africa, until a 2022 outbreak reached more than 70 countries. Globally, gay and bisexual men made up the vast majority of cases in that outbreak. But officials note mpox has long disproportionately affected children in Africa, and they say cases are now rising sharply among kids, pregnant women and other vulnerable groups, with many types of close contact responsible for the spread.

Health officials have zeroed in on Kamituga, a remote yet bustling gold mining town of some 300,000 people that attracts miners, sex workers and traders who are constantly on the move. Cases from other parts of eastern Congo can be traced back here, officials say, with the first originating in the nightclub scene.

Since this outbreak began, one year ago, nearly 1,000 people in Kamituga have been infected. Eight have died, half of them children.

Not enough awareness about symptoms

Last month, the World Health Organization said mpox outbreaks might be stopped in the next six months, with governments’ leadership and cooperation.

But in Kamituga, people say they face a starkly different reality.

There’s a daily average of five new cases at the general hospital, which is regularly near capacity. Overall in South Kivu, weekly new suspected cases have skyrocketed from about 12 in January to 600 in August, according to province health officials.

Even that’s likely an underestimate, they say, because of a lack of access to rural areas, the inability of many residents to seek care, and Kamituga’s transient nature.

Locals say they simply don’t have enough information about mpox.

Before her daughter got sick, Ms. Wisoba said, she was infected herself but didn’t know it.

Painful lesions emerged around her genitals, making walking difficult. She thought she had a common sexually transmitted infection and sought medicine at a pharmacy. Days later, she went to the hospital with her newborn and was diagnosed with mpox. She recovered, but her daughter developed lesions on her foot.

Nearly a week later, Maombi died at the same hospital that treated her mother.

Ms. Wisoba said she didn’t know about mpox until she got it. She wants the government to invest more in teaching people protective measures.

Local officials can’t reach areas more than a few miles outside Kamituga to track suspected cases or inform residents. They broadcast radio messages but say that doesn’t reach far enough.

Kasindi Mwenyelwata goes door to door describing how to detect mpox — looking for fevers, aches or lesions. But the 42-year-old community leader said a lack of money means he doesn’t have the right materials, such as posters showing images of patients, which he finds more powerful than words.

ALIMA, one of the few aid groups working on mpox in Kamituga, lacks funds to set up programs or clinics that would reach some 150,000 people, with its budget set to run out at year’s end, according to program coordinator Dr. Dally Muamba.

If support keeps waning and mpox spreads, he said, “there will be an impact on the economy, people will stop coming to the area as the epidemic takes its toll. … And as the disease grows, will resources follow?”

Health experts said that, what’s needed most are vaccines — even if they go only to adults, under emergency approval in Congo.

None has arrived in Kamituga, though it’s a priority city in South Kivu, officials said. It’s unclear when or how they will. The main road into town is unpaved — barely passable by car during the ongoing rainy season.

Once they make it here, it’s unclear whether supply will meet demand for those who are at greatest risk and first in line: health staff, sex workers, miners and motorcycle taxi drivers.

Congo’s government has budgeted more than $190 million for its initial mpox response, which includes the purchase of 3 million vaccine doses, according to a draft national mpox plan, widely circulating among health experts and aid groups this month and seen by The Associated Press. But so far, just 250,000 doses have arrived in Congo and the government’s given only $10 million, according to the finance ministry.

Most people with mild cases recover in less than two weeks. But lesions can get infected, and children or immunocompromised people are more prone to severe cases.

Doctors can ensure lesions are clean and give pain medication or antibiotics for secondary infections such as sepsis.

But those who recover can get the virus again.

Lack of resources and knowledge

Experts say a lack of resources and knowledge about the new strain makes it difficult to advise people on protecting themselves. An internal report circulated among aid groups and agencies and seen by AP, said confidence in the available information about mpox in eastern Congo and neighbouring countries low.

While the variant is known to be more easily transmissible through sex, it’s unclear how long the virus remains in the system. Doctors tell recovered patients to abstain from sex for three months, but acknowledge the number’s largely arbitrary.

“Studies haven’t clarified if you’re still contagious or not … if you can or can’t have sex with your wife,” said Dr. Steven Bilembo, of Kamituga’s general hospital.

Doctors say they’re seeing cases they simply don’t understand, such as pregnant women losing babies. Of 32 pregnant women infected since January, nearly half lost the baby through miscarriage or stillbirth, hospital statistics show.

