An Ebola outbreak in the Democratic Republic of Congo faces severe challenges as health workers strike over unpaid wages, logistics are hampered by airport closures, and the spread moves toward areas controlled by the M23 rebel group. A new clinical trial is testing experimental treatments, but experts warn that without addressing governance and trust issues, the response may fail.
Public health response cannot succeed where governance is fractured, logistics are crippled, and trust is already in short supply….no matter how robust the “pandemic response plans” are.
The outbreak has recorded 1,561 cases, including 506 deaths, since it was declared on May 15 as the spread continues to outpace response, Congo’s Ministry of Health said in its latest update on Sunday night. Compounding the response, front-line health workers in Ituri Province, the epicenter of the outbreak, have begun striking over unpaid wages and bonuses dating back to when the outbreak was declared on May 15.2 Affected staff include epidemiological surveillance teams, safety and security personnel, community outreach workers, and burial teams.
A member of the epidemiological surveillance committee in Ituri’s capital, Bunia, reported that since the Ebola outbreak was declared, workers have been demanding payment for their work, according to The Associated Press, noting that nonpayment exposes workers and their families to significant socioeconomic difficulties and seriously undermines living conditions. Some workers staged a protest outside the Rwampara Ebola treatment center, setting tires on fire before police intervened. Officials attributed the payment delays partly to logistical disruptions.
Furthermore, the closure of the Bunia airport hampers the implementation of the response, particularly for certain aspects of funding. Officials are now beginning to worry about what could happen if Ebola cases erupt in highly populated areas held by M23. This powerful rebel group seized vast Ebola cases have already been reported in the rebel zone, including one infection in the city of Goma, the rebel headquarters.
Transmission for the moment appears to be low there, according to figures released by Congo’s health ministry, but hot spots are getting closer and closer to occupied areas, moving south from the epicenter in the province of Ituri. When M23 seized territory last year, thousands of people were killed, and hundreds of thousands were displaced.
Now, the rebels impose taxes, control public utilities and present themselves as the only legitimate authority in their territory, which includes two provincial capitals, Goma and Bukavu. Officials say a full-scale outbreak in M23-controlled areas would be devastating for civilians trapped by fighting and the virus. But it may also present an opportunity for the rebels.
If M23 manages to contain Ebola successfully, it could bolster the image it has cultivated as a legitimate authority, at a time when the Congolese government is struggling to get the outbreak under control. M23 rules over a population that is highly skeptical of Ebola. Some Congolese have called the virus a hoax meant to line the pockets of government officials and foreigners. Isolation wards in Ituri have recently been burned and medical workers violently attacked.
Earlier this month, the World Health Organization and the DRC launched a clinical trial to test experimental treatments specifically against the Bundibugyo strain. The trial has begun enrolling patients in affected regions of the DRC. Still, it is expected to take several months to generate meaningful efficacy and safety data, potentially up to about a year, depending on case numbers and enrollment.
The trial is due to assess whether using the monoclonal antibody therapeutic MBP134, remdesivir, an antiviral approved for the treatment of COVID-19, and effective in treating some Ebolavirus strains, or a combination of the two therapies, might help improve survival.
“The first treatment, MBP134, is made up of two human monoclonal antibodies isolated from a survivor of the 2013-2016 West African Ebola outbreak,” Gandhi explained. “MBP134 targets binding sites on the ebolavirus that are common to multiple strains, including neutralizing multiple strains, including Ebola , Sudan, and Bundibugyo,” she detailed. “A study in non-human primates show complete reverse of symptoms of a Sudan strain of Ebola with administration of MBP134.
The second treatment, remdesivir, is a well-known antiviral used to treat SARS-CoV-2, the agent of COVID-19, and both treatments are being studied alone and in combination,” Gandhi added. The convergence of a lethal Ebola strain, unpaid and striking health workers, and insurgent-controlled territory certainly presents challenges. Public health response cannot succeed where governance is fractured, logistics are crippled, and trust is already in short supply….no matter how robust the “pandemic response plans” are.
Unless those fundamentals are addressed quickly, even the most effective and promising therapeutics will be of little use in this particular outbreak.
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