The Ebola outbreak in the Democratic Republic of the Congo (DRC) is the fastest-growing outbreak of the disease on record and is on track to eclipse the 2014 - 2016 West Africa epidemic as the largest in history.
The ongoing outbreak is caused by the rare Bundibugyo species of the virus, and currently carries a 46% case fatality ratio, meaning the disease kills nearly half of the people it infects. Since May of this year, the DRC has suffered over 5,000 confirmed cases and 2,378 deaths as the virus has spread across six provinces within the country.
What factors are making this outbreak so difficult to contain?
In their weekly Tracking Report, researchers from the Pandemic Center at Brown University wrote that most cases in the DRC are happening at home before patients have a chance to reach a hospital. This is likely increasing the number of people who are exposed to the disease while making it difficult for health care workers to detect transmission chains.
“The DRC’s province of Ituri is an area of insecurity with many armed rebel groups,” said Dr. Seth Berkley, senior adviser to the Pandemic Center and former CEO of Gavi, the Vaccine Alliance. “The physical infrastructure is extremely poor and this outbreak is being caused by an uncommon strain of the virus, which has only led to a few outbreaks in the past and does not have treatments or vaccines made for it.”
“Ongoing conflict in the region has led to the displacement of millions of people, who now must travel to seek shelter and safety, risking further spread of the virus,” said Diane Meyer, Ph.D., distinguished senior research scientist at Brown. “This conflict is making it difficult for health care workers to reach certain areas and has led to attacks on treatment centers. There are also resource shortages, including of PPE needed to protect those caring for patients, and unpaid salaries have led to health care worker strikes.”
Other experts share these concerns. Devi Sridhar, chair of global public health at the University of Edinburgh, wrote in The Guardian of geopolitical challenges that are obstructing a coordinated response. She notes that during the 2014 Ebola outbreak, the U.S., U.K. and French governments worked closely with the World Health Organization (WHO), mobilizing massive resources to halt the crisis.
Today, the “U.S. is no longer part of the WHO or working multilaterally, favoring a ‘go-it-alone’ response,” Sridhar writes. “This is in the context of defunding foreign aid, the censorship of scientists, the closure of USAID [and] the implosion of the U.S. Centers for Disease Control and Prevention.”
To Sridhar’s point, earlier this month, the U.S. State Department said it provided $512 million in direct assistance to the DRC, roughly one-tenth of the $5.4 billion the U.S. devoted to combating the 2014 epidemic.
The road ahead
Oxford University began human trials of a Bundibugyo vaccine in July, applying the same technology as the Oxford-AstraZeneca Covid vaccine, which was tested and manufactured in record time and is estimated to have saved about six million lives in its first year alone.
“The Bundibugyo vaccine has been put into a phase I trial in the U.K. and is close to, if not fully, enrolled,” Berkley said. “Unfortunately, trials have not yet started in the DRC, but this could happen anytime there is a desire to do so. Once there, a quick phase I trial could be done and then roll over into a phase IIB efficacy trial. If efficacy and safety concerns are met, the vaccine could be used under an emergency authorization for the population.”
Also in July, the WHO began funding a clinical trial in the DRC on two existing antiviral therapies. The WHO is seeking to reverse the spread of the disease by late October or early November, but warned that this meant “bringing transmission under control—not ending the outbreak entirely.”
“These are exciting developments, but it is going to take a while to understand how well those tools work,” Meyer said. “And some of the ongoing response challenges, including contact tracing of those people exposed to infected individuals, are also going to hamper clinical trial efforts of those interventions meant to prevent transmission.”