Ebola Outbreak In The DRC: Four Reasons It Will Be Hard To Contain

A road leading into Goma, the capital of the province of North Kivu in DR Congo. Picture by guenterguni/Getty Images

BY JIA B. KANGBAI

SENIOR LECTURER, 

NJALA UNIVERSITY

By the second week of the latest Ebola outbreak in the Democratic Republic of Congo it was already clear that containing the spread of the haemorrhagic disease was proving to be difficult.

On 17 May 2026, the World Health Organization declared the outbreak a public health emergency of international concern. This is its highest level of global health alert. It is mostly reserved for an extraordinary disease outbreak or event that is a public health risk to many countries through international spread and hence requires global coordinated efforts.

According to the WHO, as of 19 May 2026 the DRC had recorded more than 500 cases and 130 deaths, while its neighbour (Uganda) had recorded two cases and one death.

These statistics are huge considering that the current outbreak was only declared on 15 May. The largest Ebola outbreak was in west Africa from December 2013 to March 2016. It caused 28,652 infections resulting in 11,325 deaths in 10 countries; 99% of the fatalities were in Guinea, Sierra Leone and Liberia.

Infectious disease outbreaks are nothing new for the DRC, a central African country. Last year, while other parts of the world were shaking off the global mpox outbreak, the DRC was still struggling with it.

But the current Ebola outbreak in the DRC has potential to become huge and of long duration.

I am an infectious disease epidemiologist with experience of dealing with the Ebola outbreak in 2013-2016 in Sierra Leone.

In my view there are four reasons while this outbreak will be hard to contain:

late detection and insecurity

misdiagnosis

cultural factors

shortage of global health funds.

Late detection

One of the challenges is the time between a person being infected and being diagnosed (identifying the disease in a laboratory). This detection lag is a major problem because to control the spread of the disease, infected individuals need to be isolated. Ebola is highly contagious.

Late detection was responsible for the early deaths and increased number of Ebola cases in Sierra Leone during the 2013-2016 outbreak. Early cases went unnoticed there because Ebola was new in the country. Clinicians and laboratory scientists were totally unfamiliar with it.

The DRC is familiar with Ebola outbreaks and has witnessed more than any other country.

But in the DRC, late detection is fuelling the rapid spread of the disease and is primarily due to insecurity in the region.

The time it takes to identify an infectious pathogen in the laboratory depends on how long it takes for the pathogen to replicate to detectable level, the type of laboratory tests used, and (for some diseases) the development of antibodies. Ideally, for Ebola virus it varies between one and 32 days.

The first confirmed case was a resident of Goma, a town which lies on the border with Rwanda and is highly unstable. Fighting between DRC government forces and rebels (believed to be backed by Rwanda) has been going on around Goma for a long time.

The instability and volatility of the epicentre of the outbreak is having a major impact. Under those conditions, an infectious disease thrives and outbreaks mostly go unnoticed.

The number of Ebola cases and deaths that have been registered in the current Ebola outbreak in the DRC is difficult to place within the susceptible-infected-recovered (SIR) model, a tool used in epidemiology. Ebola’s R0 (basic reproduction number, a measure of disease transmission) ranges between 1.5 and 2.5, which means within a susceptible Goma population, a single infected person can spread the virus to an average of 1.5-2.5 Goma residents.

However, the current Ebola incidence and deaths in the DRC exceed the expected number of secondary infections based on Ebola’s basic reproduction number. As of 21 May there were over 136 suspected deaths, 35 confirmed cases, and more than 600 suspected cases caused by the Bundibugyo strain in the ongoing outbreak in the DRC.

Misdiagnosis

The delay in diagnosis may also have been due to subtle early Ebola symptoms that can be misdiagnosed. Both malaria and typhoid have identical fever symptoms.

During the early days of the Ebola outbreak in Sierra Leone, many nurses working at the Kenema Government Hospital and the Lassa Fever Hospital lost their lives because they misdiagnosed the disease as Lassa fever. Ebola and Lassa fever belong to the same class of viral haemorrhagic fever diseases since patients present with similar symptoms and pathophysiologies (what the disease does to the body).

The other challenge with diagnosis in this outbreak is that it is a different virus to the one treated in the most recent Ebola outbreaks. Bundibugyo virus was first identified in Uganda in 2007. Unlike Zaire Ebola virus disease, which was discovered decades ago, the relative newness of Bundibugyo Ebola virus disease means it’s less researched, especially in terms of vaccine and medicine development.

Cultural factors

Other factors affecting the spread are cultural practices such as ritual burials. Ritual burials are common in many African countries, like Sierra Leone and the DRC. These are ceremonies born out of the belief that death is a sacred passage to another world or ancestral realm. Mostly it starts with communal grieving and wake keeping, followed by the ceremonial preparation of the body.

In Sierra Leone a ritual burial of a high priest who died of Ebola in the southern town of Moyamba during the 2013-2016 Ebola outbreaks led to the death of scores of people who took part in ceremonial preparation of his body. It is not surprising to learn of relatives setting Ebola hospital tents on fire simply because they were prevented from handling the corpse of their loved one.

Shortage of global health funds

The cuts in global health funds and the ending of many projects through the dissolution of the United States Agency for International Development (USAID) is greatly affecting the operations and effectiveness of public health activities around the world.

Most global health security projects aimed to prepare for and mitigate any future disease outbreak.

Sierra Leone and other countries affected by the 2014-2016 Ebola outbreaks benefited immensely from international donor (including USAID) support during that outbreak.

Unfortunately, the DRC will have less international support to help fight this outbreak. The country has long experience in tackling disease outbreaks (especially Ebola) but the lack of experts and logistics on site implies an extended delay in managing this situation. The DRC has the people and the necessary labs and facilities. The major challenge with the current outbreak is that it started in an insecure environment where access to testing facilities are scarce, hence the late detection.

Additionally, the country is about the size of western Europe (including France, Germany, Spain, the UK and Italy). This vast size, coupled with insecurity, will make it difficult to channel logistics across the affected regions.

What’s needed

Tackling the current Ebola outbreak in the DRC requires a rapid, multi-tiered response. It should focus on rapid case detection, multinational support, swift collaborative surveillance and community engagement.

Over the past years the DRC has served as a scientific base for major international research institutions that work on infectious diseases and medical microbiology.

In the absence of a vaccine or medication, the health authorities should embark on community engagement to raise awareness and sensitisation. They must also enforce public health laws, especially those targeting cultures that promote unsafe burials and elevate the risk of Ebola infection. This is to prevent human transmission as many people might still be out there undetected.

READ ORIGINAL STORY HERE

A doctor’s Ebola memoir is all too timely with a new outbreak in Uganda

 

Two young orphans inspired Dr. Benjamin Black to write a book about his experiences during the 2014-2016 Ebola outbreak in Sierra Leone.

The British obstetrician/gynecologist knew the two boys, aged 8 and 9, for less than a day. When he met them, one was barely able to sip some fluid; the other was in a coma. They came from a village decimated by Ebola.

Their parents and relatives were dead.

A day after Black met them, the boys, too, died. He memorized their faces, vowed to remember them — and wrote a book with them in mind.

That book, Belly Woman: Birth, Blood and Ebola, is the inside story of what it was like to face a terrifying epidemic in West Africa that, in two and a half years, resulted in 28,600 cases and 11,325 deaths, according to the Centers for Disease Control and Prevention.

The outbreak of the Zaire strain of Ebola officially ended in Sierra Leone in March 2016. Today, there are vaccines and treatments effective against that strain.

But Ebola has not faded away. An outbreak is threatening people in Uganda, this one a rare strain of the virus called the Sudan strain, for which there is no approved vaccine or treatment.

Black is now an ob/gyn consultant in London and an adviser to international aid organizations including Medicins Sans Frontieres. We interviewed him about his experiences and their relevant to present and future epidemics.

The interview has been edited for length and clarity.

Your book is a vivid picture of what you saw and felt as the bodies added up. How did you remember so much?

The first three months I was there, I was a little bit in shock. We were seeing immense suffering, we felt powerless. It was an incredibly frightening time. I came home [to London, for a break], and that’s when I realized that this had to be recorded by someone who is in the center of it, seeing it happen blow by blow. I wrote it when these memories were fresh. It’s not easy to forget.

