The Ebola Outbreak Response So Far

The ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC) is the 2^nd largest Ebola outbreak in history, outpaced only by the 2013-2016 West African epidemic. The outbreak continues to be recognized as a public health emergency of international concern by the World Health Organization (WHO).

The US Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) has provided a summary of the Ebola response from August 2018 through November 2019, noting 2196 deaths as well as consistent challenges to outbreak control due to government mistrust and ongoing armed conflict in the region.

A total of 3296 Ebola cases have been reported as of November 17, 2019. The 2196 reported deaths represent a 67% mortality rate. The West African epidemic, in comparison, led to 28,600 cases and 11,325 deaths.

The DRC Ministry of Health has worked with a variety of partners, including the United Nations Children’s Fund, the Alliance for International Medical Action, Doctors Without Borders, WHO, and CDC, to control the outbreak.

The DRC Ministry of Health established a strategic coordination center in the city of Goma to coordinate surveillance, vaccination, and burials. Several vaccines have been evaluated in the field during response efforts. The US Food and Drug Administration recently announced the approval of Ervebo, which has been used as an investigational vaccine in the DRC.

The MMWR detailed the epidemiologic history of the outbreak. The 5 most affected health zones in DRC between August 2018 and November 2019 were Beni, Katwa, Mabalako, Mandima, and Butembo. These zones accounted for 69% of cases reported.

A majority of the cases, 1857, occurred in women. People aged 18 years or less accounted for 968 (29%) of cases. Health workers themselves accounted for 165 cases. The ongoing Kivu conflict has been responsible for displacing residents and spreading the virus, including the first cases in Uganda since 2013.

“Conflict, including clashes between armed groups and Congolese security forces, has resulted in eruptions of violence targeting civilians and displacement of tens of thousands of residents into neighboring provinces and countries (Rwanda and Uganda),” authors of the MMWR wrote.

The Kivu conflict is one of the longest lasting in contemporary history. The conflict is a clear backdrop to many of the complications that face the international response to the region’s Ebola outbreak.

In 2018, a study project by experts at New York University estimated that 134 armed groups were active in North and South Kivu. In North Kivu alone, about 70 groups were active at that time.

The conflict has a variety of historical bases, dating back to political violence over the Rwandan genocide spilling over into the DRC in the '90s. But economic demand for natural resources abundant in Kivu such as coltan, a metallic ore used in cell phones, also perpetuates conflict between the various factions involved. Human rights abuses have been reported on the part of all sides.

“The prolonged conflict has seeded mistrust toward local authorities and international partners, which has impeded effective community collaboration and led to incomplete case ascertainment and contact enumeration, vaccination refusals, and delayed seeking of health care,” authors of the MMWR wrote.

Authors also noted that nosocomial transmission of the disease in local health facilities has created resistance to hospitalization. Difficult-to-navigate tensions have emerged between communities with deeply rooted burial practices, which often involve touching bodies, and international public health groups that have linked such practices to disease transmission.

The MMWR analysis concludes that, despite progress, enhanced communication and community engagement will be necessary to end the outbreak. Authors of the MMWR emphasized working with trusted local leaders to disseminate health communication in a variety of languages.

For updates on the Ebola outbreak in the Democratic Republic of the Congo, visit the outbreak monitor.