The eastern part of the Democratic Republic of Congo (DRC) particularly around Goma and Bukavu, may become a hotspot for disease transmission following renewed conflict and the freeze in aid from the United States, warned Dr Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC).

Amid fighting when M23 rebels recently seized the two towns from DRC forces, over 400 mpox patients fled from health facilities, while outbreaks of cholera and measles are also affecting the region.

Over a million displaced people living in Goma and over 150,000 in Bukavu are particularly vulnerable to disease.

“This can be the entry point for a new pandemic,” warned Kaseya, adding that none of the regions affected by insecurity are reporting on diseases and laboratory testing has been disrupted by the United States freeze on foreign funds.

“In regions like South Kivu and North Kivu, we don’t have information, either because of insecurity or the pause in the US government funding, because the mechanism that we had in place in terms of sample referral was based on US funding provided to DRC,” Kaseya told a media briefing on Thursday. 

“The combination of insecurity, lack of funding and lack of medical countermeasures, [means] we are playing with fire.”

Earlier in the week, Grégoire Mateso Mbuta, president of the DRC Red Cross said that “the humanitarian situation is dire in Bukavu and Goma.

“In Goma, the morgues and hospitals are overwhelmed. Around 190 DRC Red Cross volunteers and a team of coordinators are working tirelessly to recover the bodies left in the streets, take measures to prevent epidemics and give the victims a dignified burial. In the face of so much need, more help must be provided urgently, ” he added in a joint statement released by the International Committee of the Red Cross, the International Federation of the Red Cross and the Red Cross Society in the DRC.

New fund for epidemics

The African Union finally gave the go-ahead for an African Epidemic Fund to raise money to address continental disease outbreaks at its meeting last week, which is crucial in the wake of the US  withdrawal of foreign funding.

The fund will be administered by Africa CDC and facilitate a flexible and speedy response to outbreaks, according to Kaseya.

“We can receive funding without any limitation, without any bureaucracy, to use that to support African countries to prepare and to respond to outbreaks,” said Kaseya.

Africa CDC will provide the secretariat for the fund, which will be guided by a board.

Aside from the DRC’s mpox outbreak, continental malaria, tuberculosis and HIV efforts, have been affected by the US aid freeze. 

The US under President Joe Biden pledged $500 million to assist the continent with mpox and other outbreaks with $385 million committed. 

Kaseya said that Africa CDC was negotiating to “see this commitment become real money”, but that talks were ongoing. 

Since the funds freeze announced on 20 January when Donald Trump assumed office, China and South Korea have pledged $4 million and Morocco has also pledged $2 million –  but this makes up a teeny percentage of US aid to the continent. 

Kaseya said that Africa CDC had engaged with US officials immediately after Trump announced the freeze a month ago, and claimed some credit securing the US waiver on life-saving humanitarian expenditure.

However, despite the waiver, numerous health projects are still in limbo as they wait for official waiver letters.

In addition, “all HIV prevention activities were excluded from the waiver, except for those aimed at preventing mother-to-child transmission”, according to amFar this week. 

“To date, few implementers have been approved to restart services under the waiver, leaving all activities, including treatment, still paused.” 

Mpox tech transfer deal with African company

While there are no accurate mpox figures from the DRC, the epidemic is growing in Uganda, Congo Brazzaville and Zambia, which has shown a huge jump in figures from 16 to 700 cases.

However, in a glimmer of good news mpox vaccine manufacturer Bavaria Nordic has “95%” concluded a technology transfer deal with an African company to enable the vaccine to be produced on the continent.

This transfer will be a “fill and finish” deal rather than the more comprehensive drug substance transfer.

Dr Ngashi Ngongo, head of Africa CDC’s Incident Management Support Team, said he was working on creating demand for the mpox vaccine including the creation of a continental stockpile to ensure that countries would buy the locally manufactured vaccine.

Image Credits: Ley Uwera/ International Committe of the Red Cross.