KINSHASA – The Democratic Republic of Congo’s (DRC) battle against the Mpox (monkeypox) outbreak shows significant epidemiological progress, yet reveals a troubling new phase of concentrated transmission in conflict-affected regions, health authorities announced. Christian Ngandu, Coordinator of the Public Health Emergency Operations Center (COUSP), provided a crucial update on December 31, 2025, detailing a dramatic shift in the outbreak’s trajectory over the past year.
Ngandu’s data illustrates a public health response milestone: “Regarding Mpox, the data is decreasing. Initially, we had a weekly notification of approximately 2,000 cases, but currently we have 250 to 300 cases per week.” This represents an 85-88% reduction in weekly incidence. Furthermore, the geographic footprint has shrunk drastically. From a peak affecting 401 health zones between 2024 and November 2025, active transmission in December was confined to just 19 health zones.
“This decline is a testament to the efforts in surveillance, community engagement, and case management,” a public health expert not involved in the briefing noted. “However, the concentration of cases in specific, hard-to-reach zones means the outbreak is entering a more complex, entrenched phase where traditional response mechanisms are challenged.”
From Widespread Outbreak to Focal Hotspots: A New Challenge
The coordinator pinpointed the remaining hotspots: “a significant number are in North Kivu and South Kivu, which are plagued by insecurity, but also in Sankuru.” This geographic shift is critically important for several reasons:
- Conflict and Access: North and South Kivu are epicenters of prolonged armed conflict and mass displacement. Insecurity severely hampers disease surveillance, contact tracing, and the delivery of medical supplies and vaccines. Health workers often cannot safely reach affected communities, and populations on the move can spread the virus.
- Clade I Dominance: The Mpox virus circulating in Central Africa, including the DRC, is predominantly the more severe Clade I (formerly the Congo Basin clade), which has a historically higher mortality rate (up to 10%) than the Clade IIb that caused the 2022 global outbreak. This underscores the urgency of containing these lingering hotspots.
- Zoonotic Pressure: Sankuru, a forested province, represents a different challenge—ongoing zoonotic spillover from animal reservoirs (likely rodents and primates). Sustained transmission in such areas requires a One Health approach, integrating human and animal disease control.
Context and Implications: Beyond the Headline Numbers
The reported decrease from 2,000 to ~300 weekly cases is encouraging but must be interpreted with caution. Surveillance in conflict zones is notoriously incomplete; the true number of cases is likely higher. The consolidation into fewer zones is a double-edged sword: it allows for targeted resource allocation, but also indicates the virus has found stable transmission chains in areas where public health systems are weakest.
This situation highlights a global health vulnerability. As long as Clade I Mpox circulates intensely in a region with limited healthcare access and frequent population movement, the risk of international spread—though currently lower than in 2022—persists. The DRC’s experience is a real-time lesson in how conflict and infectious disease create a vicious cycle, each exacerbating the other.
The path forward requires sustained international support for the DRC’s health system, innovative strategies for delivering care in insecure environments (like decentralized care points and mobile clinics), and accelerated research into vaccines and treatments effective against Clade I. The progress made in reducing cases nationwide is commendable, but the fight is now focused on the most difficult fronts.
_______