More than 1,000 dead in the Ebola outbreak in Congo

"Since January, we have had 119 separate attacks, including 42 on health facilities, with 85 health workers injured or killed in these conditions," Ryan said. "We anticipate a scenario of intense continuous transmission."

According to WHO, the epidemic is the second most deadly and the second most important in history. It was only exceeded by one in West Africa in 2014, when the disease killed more than 11,000 people.

Insecurity is a hindrance to the answer

The Director-General of WHO, Dr. Tedros Adhanom Ghebreyesus and Regional Director for Africa, Dr. Matshidiso Moeti, traveled to North Kivu and Ituri this week and "found that the situation on the ground was worse than before, "said Ryan, who recalled a sad and tragic death" from a colleague.

"Insecurity has become a major obstacle to the access, dialogue and service of the communities we wish to serve in the fight against Ebola," he said.

According to WHO, a long-standing conflict has been raging in the north-east of the country for decades. Armed groups are at the origin of intermittent violence. The UN Public Health Agency estimates that more than one million refugees and internally displaced people are traveling to the provinces of North Kivu and Ituri and come out. This movement is a potential risk factor for the spread of the Ebola virus. Ryan says that some groups can be political, other criminals and others a mix of both.

Hammer said the conflict "has complicated efforts on the ground, including not allowing the possibility" for the US Centers for Disease Control and Prevention to deploy staff at the epicenter. Last fall, the US State Department "determined that it was too dangerous to deploy our [CDC] health workers "at the hot spots," he said. "Unfortunately, I do not like to say it, but this decision has proven right."

However, CDC staff are working in safer areas of the Congo, particularly in Kinshasa and Goma, and some members of the team are "occasionally" making short strategic visits to the epicenter to facilitate the answer, he said. He pointed out that the government, in collaboration with the international community and the CDC, "has so far managed to contain the epidemic in a specific region".

Last year's Ebola outbreak in western Congo was defeated in a few months, repressed by key health ministry officials, helped by the international community said Hammer. This response was successful in part because "it was in a secure area, an area not affected by a conflict".

Hammer, who works with his counterparts and others in the region to ensure border cooperation, monitoring and surveillance, said newly elected President Felix Tshisekedi, "seeks to continue its partnership with the international community and the United States eradicate the epidemic. "

In April, Mr. Tshisekedi went to the epicenter and Washington, where he met with US Secretary of Health and Social Services Alex Azar, Dr. Robert Redfield, Director of the CDC, and as senior officials of the state department. "It's clear that it's a top priority for him," Hammer said.

More money needed

Ryan also congratulated Tshisekedi for setting up a "multisectoral committee" – a committee that joins Congo's Ministry of Defense, the Ministry of the Interior and other government groups with the Ministry of Health – to end the epidemic.

Yet, the problems are numerous and include financial difficulties. The WHO has a funding gap of $ 54 million for its own work, Ryan said. "This despite having spent more than $ 35 million of our reserve fund since the beginning of the year," he said.

The answer is costly: more than 12,000 contacts per day are needed and more than 1,000 people are vaccinated daily, some in WHO's new immunization centers.

Despite financial problems and insecurity, the WHO decided last month that the Ebola outbreak did not constitute a public health emergency of international concern, defined as a "public health emergency". extraordinary event "constituting a" public health risk for other States as a result of the international spread of the disease ". "and" potentially require a coordinated international response. "Critics believe that an emergency declaration would have replenished funds and provided relief to first responders.

The WHO is also exploring the possibility of using split doses of an existing Merck vaccine to expand the supply and introduction of a new experimental Johnson & Johnson vaccine, said Ryan.

"We currently have enough vaccines for our current strategy," said Ryan. The rationale for split doses and the introduction of a second vaccine is to develop an improved tactical approach.

"We do not plan to use this second vaccine in the epicenter," he said. The population could be better protected if WHO used the Merck vaccine for Ebola contacts, and then used the J & J vaccine beyond that ring of contacts in the "neighboring village" that was not used. is not sick yet. "

Merck's vaccine was one of the "saviors" in this response, Ryan said. "Whenever we are late in the vaccination process, the epidemic intensifies."