In early May, the head of the World Health Organisation (WHO) was celebrating. Margaret Chan was in Guinea, the epicentre of the devastating 2014-2016 Ebola outbreak, and she had good news to share with her audience in the capital, Conakry. The trials, she said, were successful: the Ebola vaccine worked.
“Scientists do not yet know exactly where in nature the Ebola virus hides between outbreaks but nearly all experts agree that another outbreak is inevitable. When this occurs, the world will be far better prepared.”
Chan could not have known then how soon her optimism would be put to the test. As she spoke, the next outbreak was already in progress.
On April 22, in Likati, a remote northern region in the Democratic Republic of Congo (DRC), a sick man stumbled into a clinic. He was feverish and weak. He was vomiting. There was blood in his urine, in his stool and even coming out of his nose. He was immediately sent on a motorcycle taxi to a larger clinic, but it was already too late. By the time he arrived, he was dead.
Just a few days later, the motorcycle driver had died too, and others who come into contact with the pair were displaying similar symptoms.
Blood samples were sent to Kinshasa for testing. The results, released on May 11, were conclusive: Ebola is back. As of May 15, WHO says, there were 19 suspected cases and three fatalities.
The DRC is no stranger to Ebola. This is the eighth outbreak since 1976, but the virus has never spread as fast or as far as it did in West Africa.
Counterintuitively, it is the country’s chronic underdevelopment that protects it — in the absence of efficient transport links, Ebola finds it difficult to spread.
This time, neither the Congolese government nor the international community is taking any risks. Teams of doctors are rushing to the region to provide emergency medical assistance — although it can take three or four days to get there.
Epidemiologists are fanning out into the area to figure out exactly who the infected patients interacted with and how far the disease has spread. Anthropologists are en route to find the best way to communicate with nervous locals, who may be reluctant to trust medical advice from this sudden influx of strangers.
But what about the vaccine that is supposed to be able to stop Ebola in its tracks?
It’s not as easy as that, of course. For one thing, Chan may have exaggerated its effectiveness. Although the WHO’s trials, conducted towards the tail end of the epidemic in Guinea in 2016, declared it be 100% effective, other scientists have questioned their methodology and argued that more tests are required.
Another factor is costs and logistics. Although there are 300 000 doses on standby in Canada, getting them to the affected area is a daunting task. “The affected area is facing a big logistical challenge, with the lack of the cold chain, on how to maintain a good temperature of the vaccine once in the remote and forested field. This requires a huge logistical operation to mount for that issue,” said Eugene Kabembi, a WHO spokesperson.
Even if the vaccine makes it to Likati, people will still have to be persuaded to take it. This is where the anthropologists come in.
“Ebola is a very frightening disease and you have different perceptions of disease … anthropologists are going out to see if people believe this is an infectious disease or if it is witchcraft or something,” said Hilde de Clerck, a medical doctor with Doctors Without Borders (MSF), which has also sent emergency teams to the DRC.
“If we get the trust, then we can move on. This is something you need to do before the launch. You could do more harm, you could frighten people, they could misunderstand what the vaccine is.”
In the coming days, the government is expected to make a decision on whether to deploy the vaccine or not. The key factor is not necessarily the size of the outbreak but the timing of new infections: if it looks as though the virus is dying out on its own then it might not be worth the cost and effort of rolling out the vaccine.
“For now it’s a relatively small outbreak but, to be honest, it’s a bit early to say this … In the coming days and weeks we will see if those identified cases are the only ones, or if the outbreak was already lingering before, and then we will know how to proceed,” De Clerck said.