And yet you write that you could not possibly remember every suffering patient. But you were deeply affected by the two young brothers you met.

I cared for them early in my stint. I made a conscious decision: “I’m going to remember them.” Their whole family had died. There was no one left to know if they were alive or dead, and no one to remember them when they were gone. Everyone deserves to be remembered. Now, years later, I see their faces. They represent the many other faces I have forgotten, those who lived, died or were lost. I believe I wrote the book for them.

What was your most difficult decision during the height of the Ebola crisis?

I worked in the Gondama Referral Center, Sierra Leone, which was not an Ebola Treatment Center.

[The GRC was a 200-bed referral hospital that treated children as well as for women in urgent need of obstetric and gynecological care.]

Women came to us with pregnancy complications. It took 24 to 48 hours to get a test confirming Ebola, so we were working blind, not knowing who had Ebola. Women were coming late to the hospital because they were scared they’d catch it at the hospital, not knowing if they already had it. When they came, it was difficult to differentiate if they were unwell because of Ebola or because of pregnancy complications. And their conditions required really invasive procedures, like Cesarean sections. As the outbreak exploded, we stopped taking pregnant patients in the GRC.

That decision still weighs on you.

We could have been wrong. It was true that if you follow the rules of infection control, you could stay safe. But still, there could have been a disaster. If we got this wrong and all of us [local and volunteer health workers] got infected, it wasn’t just that we might die. If we got infected, there would have a massive ripple effect on international responders. They’d stop coming. I’m not saying we were right to close.

I still wonder. I have no doubt that in closing our facility there were women and children who found it immensely hard to get help and maybe couldn’t get help at all.

At first, in the referral center, pregnant women were treated with maximum fear because of all the blood and bodily fluids associated with childbirth. But eventually, as you worked in specified Ebola treatment centers, you and others developed ways to provide care, save lives and keep yourselves safe.

In the beginning, most of the pregnant women with Ebola would die. Almost all the babies died. Throughout the West African Ebola epidemic, no baby of an infected pregnant mother was known to survive more than 19 days. But we found out we could save the lives of the mothers by preparing for complications, like hemorrhaging, beforehand. We gave them medications as they labored in isolation, often alone. We told them to take the medication to stop bleeding as soon as the [stillborn] baby was delivered, because we knew it would take us at least 15 minutes to get dressed in PPE. We also made sure IV access was in place before they needed it, so that when we could come in, we weren’t working from scratch.

And what about that cumbersome PPE gear you wore in extreme heat and humidity?

Comfort is overlooked as a safety measure. In the current Uganda outbreak, of course it’s very important to protect health workers. You need surgical gowns, face shields, you need to make sure you don’t get body fluids on you. But if you dress in PPE to the point where you can’t see or you can’t feel, it’s not safe for the provider or for the patient. It’s safer to be protected and comfortable than to be overprotected.

[The CDC now recommends nitrile gloves, more flexible than vinyl, and no more than two layers of gloves to maintain dexterity. The CDC also recommends single-use, disposable face shields rather than goggles, because goggles don’t cover the entire face and can fog up.]

What are some lessons to take from the previous Ebola outbreak?

I think we need to engage communities early on, to get information out, to dispel rumors. I was in London during the COVID pandemic, and — gosh, where to begin. I felt frustrated, watching history repeat itself. People in high places were saying the wrong things, spreading rumors. We were always competing with misinformation. A lot of pregnant women thought it was unsafe to get the vaccine, which wasn’t true.

Early in the Ebola outbreak, families couldn’t even see a member who’d been hospitalized.

I think it’s important for people to have contact with their relatives. Whether Ebola or COVID, people need to know how their loved ones are being treated. If patients believe they’ll be alone in the hospital, they’ll delay going. For me, during COVID, it was important that pregnant women had access to a chosen partner during labor and delivery.

What factors led to Ebola finally ending in West Africa?

There are a lot of theories. At the end, the number of treatment beds and health providers had dramatically increased. More international aid organizations came in, but I don’t think anyone believes it was all down to the international aid. Probably the biggest factor was the response of the communities themselves. Local leaders started promoting better, accurate information.

Susan Brink is a freelance writer who covers health and medicine. She is the author of The Fourth Trimester and co-author of A Change of Heart.

Copyright 2022 NPR. To see more, visit https://www.npr.org.

AFRICA: Ebola Responders On ‘Lockdown’ After Congo City’s Unrest

Smoke from the United Nations compound rises in Beni, Democratic Republic of Congo, Monday, Nov. 25, 2019. Angry residents of this eastern Congo city burned the town hall and stormed the UN peacekeeping mission, known as MONUSCO, after Allied Democratic Forces rebels killed eight people and kidnapped nine overnight. (AP Photo/Al-hadji Kudra Maliro)

BY AL-HADJI KUDRA MALIRO

BENI, CONGO (AP) — Ebola responders are on lockdown in the eastern Congo city of Beni after angry residents attacked a United Nations base to protest repeated rebel assaults, the World Health Organization said Tuesday. At least four protesters were killed, a local official said.

Every day that health workers don’t have full access to Ebola-affected areas is a “tragedy” that prolongs the second-worst Ebola outbreak in history, WHO director-general Tedros Adhanom Ghebreyesus said on Twitter.

Almost 50 “non-critical” staffers with the U.N. health agency were evacuated to the city of Goma while 71 remain, spokesman Christian Lindmeier said. He said the violence is not directed at WHO or the Ebola response at large.

Instead, Beni residents are outraged that rebels continue to carry out deadly attacks despite the presence of U.N. peacekeepers and Congolese forces. Some demand that the U.N. mission act or leave.

The bodies of four young protesters were found near the U.N. base after Monday’s attack, Kumbu Ngoma with Beni’s military court told The Associated Press on Tuesday. Investigations continued into the cause of their deaths. Six Congolese soldiers were wounded by gunfire near the base, Ngoma added.

Congo’s President Felix Tshisekedi after an emergency meeting Monday decided to allow joint operations between Congolese and U.N. forces in Beni following the protests that also burned the town hall.

Congo’s military early this month declared a new offensive against Allied Democratic Forces rebels who have killed hundreds of civilians and security forces over the past few years in the mineral-rich northeast.

After the U.N. mission in recent days was accused of inaction, it said it could not carry out operations unilaterally in a region where Congo’s military is already active, and that it cannot participate in Congolese military operations without being invited.

Any unrest in the region where numerous rebel groups are active hurts crucial efforts to contain the Ebola outbreak. The number of reported cases has been dropping, with zero cases recorded on several days this month.

Congo’s president, heartened by the trend, said earlier this month he hoped that the outbreak could be ended “completely by the end of the year.” However, WHO says 42 days without new Ebola cases must pass since the last possible exposure to a confirmed case for an outbreak to be declared over.

More than 3,100 Ebola cases have been confirmed since this outbreak was declared in August 2018, including more than 2,100 deaths.

WHO has called the trend in the declining number of cases encouraging but said the recent days of protests in Beni and surrounding areas are of “grave concern.”

Associated Press writer Jamey Keaten in Geneva contributed.

Follow Africa news at https://twitter.com/AP_Africa

UN: Spike In Violence May Jeopardize Ending Ebola In Congo

In this Tuesday, July 16, 2019 file photo, health workers dressed in protective gear begin their shift at an Ebola treatment center in Beni, Congo DRC. The World Health Organization said Friday Nov. 22, 2019, there has been “a very dangerous and alarming development” in efforts to end the Ebola outbreak in eastern Congo, warning that the eruption of violence may re-ignite the epidemic. (AP Photo/Jerome Delay, File)

THE ASSOCIATED PRESS

GENEVA (AP) — The World Health Organization on Friday noted “a very dangerous and alarming development” in efforts to end the Ebola outbreak in eastern Congo, warning that the eruption of violence may re-ignite the epidemic.

Dr. Mike Ryan, who directs the U.N. health agency’s Ebola response, said there were only seven new cases last week. But he told reporters the near doubling of “security incidents” is jeopardizing attempts to end the second-worst Ebola outbreak in history.

Officials have made progress in recent months but “if security deteriorates in the region, we could work our way to a very bad situation,” he said. Multiple rebel groups are active in the region. More than 40 civilians have been killed in the last two weeks, he said.

