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Home / Health / The Ebola outbreak in the Democratic Republic of the Congo is now the second largest in history

The Ebola outbreak in the Democratic Republic of the Congo is now the second largest in history



GENEVA – An Ebola epidemic that experts call "exceptionally dangerous" is developing in the Democratic Republic of the Congo.

To date, there have been more than 420 cases and 240 deaths. This makes Ebola the biggest outbreak of Ebola since the outbreak of West Africa in 2014-2016, when 11,000 people died. It is also the second largest Ebola outbreak ever recorded.

People have been dealing with the Ebola virus for centuries with deadly consequences. But until five months ago, Ebola had never appeared in an active war zone.

On August 1

, the World Health Organization in the Democratic Republic of the Congo declared an Ebola outbreak. The virus spread to cities in northern Kivu, an unstable province in central Africa, where the struggle between several rebel and militia groups repeatedly disrupted the tedious work of health workers responding to the outbreak.

Even though Ebola Respirents have never had so many resources to fight the virus – experimental vaccines and treatments that are promising – the incidence of the disease has more than doubled since September. Worse still, many of the newly diagnosed cases can not be linked to other known cases. That is, there are still people who spread the disease that have not yet been identified by the health authorities.

Due to the ongoing conflict in the region, the US government has decided that it is too dangerous to allow its top Ebola experts to work in the epicenter of the outbreak. The US has maintained this position despite the delay of public health officials saying that the US is not doing enough to help.


  Peter Salama, head of the World Health Organization (WHO) Health Emergencies Program.

Peter Salama, head of the World Health Organization's Health Emergencies Program.
Fabrice Coffrini / AFP / Getty Images

Unpacking how the outbreak got so bad and what the WHO needs right now, I sat down with Peter Salama, head of the WHO's new health emergencies program. His team was founded in 2016 as a direct response to the outbreak of Ebola by WHO in West Africa. This year alone, he helped the organization respond to 50 health emergencies in 47 countries.

But the Ebola outbreak in the Democratic Republic of the Congo is different, Salama said. He sat in his office in Geneva in front of a map of the Democratic Republic of Congo – which he holds in front of him "to remind me that I need to focus on it to the minute" – he led me through the extraordinary complexity of trying to curb Ebola outbreak in a war zone and why WHO could now use the best Ebola heads in the world. Our conversation was edited for reasons of length and clarity.

US experts could be used for the Ebola response.


Healthcare professionals putting on their personal protective equipment before going to a newly built Doctors Without Borders Ebola treatment center in the Democratic Republic of the Congo] Julia Belluz

The US moved in early September their staff from the Centers for Disease Control and Prevention from Beni, the outbreak epicenter. They decided it was too dangerous for America's best Ebola experts to be there – and it sounds like they would not be back soon. Could the US do more? Does WHO need these experts now?

Peter Salama

As we go more and more into the outbreak, all our capacity is taxed, so we need to give employees the opportunity to take a break and refresh themselves at some point. We have to deal with rotating employees – because here in Geneva and [in DRC] 20 hours a day is worked. We do not want people to be so exhausted that they burn out. So we need people. We have people coming and for some countries, not just the US, they have security concerns.

Julia Belluz

But I understand that Canada, Britain, even non-profit organizations with US staff, people send, and you have hundreds of WHO officials used. Is the US government an outlier?

Peter Salama

The US government is the most important country that had restrictions. Others, however, have asked many questions, need security and are limited in their contact persons.

Julia Belluz

What kind of people do you need at this point?

Peter Salama

Some of the key areas in which it is not easy to find humans are the oldest hemorrhagic epidemiologists who specialize in viral haemorrhagic fevers. [We need] Medical logisticians, but not just general logisticians – they are people who know how to build the cold chain at negative 60 to 80 degrees Celsius [to keep the vaccine cold] and ensure their integrity right down to Beni. So we do not just need the average humanitarian helper.

Julia Belluz

What about money? The WHO Health Emergency Fund has never received the $ 100 million from donors, including the United States, that it requested. How do you operate in this constant state of underfunding?

Peter Salama

When we started three years ago, we demanded $ 100 million in initial capital. We never got $ 100 million. But because it is constantly being used and constantly renewed, it is not the end of the world. Over the past two years, we've spent about $ 60 million on responding to 70 events. This year, we received nearly $ 40 million in additional pledges. So it was well supported.

