DRC Ebola epidemic declared a global emergency – at last

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The Ebola outbreak in the Democratic Republic of the Congo (DRC) has been declared a global emergency, with the World Health Organisation (WHO) calling for international support to stop its spread, according to a New Scientist report. It says this is only the fifth event to be labelled a “public health emergency of international concern” by the organisation. The move follows the death of a pastor in Goma, a city of almost 2m people that borders Rwanda and is a hub of international travel.

Experts convened by the WHO were concerned that this, alongside the virus spreading to new locations and flare-ups in areas where the outbreak was previously under control, could herald a growing epidemic. The report says despite efforts to contain the outbreak over the past year, the crisis has grown and is now responsible for the deaths of around 1,700 people, and another 2,500 possible infections. This is the second biggest Ebola outbreak on record, behind the outbreak in West Africa in 2014.

Critics have been calling on the WHO to declare it an international emergency since the beginning of the year, and Adam Kamradt-Scott at the University of Sydney, Australia, says the announcement is “long overdue”.

The report says while it is unclear why the WHO opted not to declare the outbreak an international emergency until now, one reason may have been to avoid overreactions by international governments. The 2014 outbreak in West Africa led to travel bans, trade restrictions and the closure of border crossings, which hurt local economies and made it more challenging for healthcare workers to operate.

Robert Steffen, chair of the emergency committee convened by the WHO, stressed that governments shouldn’t react in the same way, saying it “would have a negative impact on the response and on the lives and livelihoods of people in the region”. The committee said that such measures were made “out of fear and have no basis in science”.

Kamradt-Scott is quoted in the report as saying it is important that the international community steps up efforts to control the spread of the virus. So far, around 160,000 people have received a vaccine made by Merck that seems to be 97% effective. But the Wellcome Trust, a health charity, recently warned that supplies could run out, and urged the use of a second vaccine, made by Johnson & Johnson. The DRC Health Minister Oly Ilunga Kalenga responded by saying there is no need for another vaccine.

Containing the crisis has been made more challenging by conflict, the report says. Healthcare workers responding to cases occurring in conflict zones have been attacked and murdered. Distrust and scepticism about the virus and vaccines are also hampering public health efforts.

Kamradt-Scott says the public health response needs to learn the lessons from the 2014 outbreak in West Africa and use a social and diplomatic approach, as well as a medical one. “This is an outbreak that’s occurring in an area of conflict, so the only way you can help address the outbreak is if you address the conflict,” the report quotes him as saying.

 

Authorities in eastern Democratic Republic of Congo have intensified efforts to screen suspected cases of Ebola after the WHO’s declaration, reports Bloomberg. Checkpoints are being installed on roads in the provinces of North Kivu and South Kivu and near entrances to airports and border posts, Theo Ngwabidje Kasi, governor of Congo’s South Kivu province, is quoted in the report as saying.

The outbreak that began in August has killed more than 1,500 people in Congo and, the report says, it’s the worst epidemic of the disease since more than 11,000 people died in three West African nations between 2013 and 2016. “Our main focus now is really to restrict people infected with the Ebola disease from traveling to other areas to infect other people,” Ngwabidje Kasi said from Bukavu, about 100km southwest of Goma. “We are putting Ebola screening checkpoints up to isolate the sick and prevent the spread of the disease.”

The report says the WHO declaration came two days after a 46-year-old priest died from the disease after traveling from Butembo, one of the epicentres of the outbreak, to Goma. In early June, a few cases were confirmed in neighbouring Uganda.

Rwandan Health Minister Diane Gashumba said the authorities have vaccinated 2,600 health workers to prepare for the possibility of the disease crossing the border from Congo. “There is a need to be more vigilant and to avoid unnecessary visits to Goma,” she is quoted in the report as saying.

 

DRC officials say they accept the designation – with some reservations, says a Centre for Infectious Disease Research and Policy (CIDRAP) report. “The ministry hopes that this decision is not the result of the many pressures from different stakeholder groups who wanted to use this statement as an opportunity to raise funds for humanitarian actors despite the potentially harmful and unforeseen consequences for the affected communities that depend on them,” the DRC Health Ministry said.

Officials also said the DRC government had been and remained to be transparent about how funding was being used in the outbreak, and that they hope any aid group that receives an increase in funding because of the PHEIC would also be transparent about spending.

The report says the comments seem to reflect the hesitancy the some in the DRC have had surrounding a PHEIC, which they argue would do little to actually increase the outbreak response and instead further economic distress in that country. The designation comes just a few days after Goma, the region’s largest city recorded their first case of the disease.