More than 3,100 cases have been confirmed in this outbreak including more than 2,100 deaths.

Ryan also said WHO understands all the chains of Ebola transmission in this outbreak except one, a high-risk death of a moto-bike driver who went to three health centers before being identified as a possible Ebola case. He died in the community and about 360 people were thought to have been exposed to him when he was highly infectious. Only about a third have been followed.

“At this stage of the outbreak, one case matters,” Ryan said, adding that one worrisome case is enough to spark new transmission chains. “That means the virus will get ahead of us again.”

Since the Ebola outbreak was declared in August 2018, the response has been repeatedly hampered by attacks on health workers and Ebola clinics. Some assaults are believed to be financially motivated, as millions of dollars have been donated to help stem the virus’ spread.

When violence has forced the suspension of Ebola response efforts in areas like Beni and Butembo, health officials have seen a spike in the outbreak, Ryan said.

He said response teams often have used police escorts or employed guards at Ebola clinics, explaining that there are “difficult choices” in an insecure environment.

Other aid organizations have warned that linking armed escorts to a health response could worsen relations with an already wary community where Ebola had never been reported before.

UN Says Ebola In Congo Still Qualifies As Global Emergency

In this Tuesday, July 16, 2019 file photo, health workers dressed in protective gear begin their shift at an Ebola treatment center in Beni, Congo DRC. The World Health Organization says the ongoing Ebola outbreak in Congo still warrants being classified as a global emergency, even though the number of confirmed cases has slowed in recent weeks. (AP Photo/Jerome Delay, File)

BY MARIA CHENG

LONDON (AP) — The World Health Organization says the ongoing Ebola outbreak in Congo still warrants being classified as a global emergency, even though the number of confirmed cases has slowed in recent weeks.

The U.N. health agency first declared the epidemic, the second-deadliest Ebola outbreak in history, to be an international emergency in July. On Friday, it convened its expert committee to reconsider whether the designation is still valid and decide if other measures are necessary.

WHO’s director-general, Tedros Adhanom Ghebreyesus, said the situation remains “complex and dangerous” and that officials must continue to treat every case like it’s the first.

“Every case has the potential to spark a new and bigger outbreak,” he told reporters.

To date, there have been 3,113 confirmed cases and more than 2,150 people have died since the epidemic was first reported last August.

While only 15 new Ebola cases were confirmed last week, WHO noted the vast majority were not in people previously identified as contacts of others infected, suggesting health officials still have difficulty tracking where the virus is spreading.

WHO also said nearly a third of people are dying outside of Ebola treatment centers, potentially exposing families and loved ones to the disease.

“When your new cases are not coming off your contact list, that means you don’t have things under control,” said Dr. Armand Sprecher, an Ebola specialist at Medecins Sans Frontieres, or MSF.

Sprecher lamented that attempts to build trust among the wary local population are still failing. “We have not communicated very well over the last year, so can we really do this now? I don’t know.”

Efforts to curb the outbreak have been hampered by violence against health workers — some have been killed — and some local residents suspect international responders of transmitting Ebola rather than stopping it. Misunderstandings have been high in communities that had never experienced the disease before.

This is also the first Ebola outbreak to unfold in what has been called a war zone. Eastern Congo is home to numerous armed groups, and their attacks have halted response efforts many times, interrupting efforts to vaccinate people and monitor suspected cases.

This outbreak is second only to the 2014-16 Ebola epidemic in West Africa that left more than 11,300 people dead.

Uganda Says A Traveling Congolese Girl Has Ebola

In this Friday, June 14, 2019 file photo, people coming from Congo wash their hands with chlorinated water to prevent the spread of Ebola infection, at the Mpondwe border crossing with Congo. Ugandan health authorities on Thursday, Aug. 29, 2019 said a 9-year-old Congolese child has tested positive for Ebola in Uganda, after being identified and screened at the official Mpondwe border crossing, and was then taken to an isolation unit in the Ugandan border town of Bwera in Kasese district. (AP Photo/Ronald Kabuubi, File)

BY RODNEY MUHUMUZA

KAMPALA, UGANDA (AP) — A 9-year-old Congolese girl tested positive for Ebola in Uganda on Thursday after traveling from Congo, where an outbreak of the highly infectious disease has killed nearly 2,000 people.

The child, who is now in isolation at a hospital in the Ugandan border district of Kasese, traveled from Congo with her mother on Wednesday, Uganda’s health ministry said in a statement.

The girl, who was bleeding through the mouth and had a high fever, was identified and screened for Ebola at an official border crossing. She was immediately isolated. Ugandan health officials said they believed she had no contacts to worry about.

The Ebola outbreak, which was declared a year ago in eastern Congo, hasn’t shown signs of slowing down despite new treatments and vaccines given to more than 197,000 people in the region. New cases emerged in Goma, the capital of North Kivu province, in recent months and have recently spread to a new province, South Kivu.

Insecurity has been one factor in a region where rebel groups have fought for control of mineral-rich lands for decades. Ebola also has spread because of mistrust by communities who have also staged attacks against health workers. Many people in eastern Congo don’t trust doctors and other medics.

But cases of cross-border contamination have been rare, in part because of stringent screening procedures at official border crossings in the neighboring countries of Uganda and Rwanda.

In June, a family of Congolese with some sick family members crossed into Uganda via a bush path.

Two of them later died of Ebola, and the others were transferred back to Congo.

There had been no confirmed case of Ebola in Uganda since then.

Ebola Outbreak Spreads To 3rd Province In Eastern Congo

In this July 13, 2019 file photo, health workers wearing protective gear check on a patient isolated in a plastic cube at an Ebola treatment center in Beni, Congo. Congo's year-long Ebola outbreak has spread to a new province, with two cases, including one death, confirmed in South Kivu, according to the government health ministry. (AP Photo/Jerome Delay, File)

BY SALEH MWANAMILONGO, AL-HADJI KUDRA MALIRO

KINSHASA, CONGO (AP) — Congo’s year-long Ebola outbreak has spread to a new province, with two cases, including one death, confirmed in South Kivu, according to the government health ministry.

The movement of the potentially deadly disease to a new province highlights the difficulties that health workers in Congo face in controlling the outbreak.

Two new patients tested positive in the Mwenga area of South Kivu, adding to North Kivu and Ituri provinces where there are confirmed cases of the disease, according to the health ministry.

The new cases are “a 24-year-old woman and her 7-month-old child,” said Dr. Jean-Jacques Muyembe, the director of Congo’s National Institute for Biomedical Research, in a statement released on Friday.

The mother and her child had visited Beni, in North Kivu province, which is the center of the outbreak. They returned to South Kivu province where they fell sick with Ebola. The mother died Thursday and her child is being treated by a response team, said Muyembe’s statement.

The local Ebola response team has identified more than 120 people who may have been infected with the Ebola virus by contact with the woman and her child. Those people will be vaccinated to reduce the risk that they will get Ebola.

The Ebola outbreak in eastern Congo has killed 1,808 people out of 2,765 confirmed cases, according to the new report. The current outbreak, which started on Aug. 1 last year, is the second largest in history.

The spread of confirmed cases to a third province shows that health workers have struggled to contain the outbreak, despite the use of a vaccine. Many people in eastern Congo do not trust doctors and other medics.

An average of 81 new cases of Ebola are confirmed each week, according to the World Health Organization, which issued an update on the outbreak Friday. WHO said that its appeal for $287 million to fund the public health part of its campaign to control this outbreak has only received $15 million so far.

Earlier this week, doctors announced positive news that two new drugs appear to be effective at saving lives of those who fall ill with Ebola.

Muyembe and other scientists announced that preliminary results from a trial in Congo found two drugs — made by Regeneron and the U.S. National Institutes of Health — seem to be saving lives. Researchers said more study is needed to nail down how well those two compounds work. The drugs are antibodies that block Ebola. In the trial, significantly fewer people died among those given the Regeneron drug or the NIH’s, about 30%, compared to those who received another treatment.

There is less danger that Ebola will spread through Goma, the capital of North Kivu province with more than 2 million inhabitants, because about 200 contacts and suspected cases have been identified and have received proper medication, said Muyembe. He said people arriving in Goma are being monitored at the city’s entry points.

