Story at a glance
- Ebola is one of the deadliest diseases known to man, killing on average 50 percent of those infected.
- The current outbreak in the Democratic Republic of the Congo is one of the largest ever.
- New treatments and vaccines are greatly reducing mortality from the disease.
- But the major challenge now is getting treatment to the victims.
The Democratic Republic of the Congo is now in the grip of one of the worst Ebola outbreaks ever, second only to the 2014-2016 West Africa outbreak that killed more than 11,300 people.
As of Oct. 1, the current outbreak has has a 67 percent fatality rate. The World Health Organization reports 2,136 people have died, and 3,197 cases have been diagnosed. The current outbreak in the eastern portion of Congo has been going on since summer 2018 and was declared a “public health emergency of international concern” by the World Health Organization (WHO) director-general nearly a year later, July 17.
Despite this declaration, strides in medical research have made Ebola much less deadly than it was during the previous major outbreaks. New treatments have been successful in recent trials and are cause for optimism, but there are still considerable obstacles that make it difficult to deliver these treatments to those affected. Those on the ground have turned to tackling issues like mistrust in the government and poor infrastructure to make progress in the ongoing fight to treat the disease.
“We just reached 1,000 survivors of this outbreak,” says Joseph Fair, a senior fellow at the Scowcroft Institute at the Bush School of Government and Public Service at Texas A&M University. He is currently in Congo responding to the Ebola outbreak. He notes that U.S. officials are “moving mountains” to provide assistance.
Fair says he has been pleased with the speed of the U.S. response — officials from the Trump administration were on the ground a month after the outbreak started last year. From his experience in the last outbreak response in 2014, U.S. officials took months to make important decisions, which cost an extraordinary number of lives. He called the 2014 decision making process “death by conference call.”
The quick response to this outbreak may be part of the reason this Ebola outbreak is not capturing the attention of the U.S. public as much as it did in 2014. There have been no Ebola cases outside of the eastern Congo during this outbreak and the WHO recommends no restrictions be placed on travelers coming to and from the country as these mostly generate unnecessary amounts of fear.
New drug trials
During the emergency response to the outbreak in November 2018, an international team of research agencies including the WHO, the National Institute of Allergy and Infectious Diseases (NIAID) of the U.S. National Institutes of Health and the National Institute for Biomedical Research in Congo launched a study of four treatment options for Ebola.
On Aug. 9, the study had 681 patients enrolled but was stopped because two of the treatments — REGN-EB3 and mAb114 — were outperforming ZMapp and Remdesivir, two drugs that were used in the 2014-2016 outbreak in West Africa. Now, all future patients in the trials will receive the new treatments. REGN-EB3 is manufactured by Regeneron Pharmaceuticals of New York and mAb114 is an antibody treatment made by the NIAID.
Based on a review of results from the first 499 patients, disease mortality decreased to 29 percent with REGN-EB3 and 34 percent with mAb114. Comparatively, mortality was 49 percent for patients treated with ZMapp and 53 percent for patients treated with Remdesivir.
If the patient got treatment early, mortality was as low as 6 percent with REGN-EB3. On an August conference call about the treatments, Dr. Anthony Fauci, the director of NIAID, said there would be enough doses available for patients to be treated for the rest of the year.
There are also ways to prevent Ebola infection. Although they are not yet licensed, a handful of Ebola vaccines have been tested and found to confer protection against the virus. The rVSV-ZEBOV vaccine developed by Merck was used in clinical trials in Liberia during the outbreak in West Africa and is being used under “expanded access” in the ongoing outbreak. These vaccines are used for ring vaccination campaigns in areas directly impacted by Ebola to minimize the risk of its spread. Under this vaccination strategy, all people who have come into contact with someone who has a confirmed case of Ebola are vaccinated.
The fight against mistrust
Despite all of these new tools in the arsenal to fight Ebola, the battle to conquer the deadly disease continues. Congo has been an unstable region for more than two decades, which has led to deadly situations for health care workers during the Ebola outbreak in the eastern part of the country.
A lack of institutional trust and the spread of misinformation are two factors that can make it difficult to control an outbreak. A study released earlier this year showed that one-quarter of those surveyed in the Ebola outbreak areas of Congo believe that Ebola does not exist. An even higher number of people believe that Ebola is “fabricated to destabilize the region.”
Patrick Vinck is the research director of the Harvard Humanitarian Initiative and is the lead author of this study. The results of the survey are not too surprising, he says, “because of the decades of conflict and mistrust.”
Vinck says there are ways this mistrust can be reduced, though, and that this could save lives. He said working with communities to come to a consensus on safe burial practices for loved ones who died from Ebola, for example, is better than outsiders coming in during an outbreak and decreeing unilaterally what is safe and what is not.
“The medical response has improved tremendously, in large part, because there are significant financial investments in it,” he says. Vinck thinks a greater financial investment in the social response and community trust-building will make it easier to treat outbreaks years down the road.
New facilities, faster treatments
Logistics is another major sticking point in the fight against Ebola. Keeping medications cold. Shipping samples back and forth between labs. All of these things sound simple, but in many parts of the country, Congo lacks electricity to power refrigerators — and there aren’t even permanent labs to ship samples to and from — but that is changing.
“You can’t win a war without the logistics,” Fair says. He has been working in the country for 12 years and has helped rural areas get solar power, generators and liquid nitrogen available for keeping everything cold so it can be transported around the country.
He said having any sort of treatment or vaccine for Ebola is a huge leap forward over past outbreaks but, “it’s getting them into people that is the problem.” Fair says the treatments and vaccines can make it to outbreak areas, but it can be difficult for health care workers to enter the area because of political instability.
Faster ways to treat the outbreak may be coming in the form of a new laboratory that is currently being established in Goma, a city on the eastern edge of the country. Up until now, samples from potential Ebola patients from that area were sent to the national labs in Kinshasa, the capital. This delay in identifying new samples of Ebola can lead to a slow response at the start of an outbreak.
Fair has been working with Jean-Jacques Muyembe Tamfum, director-general of the National Institute for Biomedical Research, to set up a permanent lab in Goma. This lab should be open by the end of October thanks to a donation from the Mérieux Foundation of a prefabricated lab that is energy-efficient and can easily be run by local medical professionals.
“It’s going to greatly increase our throughput for this current outbreak to take the pressure off the field laboratories and it will provide a secure place for samples to be stored,” Fair says. “In the future, we should be able to avoid a case like this where it went on for a few weeks without us knowing.”
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