Alice Neema was among them. From the hospital’s isolation ward, she told AP she’d noticed lesions around her genitals and a fever — but didn’t have enough money to travel the 30 miles (50 kilometers) on motorbike for help in time. She miscarried after her diagnosis.

As information trickles in, locals say fear spreads alongside the new strain.

Diego Nyago said he’d brought his 2-year-old son, Emile, to the hospital for circumcision when he developed a fever and lepasions.

“I didn’t believe that children could catch this disease,” he said as doctors gently poured water over the boy to bring his temperature down. “Some children die quickly, because their families aren’t informed.

“Those who die are the ones who stay at home.”

A batch of mpox vaccines donated by European Union seen at the tarmac of Kinshasa International Airport in the Nsele district of Kinshasa. The Democratic Republic of Congo, the epicentre of an mpox outbreak, on September 5, 2024 received its first vaccines
| Photo Credit: AFP Photo/European Union Handout

The first batch of mpox vaccine arrived in Congo’s capital on Thursday, September 5, 2024, the country’s authorities said, three weeks after the World Health Organization declared mpox outbreaks in 12 African countries a global emergency.

The 100,000 doses of the JYNNEOS vaccine, manufactured by the Danish company Bavarian Nordic, have been donated by the European Union through HERA, the bloc’s agency for health emergencies. Another 100,000 are expected to be delivered on Saturday, September 7, Congolese authorities said.

UNICEF is going to be in charge of the vaccination campaign in the most impacted provinces, Congo’s Health Minister Roger Kamba told reporters after the delivery of the vaccine. But it remained unclear when the vaccination drive would begin.

About 380,000 doses of mpox vaccines have been promised by Western partners such as the European Union and the United States, Dr. Jean Kaseya, head of the Africa Centers for Disease Control and Prevention, told reporters last week. That is less than 15% of the 3 million doses authorities have said are needed to end the mpox outbreaks in Congo, the epicenter of the global health emergency.

The organization said that since the start of 2024, Congo has reported more than 4,900 confirmed mpox cases, with more than 629 associated deaths, representing a sharp escalation in both infections and fatalities compared to previous years. Most mpox infections in Congo are in children under age 15.

“These vaccines are vital in safeguarding our health workers and vulnerable populations, and in curbing the spread of mpox,” Kaseya said on Thursday

Following the global mpox outbreak in 2022, wealthy countries quickly responded with vaccines and treatments from their stockpiles. However, only a few doses have reached Africa despite pleas from its governments.

MVA-BN vaccine has already been used in Europe and the United States, the E.U. said, and it is authorised for use in adults. The European Medicines Agency is examining additional data to be able to administer it to children aged 12 to 17, which could happen at the end of the month.

215,000 doses were pledged and purchased for an undisclosed amount specifically to be donated to Congo, said Laurent Muschel, the Director-General of HERA.

Mercy Muthee Laker, the Congo representative for the Red Cross and Red Crescent aid organization, praised the Congolese government for procuring some vaccines but said the doses promised “were quite few compared to the need that we see on the ground.”

Other experts said it would likely be weeks before any vaccines are administered, given the financial resources and logistical planning needed to get them to where they are needed in a vast country with a limited health infrastructure.

The U.S. said last week that it donated 10,000 doses of mpox vaccines to Nigeria, where the disease has been common. It is the first known donation to Africa since the current outbreaks. Nigeria has recorded 40 cases of the virus this year, according to Nigeria’s CDC.

Mpox, previously known as monkeypox, had been spreading mostly undetected for years in Africa before the disease prompted the 2022 outbreak in more than 70 countries, Dr. Dimie Ogoina, the chair of WHO’s mpox emergency committee told reporters last month.

“What we are witnessing in Africa now is different from the global outbreak in 2022,” he said. While that outbreak was overwhelmingly focused in gay and bisexual men, mpox in Africa is now being spread via sexual transmission as well as through close contact among children, pregnant women and other vulnerable groups.

And while most people over 50 were likely vaccinated against smallpox — which may provide some protection against mpox — that is not the case for Africa’s mostly young population, who Ogoina said were mostly susceptible.

The Africa CDC said it is working on a unified response plan for the outbreaks which will be presented to African heads of state for consideration at a meeting in September.