Health officials have also vaccinated tens of thousands of people in Congo and surrounding countries in an attempt to stop the outbreak, but the virus has now continued to spread for more than a year. Response efforts have been repeatedly hampered by attacks on health workers and continuing mistrust among the affected communities; many people in the region don’t believe the virus is real and choose to stay at home when they fall ill, infecting those who care for them.

Maliro contributed to this report from Beni, Congo.

Follow Africa news at https://twitter.com/AP_Africa

Early Study Results Suggest 2 Ebola Treatments Saving Lives

In this July 13, 2019 file photo, health workers wearing protective gear check on a patient isolated in a plastic cube at an Ebola treatment center in Beni, Congo. Health authorities in Congo have halted an Ebola treatment study early with good news: Two of the four experimental drugs seem to be saving lives. More than 1,800 people have died in the African country’s yearlong outbreak. (AP Photo/Jerome Delay, File)

BY LAURAN NEERGAARD

WASHINGTON (AP) — Two of four experimental Ebola drugs being tested in Congo seem to be saving lives, international health authorities announced Monday.

The preliminary findings prompted an early halt to a major study on the drugs and a decision to prioritize their use in the African country, where a yearlong outbreak has killed more than 1,800 people.

The early results mark “some very good news,” said Dr. Anthony Fauci of the U.S. National Institutes of Health, which helped fund the study. With these drugs, “we may be able to improve the survival of people with Ebola.”

The two drugs — one developed by Regeneron Pharmaceuticals and the other by NIH researchers — are antibodies that work by blocking the virus.

While research shows there is an effective albeit experimental vaccine against Ebola — one now being used in Congo — no studies have signaled which of several potential treatments were best to try once people became sick. During the West Africa Ebola epidemic several years ago, studies showed a hint that another antibody mixture named ZMapp worked, but not clear proof.

So with the current outbreak in Congo, researchers compared ZMapp to three other drugs — Regeneron’s compound, the NIH’s called mAb114 and an antiviral drug named remdesivir.

On Friday, independent study monitors reviewed how the first several hundred patients in the Congo study were faring — and found enough difference to call an early halt to the trial. The panel determined that the Regeneron compound clearly was working better than the rest, and the NIH antibody wasn’t far behind, Fauci explained. Next, researchers will do further study to nail down how well those two compounds work.

The data is preliminary, Fauci stressed. But in the study, significantly fewer people died among those given the Regeneron drug or the NIH’s — about 30% compared to half who received ZMapp. More striking, when patients sought care early — before too much virus was in their bloodstream — mortality was just 6% with the Regeneron drug and 11% with the NIH compound, compared to about 24% for ZMapp, he said.

Among people who receive no care in the current outbreak, about three-fourths die, said Dr. Michael Ryan of the World Health Organization. All of Congo’s Ebola treatment units have access to the two drugs, he added, saying he was hopeful that the news would persuade more patients to seek care — as soon as symptoms appear.

Tackling Congo’s outbreak has been complicated both by conflict in the region and because many people don’t believe Ebola is real and choose to stay at home when they’re sick, which spurs spread of the virus.

“Getting people into care more quickly is absolutely vital,” Ryan said. “The fact that we have very clear evidence now on the effectiveness of the drugs, we need to get that message out to communities.”

Fauci said Regeneron and Ridgeback Biotherapeutics, which has licensed the NIH compound, told authorities enough doses are readily available.

One issue researchers will have to analyze: Occasionally people who receive the Ebola vaccine still become sick, including some in the treatment study, which raises the question of whether their earlier protection inflated the drugs’ survival numbers.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

1-Year-Old Daughter Of Congo Man Who Died Of Ebola Has Virus

In this Sunday, July 14, 2019 photo, burial workers put on protective gear before carrying the remains of Mussa Kathembo, an Islamic scholar who had prayed over those who were sick, and his wife, Asiya, to their final resting place in Beni, Congo. Both died of Ebola. (AP Photo/Jerome Delay)

BY SALEH MWANAMILONGO, IGNATIUS SSUUNA

KINSHASA, CONGO (AP) — The 1-year-old daughter of the man who died of Ebola in Congo’s major city of Goma this week has the disease, the health ministry said Thursday, while Rwanda closed its border with Congo over the virus outbreak that now enters its second year.

The man died on Wednesday after spending several days at home with his large family while showing symptoms. This is the first transmission of Ebola inside Goma, a city of more than 2 million people on the Rwandan border, a scenario that health experts have long feared. The painstaking work of finding, tracking and vaccinating people who had contact with the man — and the contacts of those contacts — has begun.

This outbreak has killed more than 1,800 people, nearly a third of them children. It is now the second-deadliest Ebola outbreak in history, and last month the World Health Organization declared it a rare global emergency.

Rwanda’s state minister for foreign affairs Olivier Nduhungirehe confirmed the border closure, a day after WHO officials praised African nations for keeping their borders open. Last week Saudi Arabia stopped issuing visas to people from Congo while citing the Ebola outbreak, shortly before the annual hajj pilgrimage there this month.

Congo’s presidency swiftly condemned Rwanda’s decision

WHO has recommended against travel restrictions amid the outbreak but says the risk of regional spread is “very high.” Rwanda, Uganda and South Sudan have long begun vaccinating health workers. In June, three people died in Uganda before their family members were taken back to Congo for treatment and Ugandan officials declared the country free of the disease.

The death on Wednesday in Goma “in such a dense population center underscores the very real risk of further disease transmission, perhaps beyond the country’s borders, and the very urgent need” for more global support, United Nations agencies said in a joint statement marking a year of the outbreak.

The man in his 40s was a miner returning from an area of northeastern Ituri province, Mongwalu, where no Ebola cases in this outbreak have been recorded, WHO said. He was exposed to the virus along the roughly 300-mile-long (490-kilometer) route from Komanda to Goma as he took motor taxis over a number of days through the densely populated region at the heart of the outbreak.

The man arrived in Goma on July 13 and started showing symptoms on July 22. He was isolated at an Ebola treatment center on Tuesday. He had spent five days being treated at home and then went to a health facility, where Ebola was suspected. Symptoms can start to occur between two and 21 days from infection, health experts say.

“He may not even have been aware of the exposure that he had,” WHO emergencies chief Dr. Michael Ryan said on Wednesday. Symptoms such as fever can be confused with malaria, which is endemic in the region.

Congo’s new Ebola response coordinator, Jean-Jacques Muyembe, has said there appears to be no link between the case and the previous one in Goma that was announced two and a half weeks ago. That case was a 46-year-old preacher who managed to pass through three health checkpoints on the way from Butembo, one of the communities hardest hit by this outbreak.

The declaration of a global health emergency — the fifth in history — came days after that first Goma case. It has brought a surge of millions of dollars in new pledges by international donors, but some health workers say a new approach is needed to combat misunderstandings in a part of Congo that had never experienced Ebola before.

Health workers responding to the outbreak have been attacked, even killed, in a region where rebel groups are active and the population is wary of outsiders.

There is no licensed treatment for Ebola, which is spread by close contact with bodily fluids of those infected, and survival can depend on seeking treatment as quickly as possible. And yet many people in the region don’t believe that the virus is real, health workers have said.

This outbreak is second only to the 2014-16 Ebola outbreak in West Africa that left more than 11,300 people dead.

Ssuuna reported from Kigali, Rwanda. Associated Press writer Al-Hadji Kudra Maliro contributed.

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African Union’s Lost Opportunity In DRC Ebola Crisis

Image via TRT

BY ERIC MWINE-MUGAJU

EQUATEUR PROVINCE, CONGO (TRT WORLD) -- In any country in the world, the resignation of the health minister days after the declaration of an international health emergency should not only be worrying but alarming.

Dr Oly Ilunga Kalenga, an experienced epidemiologist who was leading the fight against Ebola in the Democratic Republic of Congo (DRC) during the second biggest outbreak ever, has stepped down from his post. He says he resigned because international agencies and donors were interfering with his work, accusing them of unnecessarily pushing for the introduction of a new vaccine.

MP Muhindo Nzangi Butondo, from the most affected eastern region, backed Ilunga saying he does not want residents to be the "guinea pigs" for a new vaccine fronted by the World Health Organization (WHO).

