A second outbreak of Ebola in less than two years has struck the Democratic Republic of the Congo (DRC). Yesterday, the Congolese health ministry identified six cases of Ebola in the Equateur Province, in Northwestern Congo, in the city of Mbandanka. Four of the six people have died.
The highly lethal Ebola virus causes hemorrhagic fever, severe vomiting and diarrhea, among other symptoms, and is spread through direct contact with body fluids from an infected person.
This week’s news comes on the heels of an earlier outbreak in the Eastern region of the DRC bordering Uganda. This outbreak began in August of 2018 and hasn’t yet ended. In fact, it is the worst Ebola outbreak since the 2014-2016 epidemic in West Africa. The World Health Organization (WHO) stated that the health ministry has identified 3,406 cases and 2,243 of them have died.
The new Ebola crisis in the DRC compounds an already extremely difficult situation for public health officials. The country is also dealing with the world’s largest measles outbreak that has killed over 6,000, and Covid-19, which has infected 3,195 and killed 75.
Mbandaka, the city where the new cases have been identified, is only 200 miles from the city of Kinshasa which has more than 11 million inhabitants. With frequent travel between Mbandaka and Kinshasa this poses a potential risk of an outbreak in a densely populated metropolis.
The World Health Organization surge team is already on the ground supporting the response.
In addressing previous outbreaks, the WHO has been instrumental, not only in terms of immediate response needs, but also with regard to coordinating efforts to procure and distribute therapies and (experimental) vaccines. As part of a containment strategy, in 2018 and 2019 the WHO substantially increased the number of people eligible to be vaccinated against Ebola with promising investigational products.
WHO officials coordinated the procurement, storage, and distribution of hundreds of thousands of doses of an experimental vaccine manufactured and donated by Merck. This vaccine had been extensively tested in multiple jurisdictions in Africa, and proved to be effective in Guinea during the West African Ebola epidemic of 2014-2016.
Merck’s vaccine has been deployed in the Congo in what’s known as a ring vaccination strategy. People who are contacts of confirmed Ebola cases, and contacts of those contacts, are offered the vaccine. This includes health workers who have cared for Ebola patients.
A second Ebola vaccine was developed and donated by Johnson & Johnson, and deployed beginning in the fall of 2019. The product is a two-dose vaccine that was specifically designed to offer long-lasting protection.
In concert with the ring vaccination strategy, public health officials used the Johnson & Johnson experimental vaccine outside of the rings of contacts – as a protective wall – in order to stop the spread of Ebola.
The 2014-2016 West African Ebola epidemic was the largest in history, with 28,610 reported cases and 11,308 deaths. Beginning in 2014, the WHO, the U.S. Centers for Disease Control and Prevention, the U.S. Agency for International Development, the Ministries of Health of the impacted countries, and a number of public-private partnerships, collaborated in an ultimately successful, herculean effort to end the epidemic. The outbreak was declared over in June 2016.
In the Congolese Ebola outbreak that began in 2018 U.S. engagement has been more limited compared to its involvement in West Africa from 2014 to 2016. Even though it is less engaged than it was in the West African Ebola outbreak, the U.S. has been the world’s largest international donor of resources to the Ebola response efforts in the DRC since 2017.
Given the Trump Administration’s recent threat to withdraw from WHO it’s unclear at this point what role the U.S. will play with respect to working with WHO to combat the new outbreak in Northwestern Congo.