DR Congo races to halt spread of Ebola
Reporting breakdown and weak health systems in conflict-hit country allowed virus to go undetected for weeks
In the disease ‘hot zone’ in the north east of the Democratic Republic of Congo where Ebola has been spreading undetected for weeks, residents are gripped with fear.
It has taken a long time for the mystery deaths in the community to be identified, said Mwanza Myrah Noella, a student from Bunia, the regional capital of Ituri province on the Ugandan border.
“Everything is being done urgently, measures are being put in place in the hospitals. But that doesn’t mean you stop fearing you could be next,” she said.
The latest Ebola outbreak in DR Congo is testing both the impact of western funding cuts on pandemic preparedness and the resilience of health systems in a country that has battled the disease for decades.
“DR Congo has been the country most affected by Ebola and possesses an unrivalled expertise in managing Ebola epidemics,” said Jean-Jacques Muyembe, director of Congo’s National Institute for Biomedical Research.
Despite that experience, “rapid detection and management of an epidemic in conflict zones like Ituri requires huge financial and material resources”, he said. DR Congo alone does not possess these.
The country has had 18 Ebola outbreaks since 1976, when Muyembe provided biopsy and blood samples in the north of what was then Zaire that helped lead to the discovery of the disease. That includes the current one, which is centred in a region riddled with armed groups.
What is alarming public health officials about the latest outbreak, which has already claimed at least 139 lives and which the World Health Organization on Sunday labelled a “public health emergency of international concern”, is the breakdown that appears to have taken place in reporting procedures.
This meant the disease went undetected, allowing it to spread across several health zones to the eastern city of Goma, the capital Kinshasa in the west and in two cases across the border into Uganda.
The latest figures from international and local aid agencies in DR Congo count 536 suspected cases overall.
Only in the past week have international and local officials rushed to put in place containment procedures with a proven record in limiting the spread of the disease. Even now, the WHO is unsure of the extent of the outbreak.
“It should not have got to this stage weeks in where you have hundreds of active contacts, multiple deaths and no one had been alerted,” said a former WHO official with years of experience in complex emergencies, including the Ebola crisis in west Africa in 2014.
The first cases had been flagged at community level at least five weeks ago but there had been a “breakdown in the chain of reporting”, the person said.
The first known transmission of the disease occurred in Mongbwalu, a bustling artisanal gold mining town in north-eastern Ituri, where residents said they felt trapped.
“I have already lost two of my neighbours,” said a Mongbwalu shop owner contacted by the FT. “People are frightened, but they can’t leave because this is where they earn their money.”
Blood samples were sent last month from Mongbwalu to Bunia, where there have also been 16 suspected cases. But the laboratory there failed to detect the rare Bundibugyo strain of the disease. This is the third time this strain has taken root.
“The Bunia laboratory was unable to confirm the outbreak because it only had GeneXpert cartridges specific to the Ebola Zaire virus, which do not detect other Ebola viruses,” Muyembe said.
Samples should have been sent much earlier to Kinshasa, where they have molecular diagnostic platforms to detect the Bundibugyo strain, and those samples that did arrive had not been properly refrigerated, he added.
The former WHO official said international donors and agencies needed to address the question of why — despite huge investments in tackling Ebola over the years — seemingly insufficient funds had been dedicated towards financing the basics of prevention and containment in DR Congo. These included outreach on how to prevent contagion, diagnostics and acting early in non-affected areas.
“The Congolese out of everybody have so much experience with this, but they didn’t even have tests that work. That should be the priority, along with community outreach,” the person said, adding that whole families had been wiped out in clusters long before the disease was flagged. “The reality is you stop it and save lives with the basics.”
Relief agency officials are concerned the response gathering pace now will be greatly complicated by the conflict in eastern Congo, parts of which are in rebel hands.
Ebola has been a recurring killer in various parts of Africa and has played a formative role in global health policies to combat infectious conditions with epidemic and pandemic potential.
The current crisis is set against a backdrop of wider turmoil in the financing of global and developing world health initiatives and has revealed gaps in international efforts to target lethal infectious conditions that could become epidemics or pandemics.
The US under Donald Trump has drastically cut its aid budget and other rich countries have also slashed global health funding since Covid-19.
“I don’t think that there’s any doubt that a lot of countries have pulled back from pandemic preparedness,” said Nicole Lurie, executive director for preparedness and response at the Coalition for Epidemic Preparedness Innovations.
The way the Ebola outbreak in DR Congo “got so out of control before it was detected” was “particularly disappointing”, she said. “That I think speaks to the need for better diagnostic tests and better surveillance.”
Lurie said the “bright spot” was the number of partners now prepared to contribute to an urgent hunt to find a vaccine for the Bundibugyo virus strain.
“I’m gratified about the way the world comes together when there’s a crisis like this [but] it’s very disappointing to see how quickly that sense of solidarity falls apart when a crisis abates,” she said.