Five years since the worst Ebola outbreak killed 11,000 people in Sierra Leone, Liberia and Guinea, there's little assurance that lessons were learned, especially in the African response to the outbreak. The crafting of policy and strategy have been outsourced to international, mostly Western, agencies.

This failure to lead by the African Union (AU) and the blatant sidelining and undermining of African experts and local agencies could be fuelling the myths similar to those that surround the HIV virus - that it was manufactured to wipe out Africans. With foreign actors now entering the scene and forcing ministers to resign, fertile ground for similar myths to flourish, claiming that Ebola is a Western invention and pharmaceutical companies are scrambling to cash in.

One of the key challenges of containing the current outbreak is the distrust of the affected communities. This has seen nearly 200 health workers and facilities attacked since January according to the WHO.

Instead of taking the lead and showing that the AU is finally free from working under the shadows of the UN, whose barely noticeable intervention is only attributable to access to resources rather than contextual competence, the AU has once again decided to hand over the realm of responsibility to the WHO, potentially shattering the legitimacy credentials that it stood to claim.

Frustratingly, this has been neutered by the AU not completely abandoning the policy of non-intervention in member states, preferring instead to wait for an invitation letter.

Following the West Africa Ebola outbreak, failures jolted by the “African problems, African solutions” mantra, the AU formed a special team, suitably named the Centers for Disease Control and Prevention (Africa CDC).

There is already confusion in the public sphere regarding who is in charge; one would expect AU to be in charge, but the UN’s WHO has the mandate, however the WHO has now fallen out with one of the most locally respected epidemiologist - Kalenga. DRC President Felix Tshisekedi’s office has now taken over the coordination of the Ebola campaign.

"As in any war, because that is what this is, there cannot be several centres of decision-making for risk of creating confusion," the health minister said following his resignation.

The loss of Kalenga, an experienced medical doctor who oversaw a successful containment of Ebola in Equateur Province between May and July 2018, is a huge blow to the campaign.

The medic criticised outside pressure thought to be from the WHO, which insists on trying a new vaccine from US-based firm Johnson & Johnson. Kalenga, a qualified epidemiologist says that the vaccine is not proven and will add more confusion.

The previous vaccine made by Merck & Co, a rival of Johnson & Johnson, is said to be 97 percent effective and had been used successfully in the DRC. Kalenga and the MP Butondo argue that pushing for a new vaccine which has to be administered twice will be complicated given the on-going unrest in the region.

It should be quite alarming that a locally-trusted former minister with a good record dealing with outbreaks resigned citing “an obvious lack of ethics by voluntarily hiding important information from medical authorities”. It is worrying that the trending hashtag in the DRC lately is #NorYourGuineaPigs.

Kalenga has been on the ground since 2000 and taken the vaccine himself to help demystify the conspiracy and stigma surrounding Ebola. Being forced to resign under circumstances involving Western agencies does not only fuel the mistrust on the ground but also has the potential to intensify attacks against health workers.

With the ‘multi-disciplinary’ team coordinating the campaign ordered to report directly to Tshisekedi, one cannot help but wonder what input a career politician can have during such a medical emergency.

The epidemic has already been politicised to disenfranchise parts of Congo. It is now becoming clear that a president who came to office without a credible mandate is looking to use Ebola to get some legitimacy. He is, however, becoming a pawn in the battle of multinationals to influence the future of the Ebola vaccine.

The AU must move on from looking for a mandate and getting the people to trust it. The union has indeed progressed since 2002 when it scrapped its long-held non-interference policy regarding member states during the Organisation of African Unity (OAU) times. The new AU has been on peacekeeping missions across the continent but mostly on ‘peace and security matters’.

Its approach to intervening in matters of ‘peace and security’ should now extend to a non-military crises that could escalate on a huge scale or those that should be given a unique status requiring military intervention.

It has learned from the Economic Community of West African States (ECOWAS), which unlike other regional blocks, has a mechanism for military intervention. That's why the AU created the African Standby Force (ASF).

Uganda's approach may provide a glimpse into the situation we have at hand. When Ebola crossed to Uganda recently, its containment was not down to luck. The army is usually employed to quarantine the affected areas, under tight security, experts move in and stop the virus from spreading.

Can the AU build from this, instead of seeking comfort from its non-interference policy in non peace and security issues? As Africa seeks to integrate and facilitate the movement of people on the continent, the AU has to be hands-on; leading, intervening, fixing, building and restoring. The Africa CDC should be an elite unit ready to control and quell disease outbreaks - not providing statements of support.

Conflict-affected health systems have to deal with increased levels of violence. The ability to quarantine the affected areas is paramount to containing the spread. With the DRC now lacking effective health systems and an ineffective state, the AU and regional blocks now have an opportunity to intervene and end the UN decade of inaction to flush out insurgents and start rebuilding community trust and health systems.

Too Many In Congo's Ebola Outbreak Are Dying At Home

This Saturday, July 13, 2019 shows an Ebola treatment center set up next to the hospital in Beni, Congo. Nearly one year into the epidemic which has killed more than 1,700 in eastern Congo, a rise in community deaths is fueling a resurgence of Ebola in Beni. During a two-week period in July alone there were 30 people who died at home in the town. (AP Photo/Jerome Delay)

BY KRISTA LARSON

BENI, CONGO (AP) — Two-month-old Lahya Kathembo became an orphan in a day. Her mother succumbed to Ebola on a Saturday morning. By sunset her father was dead, too.

They had been sick for more than a week before health workers finally persuaded them to seek treatment, neighbors said. They believed their illness was the work of people jealous about their newborn daughter, a community organizer said, and sought the guidance of a traditional spiritual healer.

The Ebola outbreak in eastern Congo is ravaging Beni, a sprawling city of some 600,000, in large part because so many of the sick are choosing to stay at home. In doing so, they unknowingly infect caregivers and those who mourn them.

“People are waiting until the last minute to bring their family members and when they do it’s complicated for us,” says Mathieu Kanyama, head of health promotion at the Ebola treatment center in Beni run by the Alliance for International Medical Action, or ALIMA. “Here there are doctors, not magicians.”

Nearly one year into the outbreak which has killed more than 1,700 and was declared a global health emergency this month, a rise in community deaths is fueling a resurgence of Ebola in Beni. During a two-week period in July alone, 30 people died at home.

Health teams are now going door-to-door with megaphones trying to get the message out.

“Behind every person who has died there is someone developing a fever,” Dr. Gaston Tshapenda, who heads the Ebola response in Beni for Congo’s health ministry, told his teams.

Many people still don’t believe Ebola is real, health experts say, which stymies efforts to control the disease’s spread.

Ebola symptoms are also similar to common killers like malaria and typhoid, so those afraid of going to a treatment center often try to self-medicate at home with paracetamol to reduce fever.

But Ebola, unlike those other illnesses, requires the patient to be kept in isolation and away from the comfort of family.

Dr. Maurice Kakule, who became one of this outbreak’s first Ebola patients after he treated a sick woman at his clinic, is now trying to make it easier for those who are ill to get help in and around Beni, near the border with Uganda.

He and other survivors, who are now immune to the disease, run a motorcycle taxi ambulance. After receiving a phone call for help they go to homes, reassure the sick and take them for medical care without infecting others.

People’s most common fear is that they will only leave an Ebola treatment center in a body bag, Kakule says.

“Some have heard of the problem of Ebola but there have been no survivors in their family,” he said. “Since they had relatives die at a treatment center, they think people are killed there and that’s why they categorically refuse to go.”

They fear, too, that they will die alone, surrounded only by health care personnel covered in protective gear from head to toe.

To try to humanize the care of patients in isolation, ALIMA’s Ebola treatment center in Beni places some patients in their own transparent room called a “CUBE,” where they can see visitors from their beds. Others share a room with one other patient and a glass window where loved ones can gather.

While there is no licensed treatment for Ebola, patients in eastern Congo are able to take part in clinical trials. That’s a welcome change from the 2014-2016 outbreak in West Africa when many patients entered Ebola centers never to come out alive again. More than 11,000 people died.

Still, the measures needed to keep Ebola from spreading remain difficult for many people to accept.

