DRC Ebola outbreak still growing despite signs of progress

Geneva, Switzerland | URN | The World Health Organisation says the Ebola outbreak in the Democratic Republic of Congo is showing encouraging signs of slowing in some areas, but continues to grow and kill, with cases rising sharply in North Kivu.

WHO Director-General Dr Tedros Adhanom Ghebreyesus says transmission is declining in the worst-affected parts of Ituri Province, while South Kivu has reported no new cases since May.

However, he warned that the progress is uneven and that the outbreak remains a major threat, with more than 7,200 cases and over 3,500 deaths reported across seven provinces.

Speaking at a WHO media briefing in Geneva on Wednesday, Tedros said the response had initially fallen behind the epidemic but was now beginning to gain ground.

“Ebola epidemic in the Democratic Republic of the Congo had a big head start, and we’re playing catch-up in the response. We’re now starting to see encouraging signs that we’re gaining ground. “In the most affected parts of Ituri province, transmission is going down. South Kivu has reported no new cases since May. More than 1,700 people have recovered.”

But Tedros cautioned against interpreting the improvement in some areas as evidence that the epidemic is under control.

“But make no mistake, the epidemic continues to grow and continues to kill. More than 7,200 cases have been reported and over 3,500 deaths across seven provinces.

“Although there are signs of reduced transmission in Ituri, it’s reducing from a high level.”

WHO says about 300 new cases and 160 deaths were reported from Ituri in the week before the briefing, accounting for nearly half of the national total.

The situation is deteriorating particularly quickly in North Kivu, where the number of weekly cases has almost doubled over the past two weeks, rising from about 100 to more than 200.

The figures are consistent with current international reporting on the outbreak. Tedros said the geographical spread and differing conditions in the affected areas make the response particularly difficult.

“The area is so vast that it’s hard to speak of a single epidemic. It’s many outbreaks in many places. We must get the response right in every one of them.“

There are major cities such as Kisangani, home to 1.5 million people, and remote villages.

There are conflict-affected areas, mining zones, and sparsely populated land near the border with South Sudan.

“In a region of very high population mobility, this outbreak can still spread.”

He said difficult terrain, insecurity and attacks on health workers and health facilities were further complicating the response.

“It’s an extraordinarily difficult place in which to work. In many areas, roads are barely passable, and reaching people by small aircraft is often hard. And while most Congolese people support the response, a small minority have attacked aid workers and health facilities. That makes an already demanding job harder still.”

Tedros said the response cannot afford to lose momentum even where transmission is declining.

“The key indicators are not yet improving, and they must. The response will need to be sustained and strengthened over many demanding months.”

WHO says the outbreak is caused by the Bundibugyo virus, a different Ebola species from the Zaire virus responsible for most previous Ebola outbreaks in the region.  The current outbreak has spread across seven provinces. The WHO and Africa Centres for Disease Control and Prevention are also appealing for more resources to sustain the response.

WHO’s Director of Epidemic and Pandemic Management, Dr Maria Van Kerkhove, said the initial response plan required 581 million US dollars, but a revised assessment by WHO, Africa CDC and the DRC government has put the current public-health response requirement at 1.3 billion US dollars.

A further 1.1 billion US dollars is being sought by humanitarian partners for the wider humanitarian response.

Van Kerkhove said the scale of the funding requirement had increased as the outbreak evolved.

“We can be cautiously optimistic about what is happening, but I think we need to be realistic about the road that’s ahead of us. Looking at trends takes time.”

She said the response had strengthened surveillance and contact tracing, making it possible to identify more cases. “We have many, many months ahead of us, and I think what we want to emphasize in our messaging is that that intensity and that response needs to be maintained.”

WHO says the combined funding is needed not only for outbreak response but also for research, development and deployment of vaccines and other medical countermeasures.

WHO says trials of treatments and post-exposure prophylaxis are gathering pace, while a vaccine efficacy trial is expected to begin in the coming weeks.

More than 3,000 frontline workers have already received Ervebo, a vaccine licensed against Ebola Zaire.

However, its effectiveness against the Bundibugyo virus causing the current outbreak is not established.

WHO’s science department said an observational study involving about 20,000 frontline workers is also expected to begin, while a Phase Two and Phase Three platform vaccine trial led by the DRC’s National Institute of Biomedical Research is being prepared. The trial is expected initially to assess Ervebo before bringing in vaccines specifically developed against Bundibugyo virus.

WHO says three other candidate vaccines remain in development, including candidates from Moderna and Oxford.

Tedros said the scientific work must proceed alongside the emergency response.

“Trials of treatments and post-exposure prophylaxis are picking up speed due to increased community engagement, and vaccine trials should begin in the coming weeks. This is not just a scientific exercise. We are already preparing to expand access to products should they prove efficacious in trials.”

Tedros also noted that the DRC outbreak had spilled into Uganda, although he said the Ugandan outbreak was swiftly stopped.

He stressed that the high movement of people across the region means the response cannot be confined to the areas where the largest number of cases are currently being recorded.

Tedros said the continuing threat of Ebola in DRC  is a reminder that the response must be sustained until transmission is brought under control.

“To slow this epidemic and to stop it, we need resources. We have received generous support from many donors. We are grateful, but we need more. We ask all donors to ensure that both the government response plan and the wider humanitarian response are both fully funded.”

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