I would like to come to a more formal system where, for example, the G20 says we guarantee this fund because it is so important to global security that it will never go below $ 50 million. I would like to go there.

What distinguishes this outburst from all others?

Julia Belluz

DRC had seen nine Ebola outbreaks since the virus was discovered in 1976. What makes this 10th outbreak different?

Peter Salama

It is an outbreak that I call a perfect storm – a combination of this deadly disease in one of the most difficult and protracted crises we have around the world.

In North Kivu there is a long civil war conflict, proximity to numerous international borders – Uganda, Rwanda and South Sudan – and a population constantly on the go with 1 million displaced persons from the [6] million inhabitants. It is also a population that has been severely traumatized, especially in and around Beni [the outbreak epicenter]. People have been exposed to massive attacks since 2014, even after the genocide in Rwanda [in 1994].

This population is so traumatized that everything is seen for them through mistrust of authority and physical insecurity and the inability of the world to protect them. These viruses exploit social vulnerabilities and fault lines. That's what we see clearly in this Ebola outbreak.


A United Nations Organization for Stabilization Organization and Stabilization Vehicle in the Democratic Republic of the Congo (MONUSCO) is patrolling the road connecting Beni with Mangina on 23 August 2018 in Beni, North Kivu province.
John Wessels / AFP / Getty Images

Julia Belluz

One reason for the continued spread of Ebola is the distrust sparked by this violence and instability in North Kivu. It contributes to the spread of Ebola when people win. Do not go to treatment centers or work with responders. What is WHO doing to overcome this?

Peter Salama

The most important thing we can do is to understand what perceptions and behaviors of the community are related to the outbreak. We have both local and international sociologists and anthropologists working closely with the WHO. So we ask them questions we want to know.

For example, when we were in North Kivu for the first time, we wanted to understand more about political economy. It is a mineral rich part of the Democratic Republic of the Congo: 60 percent of the world's cobalt, the critical ingredient for electric car batteries. The mineral wealth has a lot to do with why it is so unstable. The anthropologists gave us a first briefing to support WHO's response.

Since then, we have asked them more mundane, but more critical questions – about the main burial practices and the ongoing perception of the Ebola response. Some of the feedback was fascinating. Everyone assumed it was the 10th Ebola outbreak in the Democratic Republic of the Congo that there was a high level of awareness and awareness about Ebola. But there was also a very poor public health awareness.

Julia Belluz

There was an interesting study Lancet that some time ago showed that people in the Democratic Republic of the Congo trust the Ebola vaccine but would not do so by sending their family to treatment centers , Is it still like that?

Peter Salama

Awareness and Knowledge [about Ebola treatment is changing]. There is a much more differentiated understanding of how this Ebola response fits into the population's concerns about safety and security. The constant refrain was, "Look, we think the Ebola response is really important and supports them as a community, but we want you to pay as much attention to our physical protection and safety as possible, if not more. We do not want to survive Ebola to die from physical violence. "The women's groups, the youth groups – they are very articulate. You send a message to the international community.

Julia Belluz

That seems to be a much bigger challenge than your unit or WHO can address.

Peter Salama

We have 300 employees, and I sleep every night when I think about the line of fire. Two weeks ago there was a big incident in Beni. There were bullet holes in some of our employees' walls. They sent us pictures. We temporarily moved employees who felt the effects of the fire line. A munition landed in her guest house. It did not explode, but if they did, they would all probably have died.


Young Congolese girls look at a poster explaining the symptoms of Ebola on 19 August 2018 in Mangina, near Beni in the province of North Kivu.
John Wessels / AFP / Getty Images

Julia Belluz

] This violence and insecurity – would you still say that this is the biggest obstacle to getting this outbreak under control?

Peter Salama

The key challenge has always been the merging of truly violent security incidents and constant attacks. Beni, the epicenter, has experienced more than 20 severe attacks since the outbreak on 1 August. On the other hand, we know that it is a vicious circle with the mistrust of the community. So they go together.

Julia Belluz

But people accept the vaccine?