“We cannot be oblivious to the fact that when you’re sick with Ebola you’re put somewhere away from your family, with a 50% chance of dying alone from your loved ones,” said Dr. Joanne Liu, president of Doctors Without Borders, which is helping to fight the outbreak. “I don’t blame people for not finding this attractive, despite the fact that we have a clinical trial going on.”

The day after the deaths of baby Lahya’s parents, a morgue team in protective clothing carried their carefully encased bodies to a truck for a funeral procession to a Muslim cemetery on the edge of town.

In the background was the sound of workers hammering away as they built more space at the nearby treatment center to accommodate the growing caseload.

Lahya developed a fever but has tested negative for Ebola. The infant with round cheeks and gold earrings is in an orphanage for now, while her 3-year-old sister is being cared for by neighbors who hope to raise them both.

But the sisters will have to wait a bit longer to be reunited — their adoptive father and former nanny both have tested positive for Ebola and are being treated.

The fateful decision to avoid treatment centers haunts survivors like Asifiwe Kavira, 24, who fell ill with Ebola along with eight of her relatives.

Health teams came to the house in Butembo, trying to persuade them to seek treatment. Most of the family, though, said they wanted to treat their fevers at home. After three days of negotiations, Kavira finally agreed to seek help, believing she was on the brink of death.

She would be the only one to survive.

Her mother, grandmother, brother and four other relatives all died at home. An older sister joined her at the treatment center, but medical care came too late.

“I tell people now that Ebola exists,” Kavira says, “because that is how I lost my entire family.”

___

Associated Press writers Al-Hadji Kudra Maliro in Beni, Congo and Maria Cheng in London contributed to this report.

Ebola Vaccine Hampered By Deep Distrust In Eastern Congo

In this Sunday, July 14, 2019 photo, burial workers dressed in protective gear carry the remains of Mussa Kathembo, an Islamic scholar who had prayed over those who were sick, in Beni, Congo. He and his wife, Asiya, died of Ebola. (AP Photo/Jerome Delay)

BY KRISTA LARSON

BENI, CONGO (AP) — Until his last breath, Salomon Nduhi Kambale insisted he had been poisoned by someone and that was the reason he was vomiting blood. The 30-year-old man wouldn’t give community health teams his phone number, and when they found it, he hung up on them.

Health workers were desperate to persuade him to get vaccinated for Ebola after a friend fell ill with the lethal and highly contagious disease.

But within days, Nduhi was dead. His widow and their four young children were given his positive Ebola test result and a chilling warning from a team of health workers: “If you don’t accept vaccination, you can prepare to die.”

Deep distrust — along with political instability and deadly violence — has severely undermined efforts by public health authorities in Congo to curb the outbreak by tracing and vaccinating those who may have come into contact with infected people.

Health experts agree the experimental Ebola vaccine has saved multitudes in Congo. But after nearly a year and some 171,000 doses given, the epidemic shows few signs of waning. The virus has killed more than 1,700 people and has now arrived in the region’s largest city, Goma. The World Health Organization last week declared the outbreak a global health emergency.

During the 2014-16 Ebola epidemic in West Africa, which left more than 11,300 people dead, health workers could only dream of a vaccine with a 97.5 percent effectiveness rate that could improve the odds of survival even in those already infected.

“We have it now and it’s not the miracle we wanted it to be,” said Dr. Joanne Liu, president of Doctors Without Borders. “The fact that we’ve used so much vaccine, and the epidemic hasn’t stopped, that shows us that contact tracing is not great.”

WHO says as many as 90 percent of those eligible for vaccination have accepted it, but that figure only includes those who gave contact tracers enough information to be included on a list. The success rate excludes those who distrusted health workers and fled, or those who couldn’t be found in the first place.

Health workers have been using what is known as a ring vaccination strategy: The vaccine is first given to those who were in close contact with a sick person. Then a second so-called ring is created by giving the vaccine to those who were in contact with those people.

Because of the difficulties in making that strategy work, some people didn’t get vaccinated until they had already been infected with the virus, and they developed Ebola anyway. That increased doubts about the vaccine in communities where the public health campaigns led by outsiders already were viewed with suspicion and hostility.

“The rumors were if you got vaccinated you would die,” said Liboke Kakule Muhingi, a 43-year-old farmer in Mangina, where the epidemic began last August.

His mother was among the first to die. Then, one by one, six of his sisters who had cared for their ailing mother were killed by Ebola. Kakule accepted the vaccine and made sure his wife and eight children got it, too.

“If I hadn’t, we’d all be dead,” he said.

In some cases, health teams have been unable to reach certain areas because of violence or rebel activity. Earlier this month, the head of the Congolese health ministry’s response efforts in Beni was at one point unable to return from a field visit while the military battled ADF rebels, who are linked to the Islamic State.

More often, though, contact lists have fallen apart simply because people have deliberately evaded health workers or did not understand they shouldn’t travel after being exposed. A pastor who became the first confirmed case in Goma had apparently put down fake names at health checkpoints to avoid detection. He had been sickened in the town of Butembo and then took a bus while ill.

WHO and the Congolese health ministry have now switched tactics and are offering the vaccine to anyone who wants it.

With Ebola’s arrival in Goma, a city of more than 2 million people, some wonder whether there will be enough of the vaccine if the outbreak continues.

The vaccine’s manufacturer, Merck, said it has 245,000 1-millileter doses on hand and that could rise to 900,000 over the next 18 months. The dose in Congo also has been reduced to 0.5 mL, effectively doubling the supply.

“Whether or not the available doses are sufficient to fulfill the demands depends on the evolution of the outbreak, the access to the communities and the successful expansion of the production of additional doses by Merck in early 2020,” WHO said.

There is a second experimental vaccine, produced by Johnson & Johnson, but health officials in Congo have said it will not be used because it needs further testing and would cause too much confusion. It requires two doses given one month apart.

It’s unclear how long the Merck vaccine will protect people. Scientists know from early studies that it lasts for at least a year, but the epidemic is approaching that limit. The only study to report longer vaccine durability tracked only a small number of healthy volunteers in Geneva for two years.

The new strategy of giving shots to anyone who wants them involves setting up “pop-up” sites in the neighborhoods most affected. Last week a vaccination team headed to the neighborhood in Beni where Nduhi’s wife had stayed after he died.

Outside the mud-brick home where his children still lived, a pickup truck full of plastic tables and chairs pulled over. Soon a tent was set up, and vaccination teams donned eye protection and yellow surgical gowns. Neighborhood children climbed the trees to watch.

Baraka Kathembo Makasi, a 22-year-old motorbike taxi driver, brought his wife and two children with him.

“At first I refused,” he said, “but I started seeing people die and decided to go.”

Associated Press writers Al-Hadji Kudra Maliro in Beni, Congo; Lauran Neergaard in Washington; Maria Cheng in London; and Jamey Keaten in Geneva contributed to this report.

Ebola Outbreak In Congo Declared A Global Health Emergency

In this photograph taken Saturday July 13, 2019, residents wait in line to receive the Ebola vaccine in Beni, Congo DRC. The head of the World Health Organization is convening a meeting of experts Wednesday July 17, 2019 to decide whether the Ebola outbreak should be declared an international emergency after spreading to eastern Congo's biggest city, Goma, this week. More than 1,600 people in eastern Congo have died as the virus has spread in areas too dangerous for health teams to access. (AP Photo/Jerome Delay)

BY MARIA CHENG, JAMEY KEATING

GENEVA (AP) — The deadly Ebola outbreak in Congo is now an international health emergency, the World Health Organization announced Wednesday after a case was confirmed in a city of 2 million people .

A WHO expert committee declined on three previous occasions to advise the United Nations health agency to make the declaration for this outbreak, even though other experts say it has long met the required conditions. More than 1,600 people have died since August in the second-deadliest Ebola outbreak in history, which is unfolding in a region described as a war zone.

A declaration of a global health emergency often brings greater international attention and aid, along with concerns that nervous governments might overreact with border closures.
Full Coverage: Ebola virus

The declaration comes days after a single case was confirmed in Goma, a major regional crossroads in northeastern Congo on the Rwandan border, with an international airport. Also, a sick Congolese fish trader traveled to Uganda and back while symptomatic — and later died of Ebola.