The report says after the PHEIC announcement, several international non-governmental organisations and public health institutions applauded the WHO’s decision. “Ending the Ebola outbreak is one of the Trump Administration’s top global health priorities,” said HHS Secretary Alex Azar from the US Centres for Disease Control and Prevention (CDC). “We appreciate the strong response of Dr Tedros and WHO leadership to this outbreak, yet it is clear that much more remains to be done. The US government has already played a vital role in supporting the response in the DRC and neighbouring nations, and will continue this support until we have put an end to the outbreak.”

The CDC said it is working with the US Embassy in DRC to place CDC staff in Goma; CDC also has 246 permanent staff in the three high-risk countries bordering the outbreak (South Sudan, Rwanda, Uganda), including 43 in DRC.

Oxfam said in the report that the PHEIC would bring much-needed global attention to the outbreak, and said that any new funding the PHEIC brings to the DRC must be monitored. “This is also a crucial opportunity to strengthen the public health response and to respond to broader humanitarian needs in the country. Any new funding must be accompanied by stricter accountability to ensure that everyone is working effectively together to end this dreadful outbreak, that has claimed the lives of so many Congolese people,” Oxfam said.

The report says the DRC, last week, confirmed 10 new cases of Ebola, including 6 in Beni, which also saw 3 community deaths. Beni has seen a flurry of cases in recent days, and in the last 3 weeks, 50% of all confirmed cases have come from that city. And, the report says, the DRC is expected to confirm another 10 new cases, raising the total to 2,532.

The report says vaccination continues across the outbreak zone and in Goma, with a total of 164,757 people vaccinated with Merck‘s VSV-ZEBOV. “Vaccination around the confirmed Goma case continues at the Afia Himbi Health Centre in the Goma Health Zone,” DRC ministry of health officials said. “All contacts in the city were found in less than 72 hours, including the motorcycle taxi driver that the pastor had used to get to the health center. The response teams from Beni and Butembo continue the investigations to trace the pastor’s journey and identify his contacts in these two cities.”

The report says the WHO also confirmed were no current cases of the virus outside of the DRC, dispelling a rumour that a woman from Beni travelled to Uganda while infected with the virus, before returning to the DRC. The WHO said there is no evidence to suggest she travelled to Uganda after contracting the virus.

 

A Congolese woman who may have spread the deadly Ebola virus in Uganda did not go to Rwanda or the Congolese city of Goma while contagious. Reuters Africa reports that this is according to the WHO commenting on a statement by Uganda’s Health Ministry and published by the WHO’s Africa office, which said the woman, a fishmonger, was suspected of going to Goma and Rwanda as well as Uganda before she died. That raised fears of the outbreak spreading in Rwanda, which has never had a recorded case of Ebola.

But, the report says, the WHO later withdrew the statement and shut down the website where the daily updates were being posted, saying some of the information had not been verified. “We have investigated fully, and there was no travel to anywhere but Uganda,” WHO spokesperson Margaret Harris said, adding that inaccurate conjecture had unfortunately found its way into the reports.

The report says health workers have mounted a massive campaign of vigilance and vaccination on key routes and borders in the region, and have screened almost 75m people since the outbreak was declared 11 months ago. It has killed more than 1,700 people.

The 22-year-old woman was thought to have crossed the border between Uganda and Congo at an unmonitored crossing point, the deleted reports said. Harris said there no chance she had also slipped into Rwanda without being spotted. “We are absolutely certain,” she said. “Our team… went across and talked to everybody and tracked it day-by-day. Now in her life she may have gone to Rwanda… but the important thing is she did not spend any time in Rwanda while symptomatic.” It was extraordinary that a woman with end-stage Ebola had managed to cross the border and sell fish for a day, she added.

A lot of people at potential risk were now being followed up and people were being vaccinated on both sides of the border, Harris said in the report. But it would take several days before it became clear if the woman, who vomited several times at a market, had infected anyone.

The report says other details in the withdrawn reports were also unverified, including information about a second Congolese Ebola patient travelling to the same market, an
and about a group of Ugandan health workers who may have been exposed to Ebola.

 

The spread of Ebola to Goma is a sure sign that the outbreak – first declared last August – is far from over, says a report in The Daily Telegraph. This is DRC’s ninth known Ebola outbreak and is by far the biggest.

The report says the reason the outbreak is proving so intractable is that this is the first time that an Ebola outbreak has taken place in a conflict zone – ethnic and tribal tensions which have been ongoing for many years mean there are more than 100 armed groups operating in this part of DRC. As well as coming under direct attack, responders have also been subject to curfews and lockdowns, preventing them from going out and doing their job – every time there is a pause in the response due to security fears there is a spike in cases.

