A series of attacks in war zones puts the Ebola epidemic in DRC on the brink of crisis

WASHINGTON – World experts in public health are increasingly worried about the Ebola epidemic in the northeastern region of the Democratic Republic of Congo, which has already claimed 215 lives. It is now the largest epidemic ever recorded in the DRC – with 341 probable and confirmed cases – and the third largest Ebola epidemic in history. And that continues to grow.

While the risk of global spread remains low, the threat to the country and its neighbors is very high. Constant incidents of rebel violence in the war-torn region, protests, and community resistance to medical intervention prevented the World Health Organization, the DRC Ministry of Health, and various non-governmental organizations. to intervene.

In response to an August 24 incident, the United States brought the members of the North Kivu epicenter response team to Kinshasa, the DRC's capital, to hundreds of thousands of people. kilometers away. US action is now concentrated in Kinshasa and neighboring countries, and US officials said in a briefing on Wednesday that the situation is currently too dangerous for their return to North Kivu.

Containment efforts in this outbreak have also been made more difficult, as the majority of newer cases do not appear among the known contacts of other Ebola patients, said Dr. Peter Salama, responsible for the emergency response to WHO.

In fact, in the last 30 days, two-thirds of the reported infectious disease cases are due to unknown contacts, according to Pierre Rollin, one of the best Ebola experts at the US Center for Disease Control and Control. disease prevention. This is 85 out of 129 cases.

Last week, Dr. Robert Redfield, director of the CDC, warned of the possibility of an "endemic" version of the Ebola virus, the virus is not extinguished but spreading indefinitely among the population North Kivu. Public health officials argued that every effort should be made to prevent the horror of continued transmission of the Ebola virus – a situation never seen before.

At best, Salama said the outbreak could be halted within six months at the earliest. This is a very different assessment from that of the CDC.

"If we absolutely agree, this is probably the most difficult context we have ever faced to end an Ebola outbreak," Salama told HuffPost. World health leaders have had to re-evaluate many of the usual control tactics to combat haemorrhagic fever, he said, as they now face a large displaced population in a war zone – a situation that Salama has repeatedly described as a "perfect storm."

Ron Klain, the Ebola tsar under President Barack Obama, disagrees with this latest characterization of "perfect storm". Although Ebola has never been fought in a war zone, it states that it is the "new normal", not an exceptional situation, at the time of a resurgence of epidemics to high risk.

"We will see more and more of these outbreaks in troubled areas with a history of conflict, with refugees nearby, with difficult political situations because it is increasingly the world itself," he said. declared Klain.

"We can not just treat this as a kind of perfect storm of horrible facts that we will just have to face once and never again," he said.

Salama recognizes that 80% of serious epidemics occur in fragile states. And his optimism about the control of the Ebola outbreak accompanies this warning: "as long as security is maintained."

Since the beginning of the epidemic in North Kivu at the end of July, attacks by rebel groups and community demonstrations have hindered public health intervention, repeatedly forcing Intervention agents remain confined, ending vaccination efforts and looking for contacts.

Since the beginning of the epidemic, there have been at least 20 major security incidents of various types, including one over the past weekend, said Salama during a press briefing Wednesday morning at the D & D Center. Strategic and International Studies (CSIS) based in Washington. All these incidents have "delayed us", he said.

Jeremy Konyndyk, senior researcher at the Washington-based Center for Global Development, who had previously led part of the 2014 Ebola response for the Obama administration, stressed that no matter how effective the current response is, each rebel attack compromises containment efforts.

"Whenever we see one of these attacks, case surveillance is severely disrupted and stops, people flee and you will see a corresponding increase in the number of cases the following week," said Konyndyk. "This means that no matter how much progress we believe we are making, they are as durable as the security situation allows."

To learn more about the security situation in North Kivu, click here: "Experts have stated that an outbreak of Ebola in a war zone would be a nightmare. It's even worse.

The violence resulted in a wave of new cases that began in late September. The US government and officials at the WHO said coordination with the United Nations Organization Stabilization Mission in the Democratic Republic of the Congo had been strengthened and that a force maintaining the peace had been in the area for years. MONUSCO (acronym based on its name in French) is the largest peacekeeping mission in the United States, but many still fear that violence will continue in the region.

The threat of further attacks and demonstrations for the controversial December 23 presidential, regional and legislative elections in the DRC is worrying for world health leaders.

J. Stephen Morrison, director of the CSIS Center for Global Health Policy, who led a roundtable at the focus group meeting, told HuffPost that "we are deluding ourselves" if people think the situation will soon improve.

