Congo’s Ebola outbreak is racing ahead of the global response, analysis shows
By Aaron Ross and Emma Farge
LONDON/NAIROBI/GENEVA, May 27 (Reuters) — In any Ebola outbreak, the first hours are critical. But in the Democratic Republic of Congo, the response to the fast-moving epidemic is running weeks behind — and missing thousands of people who may have been exposed.
Interviews with global health officials and documents from a coordination meeting led by the World Health Organization and the Africa Centres for Disease Control and Prevention reveal how far off the pace authorities are in battling the latest outbreak.
This time, the culprit is the Bundibugyo strain of the virus, for which there is no licensed vaccine or specific treatment. According to the WHO, the outbreak has caused a suspected 220 deaths and 900 cases, and has already crossed into Uganda, where seven infections have been confirmed.
Health teams are scrambling to locate thousands of individuals who may have come into contact with the virus, while confronting a host of challenges that make containment all but impossible. At the local level, shortages of basic supplies and deep mistrust from communities scarred by previous outbreaks are hampering efforts. Globally, the withdrawal of the United States from the WHO and broader cuts to international aid have left the response underfunded and understaffed, according to multiple health sources.
Documents from Friday’s virtual coordination meeting show that, as of last week, only 7% of the 1,261 people identified as contacts of suspected Ebola patients had been found and followed up. The WHO put that figure at more than 2,000 by Wednesday.
‘Outpacing the response’
“The outbreak is outpacing the response,” WHO Director-General Tedros Adhanom Ghebreyesus posted on Wednesday. “Attacks on health facilities make tracking cases and their contacts nearly impossible.”
In eastern Congo’s Ituri province — the epicentre of the crisis — hospitals have been attacked and isolation tents set on fire by angry mobs reclaiming the bodies of loved ones, apparently unaware of the risks posed by infectious corpses. Three experts said such violence is stalling efforts to track the virus and reach those at risk in a region already wracked by conflict and lacking basic health infrastructure.
In a summary of last Friday’s meeting, partners agreed that reaching more contacts is now the top priority as funding and emergency personnel trickle in slowly.
“Bottom line: No vaccine exists. No therapy exists. The virus circulated undetected for six weeks. Cross-border spread is confirmed. Healthcare workers are dying. Every day without a fully resourced response is a day the outbreak gains ground,” reads a presentation from the WHO Africa team at the meeting.
Professor Salim Abdool Karim, a leading South African epidemiologist and key adviser to the Africa CDC, described the outbreak as moving at “breakneck speed.”
“If you had to choose a bad place for this to happen, it would be Ituri,” he said of the province at the outbreak’s centre.
While Congolese officials are seasoned in fighting Ebola — this is the 17th outbreak since 1976 — persistent shortages remain a problem, including a lack of the right tests to detect Bundibugyo rather than other Ebola viruses. That also contributed to the delay in initial detection.
“There are very few people on the ground — and there are other problems as well, like getting fuel for the vehicles. It goes on and on,” Karim said.
The U.S. void
Several sources, including a U.S. official briefed on the Ebola response and another working with the WHO, said that in the past, such problems would have been resolved more easily and quickly when the United States worked alongside the WHO and often co-led international outbreak responses. The U.S. withdrew from the organization in January and has broadly cut international aid funding, along with a number of other wealthy nations.
“The organisations that would have been able to do this work are not there anymore,” said one U.S. official briefed on the response.
Amadou Bocoum, CARE’s country director in Congo, said his emergency response team had been cut by a third.
With the scale and origins of the outbreak still unclear, finding all potential cases and contacts is “a hell of a job,” said Marion Koopmans, a Dutch virologist on the WHO’s emergency committee.
Ebola spreads through direct contact with the bodily fluids of infected people once they develop symptoms, contaminated materials, and the bodies of those who have died from the illness. Contacts of Ebola patients need to be found and monitored for 21 days — the incubation period — so that if they develop symptoms they can be isolated, stopping further spread.
“We’re going back to the basics of Ebola outbreak responses when we didn’t have the means to contain it like we did before vaccines and therapeutics,” said Dr. Alan Gonzalez, deputy director of operations for Médecins Sans Frontières, which has asked staff worldwide to apply to reinforce the workforce in Congo.
There is also a major psychological barrier. “People are afraid,” said Mamadou Kaba Barry, head of mission in Congo for the Alliance for International Medical Action, which has run 60 health centres in Ituri for several years. He said some cases are disappearing and other suspected infections are not being reported because of mistrust.
Barry and many others fear a repeat of the worst-ever Ebola outbreak, which swept across West Africa from 2014 to 2016, causing more than 28,000 cases and 11,000 deaths.
“In West Africa, people hid, thinking, ‘What’s the point of dying and having my family unable to recover my body?’” he said, adding that a decade on, some lessons still need to be learned. “We never get used to Ebola. It’s always frightening.”
(Reporting by Jennifer Rigby in London, Aaron Ross in Nairobi, Emma Farge and Olivia Le Poidevin in Geneva, Clement Bonnerot in Dakar, and Silvia Aloisi in Nairobi; Editing by Silvia Aloisi and Andrew Cawthorne)