Paradoxical Disparities in the 2024 MPOX Outbreak Between Two Neighboring Countries: Rwanda and Burundi

Monkeypox (MPOX) has emerged as a global health concern, with the 2024 outbreak originating from South Kivu, a province in the Democratic Republic of Congo (DRC). Interestingly, two neighbouring countries, Rwanda and Burundi, have shown significant differences in their MPOX prevalence despite sharing borders with the DRC. While Burundi is one of the hardest-hit nations in the current outbreak, Rwanda has successfully managed to limit the spread of the virus. This narrative review study explores the factors behind this disparity by reviewing existing literature and data on health activities in both countries over the past decade, focusing on responses to MPOX, coronavirus disease (COVID-19), and human immunodeficiency virus infection or acquired immune deficiency syndrome (HIV/AIDS). Rwanda’s success is attributed to its centralized health intervention structure, efficient training of healthcare workers via partnership with the Clinton health initiative, rapid SMS health alerts for community workers, and a robust community-based health insurance (CBHI) scheme, the Mutuelles. Conversely, Burundi’s progress has been hampered by the independence of foreign organizations. Another key factor in the MPOX disparity between Rwanda and Burundi is Burundi's proximity to South Kivu through Lake Tanganyika, with frequent uncontrolled immigration. Monitoring these checkpoints is crucial to curb the spread of the MPOX virus in Burundi. Rwanda’s health system and policies provide a credible model for controlling disease outbreaks.