Peter Salama

If you look at the ring vaccine, you will find a confirmed case and the contacts around the case and vaccinate them. We may have made 240 rings around confirmed cases. With over 90 percent of these rings, we achieve coverage of 95 to 100 percent. So there is an overwhelming acceptance.

But what's more, is the question of why the vaccine is not used on a much larger scale – so they do not understand this ring vaccine strategy.

This question is not easy to answer. We have to explain that it is a specific disease eradication strategy [smallpox] and it has worked in previous Ebola responses. In addition, we do not have a licensed product and a limited quantity. Therefore, we need to apply a vaccination strategy that protects the vaccine.

We do not vaccinate the majority of our employees. They are not immediately at risk if they do not participate in funeral work or clinical treatments. I have not been vaccinated because I have no direct clinical treatment

Promise of new Ebola medicines and vaccines


Nurses working with the World Health Organization are preparing for the administration of vaccines in Mbandaka, an area that was met on 9 May 2018 by the 9th Ebola outbreak of the DRC.
Junior D. Kannah / AFP / Getty Images

Julia Belluz

The WHO is now giving the vaccine preventively in Uganda – but in everything you've described, it's surprising that it's not already over extends the boundaries.

Peter Salama

There have been many first successes in this outbreak reaction, things that have never been done before. One of these is the use of this experimental Ebola vaccine on this scale. We have vaccinated more than 37,000 people.

We know that vaccination has an important impact. In 19459145 we are talking about something called the Reproduction Number [or the number of people one sick person can infect]. Even for Beni, the reproduction number is 1. When Ebola is really hot, it can be up to 2 to 4.

Exploring the limits of our Ebola knowledge


Health workers burn mattresses used by patients with Ebola on August 21, 2018, in Mangina, near Beni in the province of North Kivu.
John Wessels / AFP / Getty Images

Julia Belluz

Many observers are talking about this Ebola outbreak as the main test for your health emergency unit. Did it make you think about how you work or are structured?

Peter Salama

This is probably the biggest public health test or Ebola Outbreak. This is the most difficult context we have seen, and we have people involved in Ebola since the 1980s. So it's a test for everyone, including the WHO.

We are very confident that we have the right people and systems. The problem is really the context – an outbreak that is so volatile that we need to revise our strategies on a regular basis. We remain open and ensure that we listen to experts from various advisory groups.

We use [advice] to further question assumptions and revise our strategies. There will be no time when we say, "Let's change everything and start over."

We know that these strategies – traditional public health measures and breakthroughs such as vaccines and therapeutics – will help us stop the outbreak. However, the minimum requirement from this point onwards, after the epidemic curve, is that it will take at least six months [to stop the outbreak].

Tensions in the Democratic Republic of the Congo bring supporters of Congolese opposition figures to the streets of Kinshasa, the capital of the Democratic Republic of the Congo, on November 27, 2018. John Wessels / AFP / Getty Images

Julia Belluz

] This month's elections are in the Democratic Republic of the Congo. This is a moment of true tension given the difficult political environment. Are there any concerns that the election could hamper the response, and what is the WHO doing?

Peter Salama

The elections are scheduled for 23 December and we are very anxious to ensure that Ebola is not used as a political issue in the context of the elections.

It's difficult – we need to engage all community leaders, be it the governor of Kivu, the mayor of Beni and the opposition parties – to make sure everyone understands that this is off the table. We do not want to use Ebola for this purpose. So far they have been open to it. However, it is a constant process of awareness building. It's important that the community is there.

Julia Belluz

I remember being a health reporter, I learned early on that Ebola is a virus that no one believed would cause an epidemic because it was so hard to transmit – people became so sick and dying so fast. But this was knowledge from rural outbreaks, and since it shows up in urban areas, we have seen the true, deadly potential of Ebola. What is the big snack from the point of view of the outbreak of attacks?

Peter Salama

For the last two years since I've been here, 80 percent of our major outbreaks have been in conflict-affected areas. This is the topic of the future.

The problem of outbreaks of high-threat agents in the city is really a problem of our generation. I do not think we are dealing with it. Now with yellow fever, plague, with Ebola we start to see these patterns. All bets are from [in terms of] and we think we know about disease transmission because of what has happened in rural areas in the past. It is completely different now.


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