SEATTLE, Washington — On August 1, 2018, the Democratic Republic of the Congo declared an Ebola outbreak in the Northern Kivu and Ituri provinces. In the year since the initial outbreak, it has progressed into the largest outbreak in the country’s history and the second-largest globally. This strain of the disease, the Zaire virus, is the deadliest strain of Ebola and the same one involved in the epidemic only a few years prior. The Ebola epidemic in the Congo has been a serious health concern.
There have been more than 3,000 total cases in the Congo Ebola epidemic and 2,000 deaths. A third of the cases occurred in the first eight months of the epidemic. The number of ill doubled in the following months. Infection rates peaked between April and June 2019 when at least 75-100 cases were being reported weekly. As of September 2019, the number has fallen to 70-75 cases.
The Democratic Republic of the Congo has seen nine previous outbreaks of Ebola. This time the nation was provided the means to contain the spread, including three new experimental Ebola drugs and four running Medecins sans Frontieres (Doctors Without Borders) projects.
Preparation in Neighboring Regions
Regions within the Congo neighboring countries were quick to begin protections against the disease. The 2018-19 outbreak follows the Western Africa Ebola virus epidemic of 2013-16, which claimed more than 11 thousand lives. Unlike before, medical experts are confident they have the means to overcome the disease. A vaccine has proven 98 percent successful. Plus, there are four therapies that contain the virus if given early enough.
Though the disease continues to spread within the Congo, efforts at containing the disease at the borders have proven successful. In late September of 2018, the Democratic Republic of the Congo confirmed a case in Lake Albert, an entry point into Uganda. By November 7, the Ugandan government had begun the mass vaccination of healthcare workers along the border. A similar process has since begun in South Sudan. As of late August 2019, there are nine active Ebola transmission zones. The nation was quick to respond to the crisis.
However, the Congo Ebola epidemic entered Uganda on June 11, 2019, carried by a 5-year-old child seeking medical treatment. The boy passed away the following day. He came in contact with a total of 112 people who were identified in the following two days. By June 18, 2019, 275 contacts partook in a ring vaccination program. The treatment was effective. The country went without another reported case of Ebola until late August when a young girl crossed into the country from the Congo.
Social Tensions Slow Progress
Though the disease remains largely contained at the national border, it quickly spread out from Kivu and Ituri into near areas in the northern Congo. Existing conflicts within the region have made healthcare difficult, and distrust of foreign health workers is widespread. For two decades, the eastern Congo has suffered violent conflict, reducing the presence of foreign humanitarian aid and limiting movement in nearby regions.
In a study performed in March 2019, it was found that 25.5 percent of the surveyed Congolese did not believe that the outbreak existed. Furthermore, only 31.9 percent trusted that local authorities acted in their interest. This distrust, and belief in misinformation, lead to difficulty instilling preventative measures.
Distrust in healthcare workers has been seen before. In the 2014 epidemic, healthcare workers feared that Ebola’s spread to West Point, Liberia, would make it impossible to contain the disease. This is due to the region’s history and lack of trust in the public healthcare system. Low trust in the government resulted in many looking to informal healthcare sectors for treatment, making it difficult for the government to collect data about the disease and pass policy.
MSF and WHO
The tension between Medecins Sans Frontieres (MSF) and the World Health Organization (WHO), the two greatest contributors to the fight against Ebola, further threaten to hamper treatment. The World Health Organization controls the distribution of the Merck vaccine, formally known as rVSV-ZEBOV. This vaccine was successfully able to halt an Ebola outbreak after only 33 deaths in 2018.
While 220,00 people have been vaccinated through the efforts of the DRC Ministry of Health and WHO, the MSF states that WHO is “restricting the availability of the vaccine in the field” and releasing confusing criteria for vaccine eligibility. This view is also backed by the AIDS Healthcare Foundation. Conflict on the large and local level are closely interlinked.
The World Health Organization states that they are acting based on strategy, following the ring vaccination procedure. This involves immunizing contacts and forming a protective “ring” around the vulnerable. However, due to the public’s distrust of medical authorities, the MSF claims that this tactic cannot be effective. “We have [the vaccine]now and it’s not the miracle we wanted it to be,” said Dr. Joanne Liu, president of Medecins Sans Frontieres.
Success Through Cooperation
Despite the obstacles, areas within the Congo have been able to contain the spread of the disease. In Goma where healthcare workers were able to connect to the people, vaccination rings have proven effective. Initially, Goma residents were suspicious of the health workers, fearful that they were working to further infect the population and profit off treatment. But, healthcare workers, now familiar with the environment, worked to explain the disease and treatments. They convinced more than a thousand residents to take the experimental vaccine, and the outbreak was controlled. Doctors in Goma are able to work every day, a luxury they’re hard-pressed to find out of the city.
Though the Ebola threat continues to rage, history has proven that it can be contained with prepared effort and a receptive population. Unlike before, there are now the tools to limit the disease with the Merck vaccine and newly developed therapies. Where these treatments are administered completely, the Congo Ebola epidemic can be overcome.
– Katie Hwang