Suspected Ebola cases triple in a week in DR Congo as WHO warns of rapid spread
The Ebola outbreak in eastern Democratic Republic of Congo has gained structural acceleration over the past week, with suspected case numbers rising from 285 to 854. The World Health Organization (WHO) announced 198 confirmed deaths at a Geneva press conference on Monday; that figure represents 59 additional fatalities in seven days.
WHO director general Dr Tedros Adhanom Ghebreyesus told the press that 'the next 14 days will determine the spread dynamics of the outbreak' and called on international donors to support a 285 million dollar emergency response package. Some 78 per cent of total cases are concentrated in Ituri and North Kivu provinces.
Limited access corridors are setting response teams back. Several roads that cross territories controlled by the M23 armed group cover 'about 35 per cent of the total land area that our teams cannot reach,' according to Médecins Sans Frontières (MSF) chief coordinator Dr Sarah Halim, who spoke to the BBC from Geneva. MSF is establishing a helicopter bridge between Bunia and Goma.
A critical context: unlike the 2022 episode, the current strain is Sudan ebolavirus (Sudan virus disease). The only approved vaccine, Ervebo from Merck, is approved only for the Zaire strain; vaccines that could be used against the Sudan strain have not yet completed FDA pre-review. A vaccine candidate led by Dr Sarah Gilbert at Oxford University and the Sabin Vaccine Institute has exited Phase 1 trials and submitted Phase 2 applications.
Financing is another obstacle. According to Joyce Msuya, head of the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), the current response operation costs 8.2 million dollars a day; that figure reaches 246 million dollars in a 30-day projection. The European Union announced on Monday it had approved an emergency contribution package of 65 million euros; the United States CDC has dispatched 38 epidemiologists from Atlanta to Bunia.
The recorded case profile is concerning. According to the WHO weekly epidemiological report, 47 per cent of cases are health workers or close family members of patients; this indicates protection protocols are not being adequately implemented in medical facilities. At Centre Hospitalier de Référence in Bunia, a healthcare team reported insufficient contact precautions because of protective equipment shortages.
On political coordination, Democratic Republic of Congo Health Minister Dr Roger Kamba said in a press statement that 'we are in full coordination with our international partners'. However, according to Reuters, MONUSCO (United Nations Mission in DRC) and the DRC government have differences over which corridors can be used purely for vaccine delivery.
An incident at a treatment centre near Goma in West Kivu last Friday showed that suspicion of outside intervention remains intense. Local communities protested the burning of treatment tents; Goma Governor Constant Ndima Kongba said police and WHO teams were not injured. Community leader and anthropologist Lambert Mende told the BBC that 'suspicion of external health interventions dates back to the colonial era; it is a structural awareness'.
Internationally, there is debate about whether the outbreak could disrupt flows for Ramadan, Hajj and Olympic events. The Saudi Arabian Ministry of Health expanded mandatory fever screening protocols for all travellers arriving at Jeddah on Friday. Mauritius and Kenya have also implemented passenger screening protocols on all flights departing from Bunia and Goma.
In addition to the WHO's political pressure at the top, a development worth noting on the patient-treatment side is that the monoclonal antibody cocktail known as ZMapp is being used in Bunia against the Sudan strain and has produced a 42 per cent survival improvement. This information is not clinical advice; patients' treatment decisions should be made with their treating physician. The trajectory of the outbreak in the next 14 days will depend on humanitarian corridor access, vaccine supply and community trust.