Ebola spreads across Congo as flights halted, supplies run low

Congo suspended flights to the eastern city of Bunia and regional health ministers warned of escalating cross-border risks from Ebola as the outbreak spread across three provinces and overwhelmed contact-tracing efforts.

Authorities in Congo reported 91 confirmed Ebola infections, 867 suspected cases, and 204 probable deaths as of May 22. Health workers had managed to trace only a fifth of the 1,745 identified contacts under monitoring – a surveillance gap officials described as “alarming”.

The worsening outbreak prompted Congo’s transport ministry to halt commercial, private and special flights to and from Bunia, one of the outbreak’s epicentres in Ituri province near the Ugandan border. Humanitarian and medical flights may still receive special authorisation, the ministry said on May 23.

The measures underscore how rapidly the Bundibugyo strain of Ebola is spreading through eastern Congo and into neighbouring countries. That is straining already fragile health systems and forcing authorities to rely heavily on basic public health measures because there is no approved vaccine or antibody treatment for the rare virus type.

The US expanded its Ebola response on May 23, announcing enhanced airport screening requirements for travellers arriving from Congo, Uganda and South Sudan, along with new emergency funding, medical supply shipments and the deployment of disaster response teams to affected areas.

Africa’s top public health official said the latest Ebola outbreak in eastern Congo is being fought without one of the most important tools in epidemic response: vaccines.

Dr Jean Kaseya, director-general of the Africa Centres for Disease Control (CDC) and Prevention, said response efforts to the disease are now heavily dependent on community outreach and behavioural change campaigns to slow transmission.

The outbreak, now the “second largest” after the 2014-2016 West Africa epidemic, is caused by the rare Bundibugyo strain of the virus and has no approved vaccine or antibody treatment. Dr Kaseya said hopes that existing vaccine options could provide even partial protection have faded in recent weeks.

“It’s like you are a soldier,” he said in an interview. “You go to fight without ammunition. We have to rely on public health measures.”

Regional concern intensified on May 23 after health ministers from Congo, Uganda and South Sudan met with officials from Africa CDC and the World Health Organisation in Kampala to coordinate a cross-border response. In a joint communique, the countries warned that porous borders, mining and trade corridors, humanitarian crises and population displacement were increasing the risk of wider transmission across East and Central Africa.

Uganda has already reported five confirmed Ebola infections linked to the outbreak.

Dr Kaseya said shortages extend far beyond vaccines and experimental treatments. Despite millions of dollars pledged by governments and aid agencies since the outbreak escalated, some frontline facilities are still struggling to secure basics, from personal protection equipment, known as PPE, to treatment space and laboratory supplies.

“Why are we still lacking PPE?” he said, questioning where promised funding was going.

In Bunia, not far from the Ugandan border, some patients were still being treated in ordinary hospital wards because dedicated Ebola treatment centres had not yet been fully established, he said.

Health authorities are increasingly relying on local leaders and community networks to spread the word on safe practices, including persuading families to modify long-held burial practices that can accelerate Ebola transmission.

Burial clashes

Tensions erupted near Bunia after the relatives of a man who died at Rwampara Hospital clashed with health workers who refused to release his body because of infection risks. Ebola treatment tents run by aid group Alima were later set on fire during the unrest, and local reports said some patients fled amid the chaos.

The conflict underscored the delicate challenge responders face in balancing infection control with culturally sensitive “dignified burials”, Dr Kaseya said.

“This young person was a leader of a group,” he said. “They have their own way to celebrate their leaders when they pass on.”

Africa CDC is now working through community and religious leaders, rather than relying solely on doctors and officials, to communicate public health guidance.

“When you start to use local leaders who are not medical doctors, who can speak in a more simple way, use local language, give more examples, then we can achieve something,” Dr Kaseya said.

Health officials are encouraging communities to continue funeral ceremonies while avoiding direct contact with bodies.

“They can still have the funerals, but differently,” he said.

The issue is especially difficult for women, who account for more than 60 per cent of suspected cases, according to Dr Kaseya. In many communities, women are expected to wash or touch the bodies of deceased relatives as a sign of love and respect.

“To show that you really loved your husband,” he said, “you need to touch the body”.

The behavioural and logistical challenges are unfolding alongside mounting funding needs, Dr Kaseya said.

Countries responding to the outbreak have requested about US$319 million (S$408 million) for emergency response and preparedness measures, with about 84 per cent needed for Congo and Uganda and the remainder for neighbouring high-risk countries including South Sudan, Africa CDC said.

The US State Department is working with private companies and international partners to expand testing capacity and explore potential antiviral treatments for the Bundibugyo strain, it said in a statement.

Major spending needs include infection prevention and control, water and sanitation programmes, case management, surveillance and logistics. Africa CDC also announced a partnership with India to deliver roughly 20 tons of medical supplies by May 25.

“We need to act with urgency,” Dr Kaseya said. “We need to make sure pledges that we got today can be translated into concrete money very quickly.” BLOOMBERG