Rising Ebola cases in the Democratic Republic of the Congo are ringing alarm bells across a region still scarred by previous outbreaks of the highly contagious viral disease. The World Health Organization has declared a “public health emergency of international concern”.
At least 540 suspected cases and 131 suspected deaths have been reported by DR Congo’s health minister, and two cases have been confirmed in neighbouring Uganda. But the WHO’s initial sampling suggests the outbreak is potentially much more widespread.
And what makes this outbreak “extraordinary”, said the WHO, is that it’s caused by the rare Bundibugyo strain of the Ebola virus. This has a lower fatality rate (about 35%) than the more common Zaire or Sudan strains (up to 90% and 50% respectively) but there is no licensed Bundibugyo-specific vaccine or treatment – and the tests for it do not appear to work very well.
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Experts are alarmed that this outbreak “has been able to spread for weeks undetected across a densely populated area”, said Reuters. It took weeks to identify it as the Bundibugyo strain and then pinpointing cases was “slowed by limited diagnostic capacity”, with only six tests possible per hour.
The lack of a vaccine is why I am in “panic mode”, Jean Kaseya, the director-general of Africa-Centres for Disease Control and Prevention, told Sky News. And ongoing attacks by Islamic State-backed militants in Ituri, the province at the centre of the outbreak, are “restricting surveillance and rapid response operations”.
Ituri is “rebel-held territory”, close to “porous borders” with Uganda and South Sudan that communities cross constantly, said The Times. That’s certainly one factor that’s “making containment so difficult”. Bundibugyo is also “among the least studied of the Ebola strains”: this is only the third outbreak on record.
We reached a “critical moment”, said the BBC’s health correspondent James Gallagher. Most Ebola outbreaks are small but specialists are still “haunted” by the largest, which started in 2014 and killed more than 11,000 people in West Africa. This time, there is a “significant threat” not only to DR Congo and Uganda but also South Sudan and Rwanda. But that doesn’t mean we’re “in the early stages of a Covid-style pandemic”. The risk to the rest of the world “remains tiny”.
DR Congo has “extensive experience in dealing with Ebola outbreaks”, and its response is “significantly stronger today than it was a decade ago”, Daniela Manno, of the London School of Hygiene & Tropical Medicine, told the BBC’s Gallagher. But recent US-led foreign-aid cuts have taken their toll. Containing the 2014 outbreak “relied on US leadership from USAID”, said Devi Sridharm, chair of global public health at the University of Edinburgh, in The Guardian. But “the USAID team dedicated to Ebola-like diseases was cut by Elon Musk”. Since Donald Trump withdrew the US from the WHO, the organisation’s emergency-response budget has shrunk by 37%. UK foreign-aid funding has also “fallen to its lowest level in two decades”.
The worry “is less about this becoming a global pandemic” (unlikely, as Ebola only spreads through contact with infected body fluids), and more about “the devastation it can cause” to the region and its “already fragile” healthcare systems. But this is an “interconnected world”: “if your neighbour’s house is on fire, you don’t wait and watch; you help to put it out before the fire spreads to yours.”
What next?
The WHO is sending a team of experts to Congo and, on Friday, will host an emergency scientific consultation of researchers, clinicians, public health bodies and funders. “The cash-strapped organisation has already released almost $4 million (£3 million) to combat the outbreak,” said the BBC, “but much more may be needed.” Public health officials are also considering using a combination of the existing approved vaccines for the Zaire and Sudan strains.
But communities in the region “have little trust in government or external aid agencies”, said Sridhar. If Ebola spreads to a major urban hub, it will be “much more difficult to stop”.
“I don’t think that, in two months, we will be done with this outbreak”, Anne Ancia, the WHO’s representative for the DRC, told reporters in Geneva at the World Health Assembly. The 2014 Ebola outbreak took two years to end.
