The military governor of the Democratic Republic of Congo's Ituri province, the epicentre of the Ebola outbreak, has likened the struggle to contain the spread of the virus to a “war for which they are lacking resources to fight”, the BBC reports.
“People in affected areas are not receiving enough food,” Johnny Luboya Nkashama told French broadcaster RFI, "and other diseases and overcrowding” are also issues.
He called for a “swift response”, including strengthening the capacity of staff to prevent Ituri “from descending into catastrophe”.
Officials say there are more than 900 suspected cases of Ebola, and 223 suspected deaths, since the outbreak was declared on 15 May.
The WHO said the disease may be spreading faster than originally thought. On Monday, WHO director-general Tedros Adhanom Ghebreyesus, who was due to travel to the DRC, said the outbreak was outpacing urgent efforts to scale up a response and that responders were “playing catch-up”.
Nkashama said “qualified personnel” should be deployed as soon as possible and secure treatment centres established. Our existing resources were dedicated to the war, and this second war that is now upon us demands even more."
On Saturday, the head of the Africa CDC had a meeting with Health Ministers from the DRC, Uganda and South Sudan to finalise their cross-border co-ordination in response to the outbreak.
Africa CDC Director-General Dr Jean Kaseya said they also agreed on a $319m budget to stop the outbreak from spreading.
He told the BBC that 10% of the money had been secured from the affected countries. On the same day, South African President Cyril Ramaphosa pledged an initial $5m to support the plan.
Kaseya added that African businessmen will be meeting later this week to raise additional funds, while international partners were also “committing funds”.
Africa CDC has warned that other countries on the continent – Angola, Burundi, the Central African Republic, Ethiopia, Kenya, Rwanda, South Sudan, Tanzania and Zambia – were at risk from an outbreak.
This outbreak is the 17th to have emerged in the DRC since Ebola was discovered in 1976. It is only the third worldwide of the rare Bundibugyo strain, which has not been seen in more than a decade.
In response to the outbreak, Congolese officials have mandated that the dangerous work of burying suspected victims be managed whenever possible by health authorities, which is being met by protests from families. On Friday, the government said funeral wakes and gatherings of more than 50 people would be banned in north-eastern Congo in an effort to curb the spread of the virus.
Also on the weekend, on Saturday, a group of residents of Mongbwalu attacked and set fire to a Doctors Without Borders tent set up to treat suspected and confirmed Ebola cases in the area. During that attack, 18 people with suspected Ebola infections left the facility and were unaccounted for, Lokudu had said earlier.
On Thursday, another treatment centre, in the town of Rwampara, was burned down after family were banned from retrieving the body of a man suspected to have died of Ebola.
The International Federation of Red Cross and Red Crescent Societies said that three of its volunteers had died from the outbreak in Mongbwalu, and that it was thought the three healthcare workers contracted the virus on 27 March while handling bodies as part of a humanitarian mission unrelated to Ebola.
Hobbled
Public health experts say the aid cuts by the Trump administration have shut down crucial disease surveillance networks and medical supply chains.
The New York Times reports that response to the escalating cases has been significantly hindered by the near-absence so far of the United States, historically the leader in any major outbreak, which previous funded networks across the region and maintained emergency teams to take charge in public health crises like this one.
Much of that work ended with the shutdown of the US Agency for International Development (USAID) early last year. The US Centres for Disease Control and Prevention has also lost hundreds of experts, including some in the DRC, who could have helped contain the epidemic.
Epidemiologists and others who worked on previous Ebola outbreaks say the fact that this one came to international attention weeks, or perhaps months, after it began and had already spread across international borders, is a direct result of the weakened surveillance.
American officials did not learn of the outbreak until nine days after the WHO did, and almost a month after the first person died. The delay in confirming the outbreak was in part because samples were taken to the national lab in Kinshasa, Congo, at the wrong temperature. That task previously would have been managed by USAID.
Infections have been confirmed in Goma, a Congolese city of at least 1m people on the border with Rwanda; in Bunia, a city of about 800 000 people; and in the Ugandan capital of Kampala, population 1.9m, suggesting a wide footprint for the virus. Goma is more than 550km from the region where the first cases were identified.
“The health system is on its knees here,” said Heather Kerr, the country director for Congo for the humanitarian organisation International Rescue Committee.
“Everything to do with the logistics of an Ebola response in its first phase, we would have hoped to see some US funding for that,” she said.
Logistics
Congo has deep epidemiological expertise on Ebola, but in previous outbreaks, it has counted on help from the United States with logistics and crucial supplies.
