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Amid ongoing violence, Ebola outbreak in Congo tops 1,000 cases

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The Ebola virus outbreak in the Democratic Republic of the Congo, or DRC, has topped 1,000 cases, and officials have said it will be months at least — or maybe even a year — before it is brought under control.

WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, warned that violence being perpetrated by armed militia groups — including Mai-Mai rebels and the Allied Democratic Forces — threatened to reverse the gains made in the outbreak, saying “security remains our No. 1 threat.”

Tedros Adhanom Ghebreyesus

Tedros and CDC Director Robert Redfield, MD, visited an Ebola treatment center shortly after armed men had opened fire on it, killing a policeman and wounding three workers. It was one of several attacks perpetrated on treatment centers in the course of 2 weeks amid what WHO said was “misinformation and mistrust due to decades of conflict contributing to a reluctance with some local populations to allow Ebola response teams to vaccinate, conduct contact tracing and perform safe and dignified burials.”

The outbreak, which began last summer, is the second largest Ebola outbreak in history behind the West African epidemic. In addition to 1,000-plus cases, there have been over 629 confirmed or probable deaths.

Tedros said the outbreak was “contracting,” noting that there were half as many cases per week in mid-March than in January and that the virus had been contained in 11 out of 28 communities that have had cases. But he said the ongoing violence was jeopardizing the response.

“The attacks on Ebola treatment centers are not attacks by the community but on the community,” Tedros said during a press briefing. “These attacks could reverse the gains we have made. We are working to find a balance between protecting patients and staff from attacks by armed groups and building community trust and ownership. It’s not a simple ‘either/or’ situation. We must do both to end the outbreak.”

Still, Tedros said he thought the outbreak could be contained in 6 months — a declaration that was met with some disagreement, including from Redfield, who told the website Stat that “the practical reality” is that officials needed to prepare for a longer outbreak, possibly up to a year.

Ronald Klain, who coordinated the United States’ Ebola response for the Obama administration, called Tedros’ declaration “a mistake.”

“I think WHO has largely done superb work on this outbreak, but I thought it made a surprising mistake recently when it declared the outbreak nearly contained,” Klain told Infectious Disease News.

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Tedros has asked the global community for an additional $60 million to fill a funding gap to pay for the next 6 months of the response, which he said would cost $148 million in total. But he also said he would not convene an emergency meeting to discuss declaring a Public Health Emergency of International Concern (PHEIC) to get the additional funding.

“That’s not the purpose of the emergency committee. It’s meant to assist if the outbreak constitutes a global threat,” he said. “We do this assessment almost daily. I will not hesitate to convene the committee again if needed.”

Klain suggested that Tedros withdraw his comment about how long it would take to contain the outbreak and that he “[re-escalate] global concerns.”

“It would be too sharp a shift to declare a PHEIC at this point, but it should be on the table for reconsideration in 30 to 60 days if the situation continues,” he said.

A PHEIC could be triggered if Ebola spreads to other countries. So far, the outbreak has been contained to the DRC, although some neighboring countries have begun vaccinating health care workers and other front-line responders against Ebola, fearing cross-border spread.

In the DRC, more than 91,000 people have received the experimental Merck Ebola vaccine, which Tedros has credited with averting “a much larger outbreak.” He said more than 90% of people who are eligible for vaccination — a group that now includes pregnant women — have accepted vaccination, and more than 90% of them have accepted follow-up visits.

In a first, patients are also being treated with novel therapeutics under a pioneering randomized control trial, although no data are available on how the treatments are working.

“We’re happy that people are surviving,” Tedros said.

As an example of how some communities have become more responsive, Tedros noted that residents of two towns are increasingly open to allowing qualified burial teams to bury the bodies of Ebola victims to prevent further transmission, “although there is still resistance to some extent,” he said. – by Gerard Gallagher

Disclosures: Klain, Redfield and Tedros report no relevant financial disclosures.