Containing the latest outbreak of Ebola

summary

Last month, a rebel attack in Beni, the epicenter of the ongoing Ebola outbreak near the eastern border of the Democratic Republic of Congo (DRC), was again led by Intervention teams working to contain the virus. With more than 10 major episodes of violence since the declaration of the epidemic in August, insecurity and mistrust of the community made it difficult to assess the true extent of the spread of the Ebola virus. Although the epidemic may still be limited, cases seem to be increasing – especially in Beni, where they have doubled in recent weeks – with 80% of new infections occurring in people unrelated to the "known transmission chains" (where all infected people). is known and you can follow who has been exposed with some accuracy). This means that we may only see the tip of an iceberg of hidden transmissions and that the epidemic could spiral out of control and spread to neighboring countries. Given this danger, the current strategy to combat the disease must be adapted.

Last month, a rebel attack in Beni, the epicenter of the ongoing Ebola outbreak near the eastern border of the Democratic Republic of Congo (DRC), once again put a term to the efforts of the intervention teams working to contain the virus. With more than 10 major episodes of violence Since the outbreak in August, community insecurity and mistrust have made it difficult to assess the true extent of the spread of the Ebola virus. Although the epidemic may still be limited, cases seem to be increasing – especially in Beni, where they have doubled in recent weeks – with 80% of new infections occurring in people unrelated to the "known transmission chains" is known and you can follow who has been exposed with some accuracy). This means that we may only see the tip of an iceberg of hidden transmissions and that the epidemic could spiral out of control and spread to neighboring countries. Given this danger, the current strategy to combat the disease must be adapted.

Eastern DRC has been the scene of one of the most deadly and insoluble conflicts in modern history. More than 50 armed groups are still active in the region. Originally created to protect their communities, many of these rebel militias are entangled in the messy network of politics, their shifting allegiances and their underhanded mining contracts that fuel the conflict.

This context and the inability of the government or international agencies to provide basic security, let alone basic needs, has created a mistrust of the official institutions of the population. This dynamic has been complicated by the fact that the DRC is supposed to hold elections in December, already delayed twice since 2016.

Since epidemics can grow rapidly and exponentially, definitive measures are needed now.

The current plan to end this epidemic rests on the search for contacts (identification and surveillance of people who have been exposed to people infected with Ebola during the 21 days during which they can develop an infection) and the so-called "vaccination". in ring "(immunization of these contacts and relatives with an experimental vaccine against Ebola). This approach effectively controlled an outbreak of Ebola in western DRC just a few months ago, but requires a complete and accurate understanding of infected people and their contacts, which requires daily access unhindered to their communities for months.

This was not possible this time: the areas affected by the violence have been inaccessible for days. Therefore, while contact tracing and ring vaccination should continue when transmissions can be monitored, mass vaccination of larger sections of the population should be considered in areas where this is not possible, such as Beni, which has about 230,000 inhabitants. This expansion of vaccines could immediately stop the spread of the disease.

Although such mass vaccination seems ambitious, the World Health Organization (WHO) and others have conducted much larger national campaigns in more than 40 low-income countries, including the DRC, where millions of children have been vaccinated against polio or measles in a week. These campaigns have also been successfully implemented during conflicts in Somalia, Afghanistan and Liberia. Although mass vaccination efforts target an entire population, it suffices to reach the required proportion for "collective immunity", that is, to immunize enough people so that the virus can not spread. Early studies of the Ebola vaccine have shown that it may be possible to achieve collective immunity by vaccinating as little as 42% of the population.

To be successful, mass vaccination would require community membership and Ebola teams should be able to safely access the areas in question during the day or two days needed to vaccinate everyone. Encouragingly, a recent study has shown that even very suspicious communities seem open to vaccination.

Anthropologists are already on the ground and working tirelessly to engage community leaders and armed groups. In areas that are not amenable to awareness, a neutral security force "white helmet"ideally from the African Union or from other countries without previous involvement in the conflict in the DRC, should be deployed with the sole mission of securing immunization efforts. It should be made clear to the public that this force has no allegiance to any political or institutional actors and is only there to deter violence against those who respond. In the end, communities and militias do not want their loved ones to die of Ebola and would respect such a presence if they were reassured that its mission is strictly medical.

Mass vaccination will also require an adequate supply of Ebola vaccine. Its manufacturer, Merck, is committed to maintaining a stock of 300,000 doses at all times. This could become difficult if vaccination efforts were expanded, but at present, the number of people who should be vaccinated to curb the epidemic still seems to be in the range of existing stocks. Nevertheless, vaccine production should be increased and the bottlenecks needed for this purpose should be evaluated and eliminated to ensure adequate supplies.

It is true that the Ebola vaccine is still experimental and that its health risks are not yet fully known. However, for people living in areas where every infected person is unknown, the increased risk of unconsciously contracting a deadly Ebola infection may, at this stage, offset the potential hazard of the vaccine.

After the Ebola outbreak in West Africa unleashed, many wondered why more aggressive measures had not been taken sooner. We may be at a decisive point in this outbreak.