First Ebola case in African border metropolis could be a ‘game-changer,’ WHO leader warns

The first case of Ebola was diagnosed yesterday in Goma, a city in the Democratic Republic of the Congo (DRC) that’s home to some 1 million people. Goma is a hub of transborder traffic between the DRC and Rwanda and hosts an international airport; the discovery heightened fears that the epidemic, now in its 10th month, may become even harder to squelch.

At a 3-hour high-level meeting in Geneva, Switzerland, today, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus said he is reconvening a special committee “as soon as possible” to consider whether the epidemic, which has killed 1665 people in the DRC, now needs to be declared a Public Health Emergency of International Concern (PHEIC), a designation that can rally international support but can also isolate a country when other states impose travel bans, as occurred in the West African Ebola epidemic in 2014. Noting that Goma “is a gateway to the region and the world,” Tedros said the case there “could potentially be a game-changer.” Although the epidemic is still confined to the provinces of North Kivu and Ituri, in the northeast of the country, “the response is at a critical juncture,” WHO added in a statement released after the meeting. “WHO assesses the risk of spread to neighboring provinces and countries as very high.”

The Emergency Committee is a group of external experts convened by WHO to assess whether a public health crisis potentially has global reach and requires a global response. Since the outbreak began in August 2018, the committee has convened three times, most recently in June. Every time, it declined to elevate the epidemic to PHEIC status. A WHO spokesperson says the group could reconvene as early as this week.

The call for a new assessment comes days after the DRC rejected the use of any additional Ebola vaccines—in addition to the Merck vaccine that’s being deployed widely—during this epidemic.

Many public health experts had argued for the introduction of a second, still-experimental Ebola vaccine, made by Johnson & Johnson (J&J) of New Brunswick, New Jersey; its use was discussed during an international meeting in Kinshasa on 28 and 29 June. But on 12 July, DRC health minister Oly Ilunga Kalenga announced the government would not allow the use of the J&J vaccine or any others. He cited “a lack of sufficient scientific evidence on the efficacy and safety of other vaccines, and the risk of confusing the population,” which is already very distrustful of the health workers fighting Ebola and is inundated by false rumors about the epidemic.

Unlike the Merck vaccine, which was shown to work well during the West African epidemic, the J&J vaccine has not been tested for efficacy in people potentially exposed to Ebola. But the vaccine, which consists of two different shots given 56 days apart, has been found safe in phase I and II studies involving more than 6000 healthy volunteers, generates robust antibody responses, and has protected nonhuman primates exposed to Ebola, Peter Piot, director of the London School of Hygiene & Tropical Medicine (LSHTM) said in a statement today. (LSHTM is participating in a study of the vaccine in multiple African countries.)

The Merck vaccine has been administered to some 161,000 people in the DRC, including 3000 health workers in Goma. Merck says it has an additional 245,000 vaccine doses ready to ship, and capacity to produce another 900,000 over the coming 6 months to 18 months. But experts worry that’s not enough. “We are very concerned that supplies of the Merck vaccine currently being used will run out before this epidemic ends, which would have devastating consequences,” Josie Golding, epidemics lead at the Wellcome Trust in London, said in a statement delivered at today’s high-level meeting. “There is an urgent need to deploy a second vaccine,” she said. “We regret the recent announcement against the use of the J&J vaccine and ask for this to be reconsidered. Lives … depend on it.”

Piot agrees. “It is hard to understand why such a decision was taken, going so far as to ban any research on investigational Ebola vaccines in the country during this outbreak,” he said in his statement. “The DRC has been a leader in innovation during Ebola outbreaks, and should remain at the forefront of research and innovation in this area.”

“We respect the decision of the DRC minister of health regarding Ebola vaccine studies in the country,” Paul Stoffels, J&J’s chief scientific officer, said in a statement today. “We remain ready to mobilize our resources if we are called on to help with outbreak response efforts.” The company says it has enough vaccine stockpiled to vaccinate some 1.5 million people.

Distrust of the government and Ebola response teams runs deep in the poor, conflict-ridden region of the DRC where the epidemic occurs. On Saturday, two community health workers were murdered there, Tedros told the meeting today, bringing to seven the number killed since January. There have been an additional 198 nonfatal attacks on health facilities and health workers in the past 6 months.

The newly diagnosed Ebola patient was a preacher who traveled from Butembo, DRC, at the heart of the current epidemic, to Goma by bus and was admitted yesterday to a Doctors Without Borders–supported treatment facility, where a blood test confirmed he had Ebola. The patient was quickly isolated, and the bus driver and 18 passengers are being vaccinated beginning today, according to a statement from local government authorities in North Kivu province, of which Goma is the capital. Today, the Ministry of Health transferred the patient back to Butembo for care, the statement said.

“The case was not only detected [very rapidly] but isolated immediately, avoiding all additional contamination,” said the official communiqué signed by Nzanzu Kasivita Carly, a health official with the provincial government of North Kivu.

*Update, 17 July, 10:50 a.m.: The DRC health ministry confirmed that the Goma patient died while in transit to Butembo.