For weeks, health workers have been treating Ebola patients wearing only gloves and surgical masks, if even that, rather than respirators and face shields, impermeable coveralls and surgical hoods to prevent exposure to bodily fluids.
“My heart is breaking for those workers,” said Megan Fotheringham, who was USAID’s deputy director of infectious diseases, including during the Ebola outbreak in Ituri between 2018 and 2020. “They are not protected, and they are putting their lives on the line.”
She added that USAID would have moved stockpiles of personal protective equipment that it maintained, within hours.
Congolese physicians are highly experienced in identifying and treating Ebola, said Dr Salim Abdool Karim, who leads the emergency committee of the Africa Centres for Disease Control and Prevention. But other types of assistance that the United States provided in previous outbreaks were essential.
The WHO has moved nearly 25 tons of gear from storage in Kinshasa; Nairobi, Kenya; and Dakar, Senegal, but the first shipments arrived only on Friday. “We don’t know the extent of that outbreak, so we cannot say we have enough or not,” said Dr Marie-Roseline Belizaire, who is leading the WHO’s response to the outbreak.
The State Department disputed the characterisation that the United States was any less involved in the outbreak response than it would have been in earlier years, or that surveillance was any weaker.
This week, the State Department said it was sending $23m to Congo and Uganda. Officials said the money would go toward resources including protective equipment.
Additional funding “in the nine figures” will help build and maintain 50 clinics, which may take a few weeks to months to set up, they said.
Secretary of State Marco Rubio seemed to blame the WHO for the delay in detecting the outbreak. He said the WHO “was a little late to identify this thing, unfortunately”.
The first hint of the outbreak surfaced on 5 May, when the WHO learned of a cluster of unexplained deaths.
The organisation promptly alerted the International Health Regulations, a legal framework for disclosing outbreaks. But the US withdrew from the WHO earlier this year, cut funding to the organisation, and rejected the framework, and American officials no longer talk regularly with their international partners.
By the time American officials heard the outbreak had been confirmed, around two days later, the virus had already been thought to have caused about 250 cases and 80 deaths.
The funds being released now will certainly help, public health officials said, but they are coming without the infrastructure to make them most effective. In previous outbreaks, USAID, which co-ordinated the practical aspects of a response, trained health workers, facilitated contact tracing, boosted testing capacity and provided resources for safe burials.
It would also have pushed partner organisations to move faster.
Surveillance
Historically, the United States would probably also have already set up intensified surveillance at border posts with neighbouring countries, said Courtney Blake, who helped lead the USAID response to a multi-country Ebola outbreak in West Africa in 2014 and 2015.
“In case there is spillover, we would want to make sure we’re able to capture it very quickly,” she said. “But our ability to do that swiftly has been eliminated.”
With the world’s attention now on the outbreak, health officials and workers in the region say there are signs that the US is stepping up its involvement. Dr Mamadou Kaba Barry, head of mission in Congo for the aid organisation Alliance for International Medical Action, which is setting up isolation wards in Ebola-affected districts, said that State Department staff had called his team in recent days to ask what was needed and what his organisation was in a position to do.
Many experts said the places where the US absence would be felt most sharply were in the supply chain for moving protective medical supplies and, if eventually there is a vaccine or treatment for this species of the virus, for moving those too.
“The supply chain was organised perfectly, arriving on time, and we saved lives in 2019,” said Dr Manenji Mangundu, the country director for the aid agency Oxfam in Congo and a veteran of multiple Ebola outbreak responses.
Containment efforts in this outbreak have been further complicated by the fact that the infections are caused by the Bundibugyo species, for which there is no vaccine or therapeutics. Standard Ebola tests do not detect it, meaning it had been circulating for some time before analysis at Congo’s national laboratory finally raised the alarm.
Ebola has a mortality rate of up to 50% and an incubation period of up to 21 days. The first known death in this outbreak was a nurse on 27 April, suggesting, even by the most conservative estimate, that the virus has been spreading since early April.
Experimental treatment
An HHS official, meanwhile has said they are working with a small biotech firm, Mapp Biopharmaceutical, to make an experimental Ebola treatment, reports Reuters.
The firm is working with the Biomedical Advanced Research and Development Authority (BARDA), to supply the treatment for potential use in high-risk individuals as part of co-ordinated preparedness efforts.
The investigational monoclonal antibody treatment was developed through a “long-standing public-private partnership supported by BARDA to address Sudan virus, which is closely related to other Ebola viruses”, the official said.
Lab data suggest it has the potential to be effective against the Bundibugyo virus.
BBC article – Ebola needs swift response to prevent catastrophe – DR Congo governor (Open access)
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WHO wants more funds to fight DRC Ebola epidemic
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