Democratic Republic of the Congo’s (DRC) health minister resigned in protest after being stripped of responsibility for managing the country’s Ebola outbreak by the presidency.

In a resignation letter posted on his Twitter account on Monday, Oly Ilunga Kalenga decried “interference in the management of the response” to the outbreak, which is the second deadliest in history, and the creation of parallel chains of authority.

Ilunga’s move came after DRC President Felix Tshisekedi’s office announced on Saturday it was assigning responsibility for the response to a multi-disciplinary team that would report directly to Tshisekedi.

“As a result of your decision to place the response to the Ebola outbreak under your direct supervision … I hereby submit my resignation as health minister,” Ilunga said.

“As in any war, because that is what this is, there cannot be several centres of decision-making for risk of creating confusion,” he added.

Suite à la décision de la @Presidence_RDC de gérer à son niveau l’épidémie d’#Ebola, j’ai remis ma démission en tant que Ministre de la Santé ce lundi. Ce fut un honneur de pouvoir mettre mon expertise au service de notre Nation pendant ces 2 années importantes de notre Histoire. pic.twitter.com/qEDAPkxR0B — Soutien au Dr Oly Ilunga (@OlyIlunga) July 22, 2019

Translation: “Following the decision of the president to manage the Ebola epidemic himself, I have handed in my resignation as minister of health on Monday. It was my honour to put my expertise to work for our nation during these 2 very important years of our history.”

According to DRC’s health ministry, the Ebola outbreak has killed more than 1,700 people – more than two-thirds of those who contracted it – since it emerged in the country’s eastern North Kivu and Ituri provinces last August. Combined, the two provinces border Rwanda, Uganda and South Sudan.

Vaccine controversy

In his resignation letter, Ilunga also criticised outside pressure to deploy a second Ebola vaccine manufactured by US-based firm Johnson & Johnson.

“It would be fanciful to think that the new vaccine proposed by actors, who have shown an obvious lack of ethics by voluntarily hiding important information from medical authorities, could have a significant impact on the control of the current outbreak,” he said.

The DRC’s Ebola outbreak, its tenth to date, has killed more than 1,700 people so far [Hugh Kinsella Cunningham/EPA]

It was not immediately clear what “actors” he was referring to, but international donors such as the World Health Organization (WHO) – which last week declared the epidemic a public health emergency of international concern – and medical charity Doctors Without Borders (MSF) have publicly called for the use of the second vaccine.

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An array of health experts also called for its deployment following the WHO’s declaration, including Josie Golding, epidemics lead for UK-based charity The Wellcome Trust.

“There is … a pressing need to introduce a second vaccine in the DRC to protect communities outside of the current outbreak zone,” Golding said.

Peter Piot, director of the London School of Hygiene & Tropical Medicine, seconded Golding’s call for the use of Johnson & Johnson’s product, saying “we must use all of the tools and approaches at our disposal” to end the epidemic.

“WHO has sounded the global alarm. Now it is up to the world to act,” he added.

But Ilunga said the Johnson & Johnson vaccine had proved ineffective and deploying a second vaccine would confuse people. The company has said the vaccine, which has gone through phase 1 trials, is safe.

Health workers have vaccinated nearly 170,000 people to date with an experimental vaccine produced by US-based pharmaceutical firm Merck. The vaccine is estimated to be 97.5 percent effective and, according to the WHO, may protect a person for up to 12 months.

But efforts to end the epidemic have been repeatedly hampered by a “perfect storm” of regional insecurity in eastern DRC and deep community mistrust over the crisis and towards authorities.

A study published in March by the Lancet Infectious Diseases journal found that fewer than two-thirds of nearly 1,000 respondents said they would take a vaccine for Ebola, with large segments of the local population suggesting the virus was a fabrication invented for the financial gain of business-owning local elites or to further destabilise the area.

International emergency

WHO’s emergency declaration on Wednesday came after the virus spread to Goma, a major urban hub, for the first time and a deadly attack on health workers, the latest in a string of assaults against medical personnel or health facilities.

Outside of the case in Goma, and three fatal cases in Uganda last month, the outbreak has been confined to other largely rural regions of North Kivu and Ituri.

Ebola is highly infectious and spreads through bodily fluids [Hugh Kinsella Cunningham/EPA]

The emergency designation is a rare one used only for the gravest epidemics and had only been applied four times in the past, including in 2014 for the devastating Ebola outbreak in West Africa that killed more than 11,300 people.

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Making such a declaration typically boosts global attention and can spur an increase in international aid.

The WHO said the move recognised the “possible increased national and regional risks and the need for intensified and coordinated action to manage them”, but also said no country should close its borders or place any restrictions on travel or trade because of Ebola.

Any closure of borders with the DRC could make it more difficult to move people and medical supplies in or out of the affected area, potentially hindering response teams’ efforts to end the epidemic.

“Essentially for the rest of the world, the main recommendation is: support DRC and don’t panic,” WHO spokeswoman Margaret Harris said on Friday. “Do not shut borders. Do not put on travel and trade restrictions. Do not panic.”