GOMA, Congo – say some health officials mpox cases in Congo appear to be “stabilising” – a possible sign that the main epidemic for which the World Health Organization has made a global emergency declaration in August it could be in decline.

In recent weeks, Congo has reported about 200 to 300 laboratory-confirmed cases of mpox each week, according to the WHO. That’s down from nearly 400 cases a week in July. The decline is also evident in Kamitugathe mining town in the eastern part of the Congo where the new, more infectious variant of mpox first appeared.

But the UN health agency acknowledged on Friday that only 40% to 50% of suspected infections in Congo have been tested – and that the virus continues to spread in some parts of the country and elsewhere, including Uganda.

While doctors are encouraged by the drop in infections in some parts of Congo, it is still unclear what kind of physical contact is causing the outbreak. Health experts are also frustrated by the low number of vaccine doses the central African nation has received – 265,000 – and say getting the vaccine to where it is needed in the sprawling country is proving difficult. WHO estimates that 50,000 people have been immunized in Congo, which has a population of 110 million.

Scientists also say that there must be a wider continent-wide vaccination effort to stop the spread of mpox and avoid further worrisome genetic mutationslike the one detected earlier this year in Congo after months of low traffic.

“If we miss this opportunity, the likelihood of another significant outbreak increases substantially,” said Dr Zakary Rhissa, who heads Congo operations for the charity Alima.

So far this year, there have been about 43,000 suspected cases in Africa and counting 1,000 people diedespecially in the Congo.

“We have seen how previous outbreaks, such as the one in Nigeria in 2017, can lead to larger global events if not effectively contained,” he said. The 2017 epidemic led to 2022 global mpox outbreak which affected more than 100 countries.

Rhissa said the drop in cases in Kamituga, where mpox first spread sex workers and miners – is an opening to implement more vaccination, surveillance and education programs.

Georgette Hamuli, an 18-year-old sex worker, didn’t know she had mpox until immunization teams arrived last week in the poor neighborhood where she works in Goma, the largest city in eastern Congo.

“They told us we were at high risk of infection,” she said. “We insist on condoms with our customers, but some refuse… if they don’t want to use a condom, they double the amount they pay.”

Hamuli said she and other sex-worker friends each received 2,000 Congolese francs ($0.70) from a charity to get vaccinated against mpox – but it wasn’t the money that swayed her.

“The vaccine is also necessary,” she said. “I think we’re protected now.”

The African Centers for Disease Control and Prevention has estimated that Congo needs at least 3 million mpox vaccines to stop the virus and another 7 million for the rest of Africa. So far, WHO and partners have allocated 900,000 vaccines to nine African countries affected by mpox and expect 6 million vaccines to be available by the end of this year.

Mpox outbreaks in Burundi, Kenya, Rwanda and Uganda originated in the Congo, and a number of cases in travelers have also been identified in Sweden, Thailand, Germany, India and the UK.

Fewer than half of the people most at risk in Congo have been vaccinated, according to Heather Kerr, Congo director for the International Rescue Committee.

“We only have a small amount of vaccines and nothing for children,” she said.

Vaccines for Congo come mostly from donor countries like the US and through UNICEF, which mainly uses taxpayers’ money to buy the vaccines.

“We have a charitable approach where we see only very small vaccine donations to Africa,” said Dr. Chris Beyrer, director of the Global Health Institute at Duke University. “What we need is a public health approach where we immunize populations at scale.”

Bavarian drugmaker Nordic, which makes the most widely used smallpox vaccine, said it would sell vaccines destined for Africa at the lowest possible price.

The advocacy group Public Citizen estimated that UNICEF paid $65 per dose of Bavarian Nordic’s Jynneos mpox vaccine, far more than almost all other vaccines used in public health programs.

Dr. Salim Abdool Karim, an infectious disease expert at the University of KwaZulu-Natal in South Africa, said mpox outbreaks usually peak and die down quickly because of the way the virus spreads. This time, however, he said there are two complicating factors: sexual transmission of the virus and continued spread from infected animals.

“We’re in new territory with mpox this time,” he added. “But we’re never going to solve this until we vaccinate the majority of our people.”

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Cheng reported from London.

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