While the risk of regional spread remains high, the risk outside the region remains low, WHO chief Tedros Adhanom Ghebreyesus said after the announcement in Geneva.

The international emergency “should not be used to stigmatize or penalize the very people who are most in need of our help,” he said. Tedros insisted that the declaration was not made to raise more money — even though WHO estimated “hundreds of millions” of dollars would be needed to stop the epidemic.

Dr. Joanne Liu, president of Doctors Without Borders, said she hoped the emergency designation would prompt a radical reset of Ebola response efforts.

“The reality check is that a year into the epidemic, it’s still not under control, and we are not where we should be,” she said. “We cannot keep doing the same thing and expect different results.”

Liu said vaccination strategies should be broadened and that more efforts should be made to build trust within communities.

The U.S. Agency for International Development applauded the WHO decision and said USAID officials would “continue to scale up life-saving support” to end the outbreak.

This is the fifth such declaration in history. Previous emergencies were declared for the devastating 2014-16 Ebola outbreak in West Africa that killed more than 11,000 people, the emergence of Zika in the Americas, the swine flu pandemic and polio.

WHO defines a global emergency as an “extraordinary event” that constitutes a risk to other countries and requires a coordinated international response. Last month, the outbreak spilled across the border for the first time when a family brought the virus into Uganda after attending the burial in Congo of an infected relative. Even then, the expert committee advised against a declaration.

Alexandra Phelan, a global health expert at Georgetown University Law Center, said Wednesday’s declaration was long overdue.

“This essentially serves as a call to the international community that they have to step up appropriate financial and technical support,” she said but warned that countries should be wary of imposing travel or trade restrictions.

Such restrictions “would actually restrict the flow of goods and health care workers into affected countries so they are counterproductive,” she said. Future emergency declarations might be perceived as punishment and “might result in other countries not reporting outbreaks in the future, which puts us all at greater risk.”

WHO had been heavily criticized for its sluggish response to the West Africa outbreak, which it repeatedly declined to declare a global emergency until the virus was spreading explosively in three countries and nearly 1,000 people were dead. Internal documents later showed WHO held off partly out of fear a declaration would anger the countries involved and hurt their economies.

The organization’s emergency committee will meet again within three months to assess the situation. Committee members will review whether the outbreak is still a global emergency and whether other measures are needed.

Wednesday’s announcement prompted fear in eastern Congo, where many do business across borders and travel overseas.

“I am vaccinated and I protect myself against Ebola,” said Zoe Kibwana, a 46-year-old shoe salesman who does business in Uganda, just 70 kilometers (40 miles) from Beni. “Closing the borders would handicap our economy. The health ministry and WHO need to end this epidemic as soon as possible.”

The current outbreak is spreading in a turbulent Congo border region where dozens of rebel groups are active and where Ebola had not been experienced before. Efforts to contain the virus have been hurt by mistrust among wary locals that has prompted deadly attacks on health workers. Some infected people have deliberately evaded health authorities.

The pastor who brought Ebola to Goma used several fake names to conceal his identity on his way to the city, Congolese officials said. WHO on Tuesday said the man had died and health workers were scrambling to trace dozens of his contacts, including those who had traveled on the same bus.

Congo’s minister of health resisted the characterization of the outbreak as a health emergency.

“We accept the decision of the committee of experts but one hopes that it’s a decision that wasn’t made under pressure of certain groups that want to use this as a way to raise funds for certain humanitarian actors,” said Dr. Oly Ilunga.

Those working in the field say the outbreak is clearly taking a turn for the worse despite advances that include the widespread use of an experimental but effective Ebola vaccine.

Dr. Maurice Kakule was one of the first people to survive the current outbreak after he fell ill while treating a woman last July, before the outbreak had even been declared.

“What is clear is that Ebola is an emergency because the epidemic persists despite every possible effort to educate people,” he told the Geneva meeting.

___

Cheng reported from London. Associated Press writers Krista Larson and Al-Hadji Kudra Maliro in Beni, Congo, and Saleh Mwanamilongo in Kinshasa, Congo, also contributed to this report.

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Dikembe Mutombo Records Ebola Messages For US Officials

In this Aug. 1, 2018, file photo, Dikembe Mutombo speaks during the opening ceremony of Basketball without Borders Africa in Johannesburg, South Africa. U.S. health officials are turning to a basketball hall of famer for help in one of the deadliest Ebola outbreaks in history. Dikembe Mutombo is regarded as one of the greatest defensive players in NBA history and is a well-known philanthropist in his native Congo. He recorded radio and video spots designed to persuade people to take precautions and get care that might stop the disease’s spread. (AP Photo/Themba Hadebe)

BY MIKE STOBBE

NEW YORK (AP) — Unable to send disease fighters to help battle one of the deadliest Ebola outbreaks in history, U.S. health officials are turning to basketball hall of famer Dikembe Mutombo for help.

Mutombo, regarded as one of the greatest defensive players in NBA history and a well-known philanthropist in his native Congo, recorded radio and video spots designed to persuade people to take precautions and get care that might stop the disease’s spread.

The U.S. Centers for Disease Control and Prevention began posting the spots Monday on its YouTube channel and on the agency’s website . Officials are trying to get radio and TV stations in the Democratic Republic of Congo to air them.

About 2,100 people have been reported ill — and nearly 1,500 have died — since an Ebola outbreak was declared in August in eastern Congo. It is the second deadliest outbreak of the lethal virus, which jumps from person to person quickly through close contact with bodily fluids.

Rebel attacks and community resistance have hurt Ebola response work in Congo. A World Health Organization doctor was killed in April, health centers have been attacked and armed groups have repeatedly threatened health workers. Because of safety concerns, the U.S. State Department last year ordered CDC disease specialists to stay out of the outbreak areas.

Mutombo, who moved to the U.S. in the 1980s intending to pursue a medical degree, told The Associated Press he understands where the distrust comes from.

“Someone who doesn’t look like you, who doesn’t think like you, who is not from your village, who is from other places, just walk to your village with a nice beautiful white truck and telling you ... ‘inject this chemical into your body to protect you from this deadly virus.’ That’s where there’s a fight. This is where we’re having a conflict,” he said.

“How do you that build trust? That’s the big problem we’re having in the Congo,” he said. “I believe as a son of Congo, I think my voice can be heard. Because everyone in the country knows my commitment to the humanity and the health.”

The idea for the PSA was sparked in February when Mutombo, a member of the CDC Foundation’s governing board who lives in Atlanta, was talking with Dr. Robert Redfield, the CDC’s director.

“We are deeply appreciative of his interest to try to get accurate information to the community,” Redfield said.

Mutombo, who turns 53 on Tuesday, previously did public service announcements focused on polio and yellow fever. A dozen years ago, his foundation established a 300-bed hospital on the outskirts of his hometown of Kinshasa.

The new spots were recorded in Kiswahili, French and Lingala. They talk about recognizing the early signs of Ebola, early treatment and prevention measures.

AP reporter Cody Jackson in Atlanta contributed to this report.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Fighting Ebola Is Hard But In The Congo Mistrust And Fear Is Making iI Harder

A motorcycle taxi driver gets his hands washed with a chlorine solution at a checkpoint between Beni and Butembo in eastern Democratic Republic of Congo. Temperatures are also checked and possible Ebola isolated. Still, many Ebola victims have travelled far distances and infected new parts of North Kivu and Ituri provinces. Image via CNN

BY DAVID MCKENZIE, BRENT SWALLS

BUTEMBO, NORTH KIVU, DR CONGO (CNN) -- When Ebola first struck this city of more than a 100,000 people last September, many here didn't believe it was real.

As the disease latched onto families and spread through tightly packed neighborhoods, rumors began spreading of organ harvesting and political conspiracies, even as more people got sick and died.
When the ambulances came to take people away - they would never see them again.

"They didn't know where they were taking them. They just thought they were going 'over there' to die," says Sylvestre Zongwe, a Congolese manager of primary healthcare at French NGO The Alliance for International Medical Action (Alima).

So instead of going for treatment, many stayed at home and died, their bodies still highly contagious and deadly for the family members who buried them.

"Fear prevents good management of the epidemic. Fear makes it difficult to break the chain of transmission. What was needed was to break the fear," says Zongwe.

