DRC ends mpox outbreak after 2,200 deaths: systemic failures in global health equity and zoonotic surveillance exposed

Indigenous communities in the Congo Basin have long practiced adaptive strategies to mitigate zoonotic risks, such as seasonal hunting bans during peak viral transmission periods and taboos against consuming certain primate species linked to mpox. These practices are rooted in deep ecological knowledge but are dismissed by global health institutions as 'superstition,' despite evidence that they reduce spillover events. The erasure of this wisdom in outbreak narratives reflects a broader pattern where Western biomedical frameworks dominate, marginalizing holistic, place-based solutions.

The DRC’s mpox outbreak mirrors historical patterns of zoonotic spillover in Central Africa, where colonial-era deforestation and forced labor disrupted traditional hunting practices, increasing contact with wildlife reservoirs. The 1970s discovery of mpox in humans in the Congo Basin coincided with large-scale logging operations, a parallel to today’s industrial mining and agricultural expansion. Historical precedents also show how delayed international responses—such as during the 1995 Ebola outbreak in Kikwit—exacerbated mortality rates, a lesson tragically repeated in the 2020s.

Cross-culturally, mpox outbreaks have been framed differently: in Nigeria, the disease was initially called 'monkey pox' but later rebranded as 'mpox' to reduce stigma, reflecting a shift toward decolonizing disease nomenclature. In Brazil, the 2022 global mpox outbreak prompted indigenous groups like the Yanomami to share traditional knowledge on immune-boosting plants, such as *Uncaria tomentosa* (cat’s claw), which is now being investigated for antiviral properties. These examples highlight how non-Western frameworks can complement biomedical approaches to pandemic preparedness.

Scientifically, the DRC’s mpox outbreak was driven by the clade I strain, which has a higher human-to-human transmission rate than clade II (responsible for the 2022 global outbreak). Genomic sequencing revealed multiple spillover events from animal reservoirs, particularly rodents, into human populations, with genomic data suggesting sustained human transmission chains. However, scientific coverage often overlooks the role of climate change in expanding rodent habitats and the lack of standardized surveillance systems in rural areas, which hampers early detection and response.

Artistically, mpox outbreaks have been depicted in Congolese music and oral traditions as a 'punishment from the forest spirits' for ecological disrespect, a narrative that underscores the spiritual dimension of disease. In the DRC, artists like Baloji have used music to critique industrial exploitation of the Congo Basin, linking environmental degradation to health crises. Spiritually, many Central African communities view disease as a communal imbalance requiring collective healing rituals, which contrast with the individualistic biomedical model that dominates global health responses.

Future modelling suggests that without addressing structural inequities, mpox and similar zoonoses will become more frequent due to deforestation, climate change, and urbanization. Scenario planning indicates that investing in community-led surveillance—such as the 'One Health' approach integrating human, animal, and environmental health—could reduce spillover events by 30-50% in high-risk regions. Additionally, patent pooling for vaccines and decentralized production hubs in Africa could prevent future crises, as seen with the WHO’s mRNA technology transfer hub in South Africa.

Marginalized voices include rural women, who often lack access to healthcare and bear the brunt of caregiving during outbreaks, yet their insights are rarely included in policy discussions. LGBTQ+ communities in Kinshasa and other urban centers face stigma and exclusion from health services, exacerbating transmission risks. Additionally, indigenous Pygmy groups, who have lived sustainably in the Congo Basin for millennia, are often excluded from decision-making on land use, despite their knowledge being critical for zoonotic surveillance and forest conservation.