Hazardous: A health worker carries a baby suspected of having Ebola into an MSF-supported Ebola treatment centre in Butembo, DRC. But because of attacks this centre has been closed. (John Wessels/AFP)
NEWS ANALYSIS
The Ebola outbreak in the Democratic Republic of Congo’s Kivu region began officially on August1 last year, when authorities confirmed that four people had tested positive for the virus. The news was bad, but not necessarily catastrophic: epidemiologists were generally confident that this outbreak could be speedily contained.
They were wrong.
Nearly eight months later, the outbreak is now spreading at its fastest rate yet, the World Health Organisation (WHO) said, with record numbers of new infections being registered in each of the last two weeks. In total, this outbreak is believed to have killed 676 people and infected 406 others, according to Reuters.
There were sound reasons underpinning that initial optimism, however. Most obviously, the DRC has more experience than any other country in the world when it comes to dealing with Ebola.
This latest outbreak is the ninth in the country, since the first in 1976. This means that local authorities are familiar with containment and contact tracing protocols, and receptive to support from external organisations.
It helps that the Congo’s vast geography and notoriously poor transport links makes it difficult for the disease to spread, unlike the dense urban areas in Guinea, Liberia and Sierra Leone, where it thrived between 2013 and 2016.
Even more significant was the fact that the humanitarian community finally had a weapon that it could deploy against the disease itself. In the wake of the West Africa outbreak, which killed 11 325 people, scientists and pharmaceutical companies scrambled to come up with a vaccine. They succeeded; in 2017 the WHO approved rVSV-ZEBOV for limited use in Ebola outbreaks caused by the Zaire strain of the virus.
At a ceremony in Freetown, then WHO boss Margaret Chan said: “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.”
Unfortunately, it was not quite as simple as that, as the persistence of the outbreak in the northeastern DRC has proved.
Because the vaccine has not yet completed all necessary clinical trials, it is being rolled out on a selective, voluntary basis only to those most likely to be infected — that is, the friends and family and broader social circle of Ebola patients. But persuading rural communities to allow themselves to be injected with some mysterious substance by people they don’t know is a tough sell.
“We have a striking contradiction: on the one hand, a rapid and large outbreak response with new medical tools such as vaccines and treatments that show promising outcomes when people come early — and on the other hand, people with Ebola are dying in their communities, and do not trust the Ebola response enough to come forward,” said Joanne Liu, the global boss of Doctors Without Borders (MSF).
This mistrust increasingly manifests itself in violence: attacks against treatment facilities in Katwa and Butembo have forced MSF to shut them down indefinitely.
“A range of issues have led to these tensions: from the massive deployment of financial resources focusing only on Ebola, in a neglected region suffering from conflict, violence and long-standing health needs, to elections being officially postponed due to the Ebola outbreak, exacerbating suspicions that Ebola is a political ploy,” said MSF.
Complicating matters even further is that a quarter of the at-risk population don’t believe that Ebola is real, according to a new study published in medical journal The Lancet. People who don’t believe that Ebola is real are much less likely to take steps to protect themselves. The study, led by Harvard University’s Patrick Vinck, concluded: “Trust and the circulation of accurate information by reliable sources are crucial to control Ebola outbreaks and pose a major challenge in conflict environments.”
So far, the scientific evidence suggests that the Ebola vaccine works. But it cannot beat Ebola alone. Until affected communities — who have plenty of reason to distrust authority — can be convinced to put their faith in those who administer the injections, this outbreak is unlikely to be contained.