Roundtable Report: Discussion on mpox in DRC and Social Science Considerations for Operational Response

On 28 May 2024, the Social Science in Humanitarian Action Platform (SSHAP) organised a roundtable discussion on the mpox (formerly known as monkeypox) outbreak which has been spreading in the Democratic Republic of the Congo (DRC) since early 2023.1 The objective was to appraise the current situation, with a particular focus on social science insights for informing context-sensitive risk communication and community engagement (RCCE) and wider operational responses. The roundtable was structured into two sessions: 1) an overview of the situation in DRC, including the current knowledge of epidemiology and 2) contextual considerations for response. This was followed by an hour-long panel discussion on operational considerations for response. Each session was initiated by a series of catalyst presentations followed by a question-and-answer session (Q&A). Details of the agenda, speakers and discussants can be found below. Despite estimates that less than 10% of suspected cases in DRC are being laboratory screened, the country is currently reporting the highest number of people affected by mpox in sub-Saharan Africa. It is notable that clade 1 of mpox is linked to this outbreak, which results in more severe disease and a higher fatality rate. While early cases of mpox were reported to be in gay, bisexual, and other men who have sex with men (GBMSM), the disease is now being detected more widely in DRC. The majority of those affected are children (up to 70% by some estimates2), which is a cause for concern. The outbreak is occurring on top of an overall high burden of disease and significant challenges to the health system and humanitarian interventions. The apparently heterogeneous picture of mpox across DRC – affecting different geographies and population groups – is shaped in part by social, economic and political factors. For instance, in South Kivu, accounts indicate that transmission via intimate and sexual contact is significant in mining areas, with an estimated one third of cases of disease reported in female sex workers. This raises questions about transactional sex and related stigma in these areas, as well as the implications of cross-border mobility linked to mining livelihoods for the spread of disease. A history of conflict and militia activity has additional implications for humanitarian intervention and is a factor in uptake and implementation of control strategies such as vaccination. Severe limitations in government health facilities in remote areas and a plural landscape of biomedical and non-biomedical providers are additional factors to consider for patterns of care-seeking and the timely provision of biomedical care. The limited reach of formal healthcare, including surveillance, makes it difficult to estimate the extent of cases and control disease spread through conventional epidemiological strategies. There are likely further challenges in accessing less visible populations such as GBMSM, as research in Nigeria has suggested.3,4 These complex contextual realities raise significant questions for mpox response. The roundtable convened a diverse range of expertise to offer perspectives from existing research and knowledge, with an emphasis on social science evidence. This roundtable report presents a synthesised version of the roundtable discussion with additional context as needed.