DRC, mystery disease and what can be done to stop deadly pathogens?

Almost two weeks ago, the WHO was informed of an outbreak of an undiagnosed disease in the Democratic Republic of Congo (DRC) that has now reportedly caused 143 deaths.

After days of confusion about the disease making people sick, officials say that test results suggest malaria may be driving the deadly outbreak in DRC’s Kwango province, but experts warn other pathogens could be involved.

Of 12 samples tested, 10 were positive for malaria, Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), announced at a recent press briefing. He added that the investigations continue to pinpoint the precise causes of illness.

Samples are being sent to Kinshasa for further analysis, highlighting the lack of local testing capacity.

“In a case like this, it is important to remember that malaria is a significant disease and can lead to death,” Dr Krutika Kuppalli, an infectious diseases expert at the University of Texas, told TRT World.

Dr Kuppalli added that malaria, transmitted by specific mosquito species, remains a persistent global health challenge influenced by biological, environmental, social, and systemic factors.

“Despite significant progress in reducing malaria’s impact in many regions, its eradication faces several barriers,” she noted.

The cases are up from 111 reported during the previous week. The outbreak has disproportionately affected children, with nearly 42 percent of cases reported in those under five.

Dr Abdi Mahamud, the WHO’s interim director of alert and response coordination, said malaria is endemic in the region and that the rainy season has led to an expected rise in respiratory illnesses.

“For example, Kinshasa is seeing a rise in flu and COVID,” he stated. While the epidemiological data do not indicate an explosive increase in cases or deaths, he highlighted that “the high infant mortality shows that the issue needs to be addressed in Panzi and other vulnerable regions.”

Dr Kuppalli further underscored the importance of other contributing factors. “It is also important to remember that in persons who are malnourished and don’t have access to high-quality medical care, this may affect the severity and clinical presentation of the disease.”

Myriad contributing challenges

Experts caution that the crisis illustrates deep-rooted vulnerabilities in the region, where overlapping health, environmental, and social factors hinder effective disease control. Hayley MacGregor, a Research Fellow at the Institute of Development Studies, suggested the involvement of more than one pathogen cannot be ruled out.

“Critical to note in the WHO reports is the fact that there have been severe cases in children, and malnutrition is likely to be severe in this area. It is an area characterised by political insecurity, and severe food insecurity appears to have intensified the illness,” MacGregor told TRT World.

MacGregor also pointed out that anaemia observed in many cases could be pre-existing, reflecting the impact of social and political-economic conditions on health. Vaccine coverage in the region is believed to be low, and access to preventative and curative health services is extremely limited.

She highlighted logistical challenges in sample testing, noting that samples must be transported to the INRB in Kinshasa due to the lack of laboratory capacity in the region.

“These challenges have also been noted in the other outbreak in the region, namely Mpox,” she added. Democratic Republic of Congo has been unable to launch an mpox vaccination campaign in the capital Kinshasa due to a shortage of doses.

What can be done?

According to MacGregor, the current health crisis highlights the broader political and structural issues.

“The conditions on the ground are a sober illustration of the wider political and structural issues that hamper surveillance and response of known and emerging diseases,” she said. MacGregor explained.

“First, one needs to be able to take samples, which requires people to trust the system and have access to health services, as well as trained staff to collect the samples. Second, it requires storage and transport facilities, a laboratory to test the samples, and skilled lab personnel. All of these components must be in place for effective surveillance,” she noted.

Testing for new diseases in remote regions like rural Congo is fraught with logistical and systemic challenges, from gaining community trust to ensuring trained staff, proper storage, transport, and laboratory capacity.

“Addressing the humanitarian situation, political instability, and trust in government and other actors is critical to outbreak response. Outbreak preparedness also requires investment in improving structural realities, such as public health surveillance and access to affordable medical care,” MacGregor concluded.