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The Ebola epidemic in the Democratic Republic of the Congo is now the second largest in its history, according to World Health Organization.
Since the epidemic was declared on August 1st, 426 people suspected or confirmed to have been infected with the deadly haemorrhagic virus, who killed at least 242.
"It's a tragedy because it should be completely preventable, 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 several fronts. The epidemic is in a war zonewhere violence and demonstrations often interrupt efforts to control the disease. There was a slight increase in community resistance to medical operations, which are often composed of international interveners whose foreign status sometimes gives rise to fear and mistrust, especially in the last hotspots of the outbreak in Butembo and Katwa. The preparation of the December 23 elections in the country are should be sowing even more turmoil and political instability. And now there is a threat of terrorism According to the US Centers for Disease Control and Prevention, directed to the US Embassy in Kinshasa, which could limit an already limited flow of US actors in the DRC.
The number of cases continues to climb, health workers continue to catch up close to one-tenth 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 to stop the transmission."
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 and new treatments – today in the arsenal of global health. More than 30,000 people have been vaccinated to halt the spread of the disease – an answer that could only be deployed at the end of the epidemic in Africa. West in 2016 – and yet, the epidemic in the DRC continues to grow.
"We have reached the stage 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 are worried about the possibility that Dr. Robert Redfield, head of the CDC, spoke earlier this month: that the Ebola virus could become "endemic" for the first time in history – meaning that he would not be trampled and would live 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 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 WHO, the situation at the time epicenter in the city of Beni seems to be going in the right direction. But ongoing violence is a constant concern – doubling the number of cases in October – and two new hotspots are in Katwa and Butembo.
An increasing number of cases in Butembo, a large community of one million people with limited infrastructure located less than 30 km from Beni, raises the risk of widespread urban spread. Médecins Sans Frontières plans to open another Ebola treatment unit in the region. Ryan added that it is almost full.
And community resistance continues to be a major problem as the epidemic infiltrates into new areas, such as Katwa. Last weekend, local residents recovered the highly contagious body of an Ebola victim from a Katwa health doctor. center instead of allowing staff to bury it safely, Nora Love of the International Rescue Committee told HuffPost. As Love, the IRC field coordinator in Beni, points out, as the epidemic spreads, new communities need to be informed about the risks of spreading the Ebola virus while learning to trust the medical teams that arrive.
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 probably spreading 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. The 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.
MSF Ebola expert Dr. Michel Van Herp, who was on the ground in October, said the crowds, population movements and possible political violence that the election could create would only make the epidemic more difficult to control.
For Klainall of 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 outbreak for "leading from behind," in Klain words. Although the United States has contributed significant amounts of money and expertise to the response, CDC and USAID stakeholders are not allowed to travel to the field at the time of writing. l & # 39; outbreak. epicenter fearing for their safety, in what the experts call a "Benghazi-hangover. This keeps some of the world's leading experts out of the potential shootings 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 terrorized the region for decades – by killing US peacekeepers and DRC military forces and targeting civilians during 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, links cited between the group and a Waleed Ahmed Zein, financier of the Islamic State, who had sent an undisclosed amount to ADF.
The US embassy in Kinshasa has been closed to the public since Monday after it issued an alert regarding acredible and specific"Terrorist threat this 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 WHO, while acknowledging his gratitude for the considerable funding from the US and CDC staff for its support to Geneva's efforts and the DRC's borders neighbour country, lack of field support 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."
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 time of the epidemic. epicenter. 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. "
Dr. Thomas Inglesby, Director of the Johns Hopkins Center for Sanitary Security, argued In an article published Wednesday in the New England Journal of Medicine, the WHO said that the WHO should declare a public health emergency of international concern. WHO has chosen 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 and NGO staff, along with the DRC Ministry of Health, had been battling the Ebola virus in 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 for years). This would trigger a complete tearing the international response team Morrison fears is "close enough" to happen – and 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 a precipitation and an acceleration. "
Ryan also talked about the serious possibility.
"We are only hoping now that the security system will not deteriorate anymore, which could trigger a necessary withdrawal from the field, and nobody wants it. Because at this point, if we have to remove important resources from the field, this virus is no longer under control. "
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