Battling Ebola in Congo
A public health emergency of epic proportions is unfolding in the Democratic Republic of Congo. Since Ebola first reemerged in the Central African country last August, the death toll from the viral hemorrhagic disease had reached nearly 1,400 as of June 5.
Medical personnel have been the targets of armed attacks, although no one is exactly sure by whom or why—and international aid organizations likely would have already pulled out all their workers if the epidemic were not on pace to become the worst Ebola outbreak in history.
As the World Health Organization reported that it could be two years before the outbreak is over, Tufts Now spoke with Diafuka Saila-Ngita, a research associate professor at Cummings School, about the situation in the DRC.
A veterinarian and global health expert based in Kinshasa—the DRC’s capital—Saila-Ngita helps develop the capacity of current and future health professionals called upon to prevent and respond to emerging infectious disease in Central, Eastern, and Western African countries where major outbreaks have occurred recently.
He is one of several Tufts faculty members working on One Health Workforce, a five-year, $50 million initiative headed by Cummings School and University of Minnesota that seeks to ensure that universities in East and Central Africa and Southeast Asia are teaching health-care workers to address pandemics from myriad perspectives.
Saila-Ngita spoke with Tufts Now about the history of Ebola in the DRC and why it has such a grip on the country now. “I don’t see an end in sight” he said.
Tufts Now: How concerned should we be about this outbreak?
Diafuka Saila-Ngita: Very. DRC has gone through Ebola many times; this is the tenth outbreak since the virus was discovered here in 1976. As a result, DRC is home to significant expertise in how to control the disease—unlike West Africa, which was caught by surprise during the 2014-15 outbreak.
So usually an Ebola outbreak wouldn’t be considered a very big event here, but this one has been tricky. Based on past experiences, we should have been able to control the disease by now. Yet health officials here are very worried about the way the numbers are moving. Dozens of new cases are still being diagnosed weekly. We’ve seen more than 2,000 cases and close to 1,400 deaths, which is far beyond what we’ve ever experienced in terms of mortality.
Why is this outbreak so difficult to end?
This Ebola outbreak is different from others in the DRC in that it’s affecting urban areas, whereas the previous nine outbreaks were in rural or semi-rural areas. We are currently fighting Ebola in two major cities: Butembo, which has a population of more than a million people, and Beni, which has about a quarter million people. This is also the first time we’ve had an Ebola outbreak across two different provinces; in addition to North Kivu, where the two cities are located, Ebola is in Ituri, where it’s affecting several rural areas.
The second and perhaps larger problem is that this outbreak is occurring in a very unstable area. There has been political unrest for decades, and there’s ongoing violence—which naturally creates a climate of fear and mistrust. When the presidential elections were organized in December, the government decided not to hold them in that area, blaming Ebola. Yet residents there saw people come in from other countries and other parts of DRC as part of the Ebola response. As a result, there were rumors that Ebola had been purposely brought in as a weapon, which caused some people to be reluctant to be vaccinated.
Citizens of the affected areas also see people coming and profiting from the outbreak, which they’re now calling “the Ebola business.” You can see where that perception is coming from. Despite the local expertise in responding to Ebola in DRC, many of the responders are from other countries and are perceived as receiving a lot more money than the Congolese. People from other provinces in the DRC are also perceived as profiting by engaging in Ebola-related businesses. It is only the locals who don’t seem to be making money.
So the image of the “Ebola business” has created a big problem in this response. You mix it with rebellion and insecurity—and the complexity of Ebola being in urban areas—and all those things add up to an outbreak unlike any we’ve seen.
Do you see an end in sight?
For eight months now, we’ve tried the classic way of intervening that we’ve done for the forty years we’ve had Ebola. I don’t expect a different result, where we curb the outbreak, if we stay on this same path. We need to change the strategy to one that really involves the local communities.
Is there any positive news to report?
Yes—it’s good news that the outbreak has been restrained to the locations where we first detected Ebola about eight months ago. Goma, a large city directly in line with the affected areas, hasn’t seen any cases. And neighboring countries haven’t been affected, despite an Ebola case being confirmed close to the border with Uganda. So the disease has been well controlled in terms of keeping it where it is. [On June 11, after this story originally published, Uganda confirmed the first case of Ebola outside DRC.]
Another positive change we’ve seen with this outbreak—and one that has likely contributed to that containment success—is vaccination. This is the first time that many people have been effectively vaccinated with an experimental vaccine against an Ebola outbreak—from front-line responders to those living among the affected populations.
How do you feel about the training you’ve been leading in the DRC in light of the current outbreak?
I think our strategies are the right ones to deal with situations like this. Half of our work involves fostering collaboration across disciplines, and the other involves directly training people.
People have started to understand that you cannot do it alone when it comes to outbreaks of this nature. You have to bring in psychologists, anthropologists, and sociologists, and you need to have good communicators. And when you look at the team managing this outbreak, it involves many disciplines.
I think we’ve been successful in our efforts to train a different type of epidemiologist. Traditionally, when there is an outbreak, epidemiologists look for the index cases—the first stream of people affected—and then keep looking for contacts from there to manage the disease of those people.
The One Health approach is a bit different. We train epidemiologists to also go in the forest to look for clues. That’s because when it comes to Ebola and many other emerging infectious diseases, patient zero likely had some contact with a wild animal. When we hear that first index case ate some game meat, we want to find out what that was. An antelope? A python? Then we can look at the population of that species for abnormalities.
To get community leaders far more involved, we have been training people at the district level to work with territorial administrators for two or three years now as part of One Health Workforce. We also have been preparing for an outbreak in an urban area by targeting our efforts around cities. But we hadn’t yet reached the territories affected by this outbreak. The Congo is just so big. It has 147 territories or districts—and we have only gotten to training about fifteen of those so far.
Genevieve Rajewski can be reached at email@example.com.