The Ebola epidemic in the Democratic Republic of Congo is now the second largest in history, according to figures from the World Health Organization. Since the outbreak on August 1, 426 people have been suspected or confirmed to have been infected with the deadly haemorrhagic virus, which killed at least 242 people.
"It's a tragedy because it should be completely avoidable, but it's not," Stephen Morrison told HuffPost. The director of the Global Health Policy Center, a program of the think-tank Center for Strategic and International Studies, pointed out that although this epidemic is still minimal compared to that which began in 2014 in West Africa, it killed more than 11,300 people and infected 28,600 – it's very dangerous.
The Ebola crisis has become a battle on many fronts. The epidemic is located in a war zone where violence and demonstrations often interrupt the efforts to control the disease. Community resistance to medical operations has increased slightly, often made up of international stakeholders whose foreign status sometimes gives rise to fear and mistrust, especially in the latest hotspots. outbreak of Butembo and Katwa. Preparations for the December 23 elections in the country are expected to result in further unrest and political instability. And now, there is a terrorist threat against the US embassy in Kinshasa, which could limit an already limited flow of US actors in the DRC, according to US Centers for Disease Control and Prevention.
The number of cases continues to grow, health workers continue to account for almost one-tenth of cases, and infants and children continue to be infected at alarming rates.
Mike Ryan, WHO Assistant Director-General for Emergency Preparedness and Response, emphasized that although the international organization knew that its strategy would work, there was no solution. miracle to extinguish the epidemic if it was not to prepare an answer.
"We have almost always been behind the virus" during this outbreak, he said. "The virus is spreading to the next place before we have a complete chance of stopping transmission."
As long as the situation gets worse, no better, the end is really not in sight.
Ron Klain, former tsar of Ebola under President Obama
Morrison and other global health experts are particularly disturbed by the fact that the epidemic in the northeastern region of the DRC has reached such magnitude, given the important new tools – an experimental vaccine but very effective, as well as new treatments – today in the arsenal of global health. More than 30,000 people have been vaccinated to stop the spread of the disease – an answer that could only be deployed at the end of the epidemic in West Africa in 2016 – and yet, the epidemic in the DRC continues to develop.
"We have reached the point where we have all the tools to stop this epidemic, but this effort is unsuccessful and we have to wonder why," Morrison said.
With the growing number of cases, experts worry about the possibility raised by Dr. Robert Redfield, director of the CDC, earlier this month: that the Ebola virus could become "endemic" for the first time in the world. history – which means that he would not be defeated living in the area.
"The human toll is increasing and the risk of spread in Uganda is increasing, and on the current course, the epidemic is only worsening," said Ron H Klain, the "tsar" of Ebola in the Obama administration, at HuffPost. "This is the paradigm of the truly scary epidemic problem of the future, where it is not only difficult to control medical problems, but security, diplomatic and geopolitical problems."
A cascade of problems
According to Ryan from the WHO, the situation at the epicenter of the city of Beni seems to be moving in the right direction. But ongoing violence is a constant concern – doubling the number of cases in October – and there are two new hotspots in Katwa and Butembo.
A resurgence of cases in Butembo, a large community of one million people with limited infrastructure and located less than 30 miles from Beni, raises fears of unbridled urban spread. Médecins Sans Frontières plans to open another Ebola treatment unit in the region. Ryan said it's almost full.
And community resistance continues to be a major problem as the epidemic infiltrates new areas like Katwa. Last weekend, local residents recovered the highly contagious body of an Ebola victim in a health center in Katwa instead of allowing staff to bury it safely, said Nora Love of the International Rescue Committee. As Love, the field coordinator for emergencies at IRI in Beni, pointed out, as the epidemic spreads, new communities need to be informed about the risks of spreading Ebola while learning to trust medical teams. who are coming
This community resistance has triggered the most worrying trend in recent weeks in Katwa and Butembo: a number of people who have been in contact with known patients with Ebola have refused vaccination or follow-up and have been found a few days later in health facilities or died on their premises. after the probable spread of the disease.
"Many were known as contacts but had gone out of follow-up because they did not want to be found," Ryan said. "This is a worrying trend because it means to some extent that the disease is underground."
And that does not mean anything about the growing fear of elections scheduled for December 23rd. Elections for the successor of President Joseph Kabila, delayed for two years, are already sowing distrust by the community. And the northeastern region where the epidemic is occurring is already very hostile to the national government, Morrison said, because of the lack of security of the past 20 years. So no one really knows how the country will react to the election results – no matter how it goes.
Dr. Michel Van Herp, an expert on MS Ebola, who was on the ground in October, said the massive crowds, population movements, and political violence that the election might create would only make people feel guilty. epidemic more difficult to control.
For Klain, all these complicating factors mean that this epidemic is far from over.