The report says an outbreak of fighting in neighbouring Ituri province recently underlined the fragile security situation and the possibility it could escalate further – the only way out for those fleeing violence in Ituri is through the Ebola zone, risking further spread of the disease.

The report says the Ebola responders themselves have also come under attack for a variety of reasons. Clinics and treatment centres have been torched and a WHO epidemiologist from Cameroon – Richard Valery Mouzoko Kiboung – was killed in April. Since January there have been nearly 200 separate attacks on staff and clinics and seven staff have been killed in total – just recently two Ebola workers were killed in their homes, both of whom had been subject to threats since December. The ministry of health says neighbours were jealous that they had found employment in the Ebola response.

The report says to bring the outbreak under control experts say that 70% of patients should be treated within three days of displaying symptoms. Treatment times are currently nowhere near this because people are still not coming forward quickly enough – and this is mainly due to a lack of trust. The disease is raging in poor and remote areas and local people are suspicious of the influx of people and money to an area which has been neglected for many years. Since January, 2,000 children have died from measles alone in DRC, leading local people to wonder why Ebola is the focus of such attention.

The report says a survey carried out by researchers from Harvard University earlier this year showed that one in four people in the worst affected areas thought the virus was fake and a third thought the outbreak was fabricated for either financial gain or to destabilise the region.

Dr Tedros Adhanom Ghebreyesus, director general of WHO, acknowledges these frustrations, saying he was embarrassed to come to the region and just talk about Ebola. “To build trust we must demonstrate we are not parachuting in to deal with Ebola and leaving once it’s finished,” he is quoted in the report as saying.

In March, Médecins sans Frontières president Joanne Liu was highly critical of the “militarised” public health response to the outbreak. She said that heavy-handed tactics – which included the police and army forcing people to attend treatment centres – were not only unethical but also counter-productive as they discouraged people from coming forward.

The report says in recent weeks there is some evidence that the strategy has changed, with more Congolese leading the response. New tactics such as the use of Ebola survivors, who have immunity to the disease, to care for patients, act as ambulance drivers and to help with community engagement should go some way to resolving this.

The report says UK international development secretary Rory Stewart urged other G7 countries such as France and Japan to do more to respond to the crisis. The UK and US governments have been generous – with the UK pledging a further £50m. But other richer nations have not responded in the same way that they did to the West Africa Ebola outbreak of 2014-15. So far, WHO has received less than half the funds it says it needs. It requested $98.4m for the period February to July but has received just $43.6m, leaving a funding shortfall of $54.8m.

The report says the WHO has been the outside agency leading the response but it cannot act alone. It can lead on public health but security and a broader co-ordinating role is not in its remit. A new UN emergency coordinator, David Gressley, was appointed at the end of May and was given the task of taking the response closer to the community and giving it a more “humane” face.

Tariq Riebl, International Rescue Committee’s emergency response coordinator for Ebola in DRC, said that “community engagement and continued demilitarisation” must be the top priorities of any new strategy agreed by the major partners. Excluding local people from decision making has been an ongoing criticism.

The report says looking at what is working – the outbreak has been confined to the North Kivu province of DRC and international spread to Uganda last month was quickly contained. Most experts believe that without the vaccine – which has been given to 160,000 people as a prevention tool – there would have been many more cases. However, there are only 450,000 doses so there are fears that it could run out.

The report says the DRC government has ruled out the deployment of a second vaccine developed by Johnson & Johnson, to the dismay of some who believe that responders need everything at their disposal to bring the outbreak to a close. The government said there was not enough information on the vaccine’s safety and efficacy for it to be confident to introduce it.

As well as experimental treatments not available in previous outbreaks, the care of patients is much improved, the report says. Survival rates for those in treatment centres are at around 70%. There is also some evidence that if you have the virus the vaccine can reduce the symptoms. Other less hi-tech innovations include body bags with a transparent window to enable people to see their loved ones. Burials have been a source of anger because local custom is for people to touch and wash their dead – but dead bodies can still be contagious.

The report says another innovation is US NGO Alima’s Ebola cube – a tent with transparent walls so patients can be monitored from the outside without the need for staff to put on cumbersome protective equipment. It also means family members can see their loved ones being cared for.

Tedros described the outbreak as more than just a health emergency and “one of the most challenging humanitarian emergencies any of us have ever faced”. It is clear this outbreak is far from over, the report says.

 

New Scientist report
World Health Organisation statement
Bloomberg report
CIDRAP material
Reuters Africa report
The Daily Telegraph report


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