Alarm bells should be blaring about the growing mpox outbreak in the Democratic Republic of the Congo, where community organizations best positioned to prevent a wider outbreak or pandemic report a lack of funding and shortage of basic supplies. It was only in early October that limited quantities of vaccines reached some impacted communities. But health care and other frontline workers remain unprotected and under-resourced.
It’s as if the world had not just experienced a major pandemic, during which we painfully learned that a faster and more robust investment in early action and preventive measures could have slowed transmission and saved countless lives.
In August, the World Health Organization declared mpox a “public health emergency of international concern.” To date, there have been more than 100,000 documented cases across 123 countries. The numbers are likely higher due to limited testing and health care access for those impacted. In response, in September the White House announced a $500 million commitment to support African countries’ efforts to respond to and contain the disease.
As cases continue to mount, the human and financial costs increase. For example, in August, the Africa Centers for Disease Control and Prevention estimated that $245 million was needed to respond to the outbreak. Months later, the amount needed is likely much higher. And, if the aftermath of past humanitarian disasters has taught us anything, sending all of the funds to any one central actor would be a grave mistake.
For decades, bottlenecks, delays, and diversions of donated funds have plagued the humanitarian and development sectors in the U.S. and globally. Typically, only a small percentage of the funds donated to international NGOs reach the ground.
While dollars should always be stretched to maximize impact, it’s urgent in under-resourced crises like mpox. Humanity cannot afford business as usual when donor dollars are underutilized, especially when we have a time-sensitive opportunity to save lives. There is an urgent need for more direct donations to locally led organizations to ensure funds reach the front lines as quickly as possible.
Humanity cannot afford business as usual when donor dollars are underutilized, especially when we have a time-sensitive opportunity to save lives.
Our nonprofit, Disaster Accountability Project, created SmartResponse.org, a global clearinghouse and network of locally led human service and environmental organizations that prepare for, respond to, and recover from disasters. The website makes it easier for donors to identify and directly support on-the-ground groups, especially in the immediate onset or aftermath of disasters. The model is unique because we help make direct connections between donors and organizations rather than to another donation platform or offshore intermediary.
Many in our network of DRC-based organizations, who previously responded to Ebola and Covid-19, are now reporting a lack of funds and basic supplies. These local public health professionals on the ground are the first line of defense, but they do not have the resources, such as personal protective equipment and medicines, to stop the spread of an outbreak that could potentially become another pandemic.
Numerous organizations have reported that quarantine centers have not received food, causing infected people to leave and return to their families, increasing the spread risk.
Consider this: The cost of feeding infected populations is significantly lower if a locally led NGO is directly funded to do it. If funds are first sent to an outside intermediary — typically an international organization — costs jump and delays are inevitable, because that organization usually takes a percentage and either gives a grant to another international organization or subcontracts a local group. Delays result in additional spread.
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Jean Mudekereza Kahunga, program director of the Women’s Association for Promotion and Endogenous Development, or AFPDE, a DRC-based women’s rights and welfare organization with in-house doctors and nurses, wrote to us by email: “Given the high number of confirmed mpox cases here at home, the South Kivu Province is considered the global epicenter of the mpox epidemic. Faced with the influx of cases of mpox in the health zones that we support and faced with the frequent movements of populations in our region, we find ourselves unable to provide a service to communities to stop the spread and take care of the sick because of the limited means at our disposal.”
AFPDE also specifically listed a need for medications, funds to pay service providers, food for people in quarantine, personal protective equipment, chlorine, specialized medical waste trash cans, liquid soaps, soap powder and bars, receptacles, aprons, tests and other laboratory supplies, and more.
Imani Gubandja Nkmere Honoré, coordinator at the DRC-based Actions for Justice, Peace and Development, or AJPD-RDC, told us by email that his human rights organization needs transportation funds for outreach to remote communities, support for communication and coordination, generic medicines, PPE, and more. In addition, in order to “combat the prejudices and stereotypes that rural populations are propagating” about mpox, his organization is deploying a team of clinical psychologists directly to communities to support those infected with mpox as well as their families.
Global efforts to directly fund local organizations are not moving quickly enough to prevent a public health disaster from continuing to spiral out of control.
Imani mentioned that his organization is also focused on serving war-displaced people impacted by the disease, another complexity best addressed by local human rights organizations that are already serving displaced and traumatized populations.
Meanwhile, global efforts to directly fund local organizations are not moving quickly enough to prevent a public health disaster from continuing to spiral out of control. In September, the U.S. Agency for International Development released a new policy on locally led humanitarian assistance, setting a goal that at least 25 percent of USAID humanitarian and development funds would reach local, in-country actors. Although the news is welcome, it conversely means that 75 percent of funds intended for humanitarian and development outcomes may not reach local organizations and actors.
In an email, Jonas Habimana, executive director of the DRC-based Bureau of Information, Training, Exchanges and Research for Development, or BIFERD, said it best: “We have integrated Mpox into existing interventions and do not have specific funds allocated to Mpox,” adding that “local civil society needs to be actively involved in the response,” but has limited resources.
Note: All interviews were translated from French.
Ben Smilowitz is an attorney and executive director of Disaster Accountability Project, a nonprofit improving effectiveness, efficiency, and equity in disaster relief and humanitarian aid.
Ankush Bansal, M.D., is an internal medicine physician and recent Board President at Disaster Accountability Project.