For doctors and nurses fighting mpox in the Democratic Republic of the Congo, the virus itself is not the only enemy. They are also facing swirling rumours and misinformation.

The first of millions of promised doses of mpox vaccine have finally started to arrive. Now the focus is on ensuring that people who need them will take them when the vaccination campaign begins next month, and teaching wider communities how to protect themselves.

Conspiracy theories spreading across the country include the suggestion that mpox has been invented by white people in order to sterilise Congolese people with vaccines – or that it is just a money-making scheme from pharmaceutical companies. Mistrust in medical institutions and treatments is in many cases a legacy of racist colonial policies.

“You see this kind of misinformation – and it spreads [more] quickly than the normal information,” said Dr Junior Mudji, chief of research at Vanga hospital in the west of the DRC.

With about 26,000 mpox cases reported across the DRC this year, officials are working to combat myths, teach people how to prevent infection and where to seek treatment, and lay the groundwork for vaccine acceptance.

The immunisation campaign is likely to be highly targeted and initially offered to frontline health workers and other groups particularly at risk, including contacts of known cases. Information on prevention and self-care, however, including the importance of regular hand-washing, needs to reach everyone.

Polling of almost 200,000 people in the DRC carried out this month by the UN children’s agency, Unicef, found only 56% had heard of mpox. There was patchy knowledge of symptoms and of how the virus was transmitted and could be prevented.

It is a challenging arena in which to spread reliable information. The DRC is a vast country with many remote areas that are hard to reach by road, and less than half of the population has a mobile phone.

Many people have been displaced by conflict and, Mudji emphasised: “There is a problem of trust between politicians and the population.”

He recently took part in a broadcast phone-in about mpox. “From the questions I received, it was clear that people lack good information. I told them that it is not a disease coming from US or European people – it has been in our country for a while, and now we have an outbreak.”

Mudji’s hospital is used to seeing cases of mpox arrive from its rural surroundings, typically after people have eaten diseased bushmeat, and treats about five cases a month, typically in young children. “We know this disease,” he said.

But historically it has not been common across the DRC, which now finds itself the centre of an international public health emergency, thanks to a new variant that has reached as far afield as India and Sweden. That meant, Mudji said, that “many people don’t know how exactly to manage these cases.”

Patients with mpox had long faced stigma, he said. “People will find a reason to say, ‘This family, they have done bad things, this is why they have been punished.’ It’s not easy, but the only way to fight bad information is providing good information.”

Conspiracy theories are also in evidence in the capital of North Kivu province, Goma.

“Why is it that epidemics like Ebola and mpox are a regular occurrence in our country, but not in other countries? I think the west wants to weaken us by spreading diseases left and right,” said Irankunda Alice, a 40-year-old seamstress.

Gloire Kikandi, 30, a hawker, said: “I believe that the epidemic diseases we have at home are manufactured by foreigners, greedy for money and eager to block Africa’s demographic growth.”

Gershom Risasi, a 60-year-old teacher, said: “Just as paracetamol manufacturers may want to sell their wares when there are several headaches, so foreign pharmaceutical companies may want to sell vaccines and make billions of dollars. Foreigners are looking for ways to weaken our health and thus take over the natural resources in the east of our country.”

Dr Rodriguez Kisando, a doctor from Goma, said rumours had also spread during previous epidemics such as Ebola or Covid-19. “When people don’t have access to information, they believe rumours,” he said.

“In the context of the Congo, epidemics occur at a time when there is a crisis of confidence between the governed and those in power. Some people even believe in conspiracy theories; people think that the epidemics have been manufactured abroad.

“That’s why we can’t wait for epidemics to break out before we start communicating,” Kisando added.

Unicef is working with the government to spread accurate mpox information through a network of “community action cells”, whose members include local chiefs, religious leaders, frontline workers, teachers, social service providers and women.

Sophie Chavanel, a Unicef DRC communications expert, said: “These groups are briefed and trained and then go into communities to spread the word, either in public spaces such as markets or motorbike [taxi] stations or suchlike.

“But they also visit families, house by house, to provide the right information. They take a small plastic chair and they sit with a mother or a couple of neighbours and they start having a discussion.

“Because it’s someone from the community, there’s more trust in what they say, rather than what an outsider might say or what they hear on social media,” she says.

Misinformation is not an unsurmountable obstacle. The Unicef poll that found low awareness of the virus nonetheless found a relatively high willingness to take a vaccine – 75% of people said they would accept one if offered.

“There is not a high level of hostility per se. It’s more about opening up a discussion,” Chavanel said.

“From my experience, and having done this for quite some time, ensuring people have the right information goes a long way. And it’s very much an exchange: listening to people’s concerns and providing answers back.”