"This [Ebola outbreak] will become out of control quickly. Just look at the pattern of blows inflicted by the ADF and our inability to stop them, "he said, referring to one of the two rebel groups responsible for the vast majority of the violence. "We are on the verge of crisis."

The ultimate fear – what Salama called a "game changer" – would be an attack directed at outside workers with the WHO or NGOs who came to help. There have already been multiple attacks against local actors, including Red Cross volunteers and two unarmed members of the DRC's immediate medical intervention unit. were killed.

As the North Kivu region is currently categorized as a Level 4 security threat in the United States, a kind of direct attack on external medical responders would trigger a Level 5 tag and result in the evacuation of those forces. would have been catastrophic for efforts to contain the epidemic.

This is a scary scenario, said Rear-Admiral Tim Ziemer, currently Acting Assistant Administrator of the United States Agency for International Development in the Office for Democracy, Conflict and Humanitarian Assistance.

"We should probably hold a high-level side event to look at the implications of this and what it requires of us all," he said. "We can not be blind and turn our backs on this current challenge because turning your back does not mean that it will not go away," he added.

Previously, Ziemer was the head of global health security at the National Security Council, which coordinates the US response to the DRC epidemic. Observers have argued that the decision of National Security Adviser John Bolton to revamp this agency earlier this year has reduced the power of global health security experts at the Trump White House.

While global health experts are still commending the US for their financial and logistical response to the epidemic – and attributing it to Merck's already-invaluable but already invaluable Ebola vaccine, which more than 30,000 people have received during this time. epidemic – some wonder if there is a new status quo in global health leadership.

"They lead from behind," said Klain, emphasizing US deference to other stakeholders on security issues and the situation on the ground in North Kivu.

"It's not the same kind of US leadership in a global health crisis we've seen in Democratic and Republican administrations before," Klain said, citing Obola's response to the Ebola virus and George W.'s efforts. Bush to fight HIV / AIDS in Africa. "For an administration that likes to talk about" America first ", its approach to Ebola has been" America is one of many "."

The fact that the US response teams are not at the epicenter of the outbreak is a reflection of a "hangover in Benghazi," said Konyndyk, suggesting that no one in the country is likely to be in the midst of the epidemic. Current administration that focuses on the epidemic has enough influence to put pressure on Bolton. least President Donald Trump, on this critical issue.

"There is no substitute for being there," Konyndyk said.

The absence of global global leadership alongside WHO is also causing him concern. "At one point, an answer becomes more complex than what the WHO can handle alone," Konyndyk said.

Indeed, during the 2014 outbreak in West Africa, the WHO was excoriated for its ability to drag its feet. The attention and resources of the United States have ultimately been instrumental in scaling up the global response. And yet, this epidemic killed 11,300 people and infected another 28,600.

Morrison hopes that world leaders will not waste the time they did between February and August 2014 before taking definitive action.

In the epicenter of the epidemic, the city of Beni, the spread of the Ebola virus has been brought about by the transmission of the disease in "modern" facilities, according to Salama. Practices in these 300 health centers, which combine traditional healing and modern medicine, are not optimal. Workers reuse needles and treat no cases.

An epidemic of concomitant malaria pushes many – especially children – to health centers. According to the WHO theory, they would come into contact with patients infected with the Ebola virus or would receive injectables with the same needles as those used for Ebola patients. Without registers, it is extremely difficult to find contacts among the population of people exposed through the traditional system.

This is a critical idea of ​​the spread of the disease, but the WHO first suggested it to STAT almost a month ago. Given all the other challenges of fighting the Ebola virus in an unstable urban community of 200,000, it is not clear that this theory is enough to halt the epidemic anytime soon.

Klain said that it also looked like something he had noticed in recent weeks in the WHO public statements: "the beginning of a hint of apology". It's a shame, he said, considering that the organization has made tremendous progress since its fatal slowness. response in 2014 and that, until recently, it was necessary to "congratulate" for his frankness in the face of the gravity of the situation in the DRC.

The bottom line is that the Ebola outbreak continues to expand and not contract in new areas – a total of 14 health zones of considerable geographic size, according to the report of the Ministry of Health of Wednesday – and infect new unidentified people.

"At the moment, the position of public health authorities around the world should be that we have an epidemic that is spreading in every way imaginable and that we do not control it," said Klain. "And until you've taken it, you simply are not."

CORRECTION: An earlier version of this article indicated that there had been 219 deaths during the recent Ebola outbreak. There were 215.