It's this extreme mistrust, along with simmering conflict and what many responders on the ground believe has been a flawed response, that has allowed the world's second-biggest Ebola outbreak on record to continue unabated more than 10 months after the first cases were found.

Despite millions of dollars in funding, and an effective experimental vaccine, Ebola is spreading to new parts of Congo's North Kivu and Ituri provinces and re-infecting areas thought rid of the virus. This month, it also made the long-feared jump across the border to neighboring Uganda, though at this stage those isolated cases appear to be contained.

A conflict the world forgets

Butembo's residents live at the frontier of a conflict that the world often forgets.

Hemmed in by multiple armed groups that commit repeated atrocities and harassed by the national military frequently accused of human rights abuses, they are famously and understandably distrustful of newcomers.

Earlier this year, unknown assailants destroyed Ebola treatment centers in Butembo. In April, a World Health Organization epidemiologist was killed in an attack on the University Hospital. In total there have been 130 attacks on health facilities between January and mid-May, causing four deaths and injuring 38.

Because of these security concerns, the White House barred world-renowned specialists of the US-based Centers for Disease Control from setting up a base in the heart of the epidemic (although it does have staff based in the regional capital Goma.) Similarly, Doctors Without Borders (Medecins Sans Frontieres) closed its treatment centers in some Ebola-hit areas and retreated to Goma.
Faced with an epidemic that is out of control and continued violence targeted at the response, health authorities are urgently searching for a different strategy to stop Ebola.

"During the first seven months of the epidemic we had more than 1,000 cases, now we have more than more than two thousand cases in a very short time," says Antoine Gauge, a response specialist with Doctor's Without Borders (MSF).

A draft internal World Bank assessment on the response from late May seen by CNN, describes the mounting shock at the rising death toll.

"Alarmed by the huge and unexpected surge in recent months in the number of new cases, a number of aid agencies and implementing partners have expressed concerns over many aspects of the response," it reads.

It describes a response top heavy on operational costs like salaries and hazard pay. More than half of the budget for WHO's strategic response plan during that period was allotted to staff remuneration. At the same time, it also shows that WHO was 40 million dollars short of its requested funding.
"We are absolutely outraged about how this response is going," one senior humanitarian official based in North Kivu told CNN, saying that WHO would be better served by letting more nimble expert teams, that cost far less, do the work. The official refused to be named, citing fear of criticism from the WHO.

Christian Lindmeier, a spokesman for WHO, says the organization is committed to the people of the DRC affected by the disease and that every key aspect of the response was labor-intensive.

"As some partners and NGOs have had to leave due to insecurity or other reasons, WHO has stepped in and absorbed their tasks," he said in an emailed statement.

"We owe a great deal of gratitude to the 700 brave WHO personnel who, working in partnership with the DRC Ministry of Health and hundreds of their national health workers, ensure that the response continues to operate across all vital functions, particularly when support is not immediately available from others."

Community care

Alima, the French NGO, believes it has found a solution to the mistrust that has stopped people seeking treatment. It's both hidden and in plain sight. Perched half-way up a hillside next to a school, their Ebola reception center is right inside a local clinic in the heart of the community.

A thermometer and a quick consult separates incoming suspected Ebola cases from other patients.
Community members were brought in and consulted at the beginning of the construction.
There are no alarming Ebola warning signs and posters. It just looks like part of the existing clinic. And that was the point: It's not a scary place, hidden away. It's in the community, as part of a system that treats all ailments.

"As soon as we fixed our approach, the results were there," says Zongwe.

But to the frustration of Alima, it is the only reception center of its kind in Butembo. Plans to build more have stalled. And, while innovative, it isn't nearly enough to stem the spread.

"This potentially could've been controlled earlier in the outbreak, when it was in a rural area, but letting it go fester underground with unknown chance of transmission, has really prolonged it, and we need to make sure we do everything we can to stamp it out now," says Dr. Ben Dahl, a leader of the CDC response based in Goma.

Innovation in treatment means if Ebola victims are identified quickly and get to treatment centers from reception centers, hospitals, or clinics, they have a much better chance of surviving.
To make treatment easier and less intimidating, Alima has developed what they call "the cube." Separated by a thin layer of transparent plastic, patients are able to interact more directly with doctors -- they can talk to family members who visit. All of it is an attempt to reduce the fear of Ebola and convince people to come in.

Major reset

During and after the devastating Ebola outbreak that spanned several countries in West Africa from 2014 to 2016 and killed more than 11,000, the WHO faced scathing criticism for acting too slowly and warning the world too late.

In response, the global health agency reorganized its emergency response structure and strengthened its operations.

But in this outbreak, at least according to the responders we spoke with on the frontlines of treating Ebola, it hasn't worked as planned.

David Gressly, freshly appointed by the UN as an Ebola Tsar of sorts, says the Ebola emergency response has gone through a major reset in recent weeks in the wake of internal criticism and a mounting death toll.

"If the virus continues to circulate, it remains a constant threat to spread to other provinces in this country and to neighboring countries and one day it will if we don't find a way to bring it to a halt," says Gressly, who previously managed the region's UN peacekeeping operations.

A motorcycle taxi driver gets his hands washed with a chlorine solution at a checkpoint between Beni and Butembo in eastern Democratic Republic of Congo. Temperatures are also checked and possible Ebola isolated. Still, many Ebola victims have travelled far distances and infected new parts of North Kivu and Ituri provinces.

CDC's Dahl says that the existence of the vaccine, which while experimental has been found to be 97% effective in the Congo, has led to complacency and the legwork of tracing patient contacts and quickly isolating them has not been done thoroughly.

"We were very fortunate to have this vaccine. It has probably reduced some of the cases and without it, we would have a much larger number of cases," he says.

"But they have not been doing the public health fundamentals of quickly following all the contacts, listing all the contacts, and isolating them as soon as it becomes symptomatic," he says.
He says around half of cases are still unknown to the contact lists and a large number of positive cases are deaths in the communities -- from people who wouldn't trust or couldn't get to early treatment.

Contact lists allow epidemiologists to ring-fence an outbreak. When a positive case of Ebola is identified, the victim is interviewed to find out who they were in contact with. All of those people get on a list and, in an effective outbreak response, they are closely monitored.

To get this outbreak under control, the CDC says more than 70% of cases need to seek treatment early and upwards of 80% of cases need to be on the contact lists. Otherwise, it will continue to spread.

Beaten up and stoned for taking temperatures

Samuel Mutahwa was unemployed when the virus hit Butembo, but when the outbreak hit he volunteered to help. Now he plays a critical detective role of tracing contacts that could help break transmission.

Armed only with a thermometer, he leads his contact tracing teams through the neighborhoods of Butembo. Twice a day for 21 days -- the maximum amount of time from time of infection to onset of symptoms -- they follow up with their list of patient contacts.

Mutahwa entered the compound of a grandmother and grandson that visited a sick friend in hospital. 

The friend later died.

"36.8 -- she is fine," says Mutahwa, holding a thermometer up to the smiling woman.

But earning the trust of his own community has been a hard fought and dangerous process. In the early months, Mutahwa says that he was beaten up and stoned.

"They said they were going to kill me. But I said no, I know what I am doing. I have to save the life of my people," he says.

Survivors part of the solution

Ebola is an intimate disease that is highly contagious but only contracted through direct contact.
It attacks families and then spreads through communities -- often through so-called "super-spreaders" the 20% of cases that spread the disease to 80% of the people.

It is often the personal choices of Ebola victims that can have an outsized impact on the transmission chain.

When the sister of Roger Mumbere Wasukundi, 17, got sick earlier this year, he says nobody wanted to believe that she had Ebola. They didn't even believe that Ebola existed.

After they buried his sister, his aunt got sick and quickly died. Roger, his mother, and his father all contracted the virus. Only Roger and his mother survived.

"I was sent to the treatment center because I didn't want to give up. They told me I could survive and I believed them. Everyone prayed for me," he says, sitting in his classroom in Butembo.

He still dreams of being a lawyer, but the virus still affects his health, his eyes clouded by the after effects of Ebola.

He believes that survivors like him can help turn the tide in the fight against Ebola and dispel the mistrust that has made the disease so hard to beat.

"Ebola survivors (need to) go talk to communities. Because this epidemic is very real," he says.