"As long as the situation worsens, not better, the end is really not in sight."
An American response blocked in the field
The United States has been criticized during this epidemic as "leading from behind," in Klain's words. While the United States has donated significant amounts of money and expertise to the response, CDC and USAID stakeholders are not allowed to go out into the field at any time. Epicenter of the epidemic due to fears for their safety. What experts call a "hangover of Benghazi". "It takes some of the world's best experts away from the potential shooting of violence in Beni, but also from the Ebola outbreak area.
The fighting around Beni, which led to the withdrawal in August of part of the CDC force in Kinshasa, the country's capital, was mainly driven by the Allied Democratic Forces insurgent group. ADF has been terrorizing the region for decades – killing American peacekeepers and DRC military forces, and targeting civilians with machete attacks and kidnappings. A report published two weeks ago by the Congo Research Group, based at the Center for International Cooperation at the University of New York, discussed links between the group and a financier of the Islamic State. Waleed Ahmed Zein, who sent an undisclosed amount to ADF.
The US embassy in Kinshasa has been closed to the public since Monday after it issued an alert on a "credible and specific" terrorist threat over the weekend. CDC spokesman Benjamin Haynes told HuffPost that in light of the state department's threat and direction, it was difficult to determine whether the new US intervention staff would be able to travel to the DRC until February 1 at the earliest, which means that the US reaction in the country might not be able to cope with the rising cases.
Ryan, from the WHO, acknowledged his gratitude for the huge funding from the US and CDC staff who contributed to Geneva's efforts and the DRC's borders in neighboring countries, but this lack of assistance over the land is a loss.
"It would obviously be a big development if we could have more CDC resources on the ground, but it's not for lack of effort or courage on the part of the CDC," Ryan said. "Everyone must take into account the security assessments of their own countries."
On Thursday, in the Journal of the American Medical Association, more than two dozen global health officials have called for an increase in the number of CDC workers, not only in Kinshasa, but also at the epicenter of the epidemic . They are part of a growing group of experts urging CDC's return to the field, saying that without the extension of the agency's expertise and resources, the epidemic will continue to grow.
A question of international leadership
Klain's concerns about the US government's abdication as a leader are shared by many other world health experts, who say that without an increase in true international resolve, this outbreak will continue to become infected. and expand.
Morrison was a little more direct, saying there was "no appetite" among the United States, the United Kingdom, Germany, France and other world leaders to mobilize with the resources necessary to truly intervene.
"There is a certain level of silence about this," he said. "I just think that we are in a particular moment between inner populism, creeping nationalism, the Brexit and EU crises and America first that changed the security calculations. "
We have reached the stage where we have all the tools to stop this epidemic, but this effort is not successful and we must ask ourselves why.
J. Stephen Morrison, Head of the Center for Global Health Policy at CSIS
Dr. Thomas Inglesby, director of the Johns Hopkins Center for Health Security, argued in an article published Wednesday in the New England Journal of Medicine that WHO should declare a public health emergency of international concern. The WHO chose not to call a USPIE for this outbreak earlier last month.
"WHO, the DRC, other governments, including the United States, and NGOs need to find ways to step up their efforts beyond what has been possible so far," Inglesby said. HuffPost. "If the effort is not intensified, the epidemic will likely worsen."
Or, as the authors of the JAMA article say: "It is in the national interest of the United States to control epidemics before they escalate into crisis. The cost of fighting this epidemic is much lower than if mass mobilization was needed because of the international spread of the virus. "
In this debate, WHO and voluntary non-governmental organizations are still working in the field. Many people were deployed several times during the year, as WHO staff and NGOs, along with the DRC Ministry of Health, had been fighting the Ebola virus in the DRC for the past month. April, when the Ecuador epidemic was declared. This epidemic ended a few days before the announcement of it.
"Everyone has been working for a long time, everyone is tired, everyone is stressed and now it's time to double," Ryan said. "We must not only maintain our efforts, but we must increase our efforts in the face of fatigue and insecurity."
The worst-case scenario feared
World experts fear a worse scenario in which ADF or Mai Mai, another rebel group, would attack or kidnap Ebola health workers (kidnappings of NGO workers and clergy in the region) have been happening for years). This would trigger a complete withdrawal from the international intervention team, which Morrison fears will be "close enough" to happen – and that would be "catastrophic".
"The spread has been slowed down and limited to a certain extent by international mobilizations, but it does not work to stop it and to bend the curve," he said. "It slows the trajectory. If you remove these links, there will be precipitation and acceleration. "
Ryan also talked about the serious possibility.
"We simply hope that the security system will not deteriorate anymore, which could trigger a forced withdrawal of the land, and no one wants it. Because at this point, if we have to withdraw important resources from the field, that the virus is out of control. "