By World Healthcare Journal-
With cases of the disease passing 2000, turmoil rising in the region, anticipated vaccine shortages and a measles epidemic developing, the DRC now faces one of the most difficult healthcare crises ever seen.
On 1 August 2018, the government of the Democratic Republic of the Congo (DRC) confirmed an outbreak of the Ebola virus in the North Kivu province. Since this announcement, the disease has continued to affect the region, spreading throughout the DRC to Uganda. Infection rates have risen precipitously since August, and now this outbreak has become the second largest Ebola epidemic the world has seen yet.
But the DRC is not only facing an Ebola crisis in the east. Measles has been on the rise in the country, with nearly 90,000 cases of the disease recorded since January. At the time of publication, measles has taken 1,815 lives within the DRC and is showing no signs of slowing down.
Confirmed cases of Ebola in the DRC
To make matters even worse, the Allied Democratic Forces (ADF), a group allegedly allied with militant group ISIL (the Islamic State of Iraq and the Levant), claimed responsibility for an attack on the eastern regional city of Beni where the Ebola epidemic is currently ongoing.
Terror attacks within the DRC have been widespread and have created a disastrous effect on the healthcare system. Mistrust of foreign aid services in the local communities, in addition to threats from groups such as ISIL, means that people in high-risk areas are going untreated. Many fear going to Ebola treatment centres, choosing instead to stay at home which risks further spread of the disease.
The negative sentiment towards foreign aid services has also led to multiple violent attacks on healthcare facilities. According to the World Health Organisation (WHO), more than 100 attacks have been carried out on treatment centres and health workers since the beginning of the year. WHO was forced to temporarily halt response activities in April this year after an epidemiologist was murdered when armed militia attacked a hospital.
“The control of the epidemic won’t be achieved without the mobilisation of the population, and it is clear that the actors of the response, MSF (Medecins Sans Frontieres) included, did not manage to gain this trust,” Emmanuel Massart, MSF's emergency coordinator in Katwa, stated earlier this year.
The impact of Ebola outbreaks
Ebola, known medically as Ebola Virus Disease (EVD), is a rare and deadly disease most commonly affecting people and primates. It is caused by an infection with a group of viruses within the genus Ebolavirus. The viral infection spreads to people through direct contact with bodily fluids of a person who is sick with or has died from EVD.
The worst Ebola epidemic on record was the 2014-2016 West Africa outbreak - which took the lives of 11,325 people, and caused an estimated $2.2bn loss in GDP within Guinea, Liberia, and Sierra Leone. This outbreak had a monumental impact on West Africa and decimated healthcare systems. In Liberia alone, 8% of the country’s doctors, nurses and midwives lost their lives to the outbreak.
Worryingly, such deadly outbreaks are becoming more and more common. In an interview with the BBC, the Chief of Emergencies at the WHO Michael Ryan spoke about the continuing crisis in the DRC and the developing crises around the world.
“I don’t think we’ve ever had a situation where we’ve been responding to so many emergencies at one time. This is a new normal; I don't expect the frequency of these events to reduce," he said.
Mr Ryan also stated that WHO is tracking more than 160 disease events worldwide, nine of which are currently at the highest emergency level, (level 3) which is defined as “a single or multiple country event with substantial public health consequences that requires a substantial international WHO response. ”
At the time of publication, at least 1,440 people have died from the Ebola crisis in the DRC. Up to 550 people are estimated to have recovered, but WHO has stated that it could potentially be missing up to a quarter of all cases in eastern Congo.
How can we begin to treat Ebola outbreaks?
Ebola is a truly deadly disease. The average Ebola case fatality rate is around 50%. These fatality rates have varied however from 25% to 90% in past outbreaks, with survival rates dependent on region, aid efforts, international response and treatment development.
However, in recent years more Ebola treatments have begun to emerge. While no antiviral treatment or therapy is currently available, developing vaccinations for Ebola have shown incredibly promising results.
The vaccine presently in use in the DRC, known as rVSV-ZEBOV, was developed in 2015 during the West Africa outbreak. Since then, the vaccine has been deployed in multiple Ebola outbreak areas. More than 111,000 people have been vaccinated in the DRC since the outbreak was declared in August 2018.
The medical aid companies are distributing the vaccine in a system known as “ring-vaccination” which works by providing the vaccine to those most in need of protection, ensuring that the vaccines are used are to their fullest potential.
Ring vaccination system
- First cohort of patients in direct contact with those who are infected with Ebola (Ring 1)
- Second cohort of people in direct contact with the first cohort (Ring 2)
- This process will then continue, proceeding in further rings, until the threat of Ebola has been contained.
One case study of the effectiveness of the vaccine studied more than 11,000 people, amongst which more than half received the vaccine. Of the vaccinated group, zero Ebola cases were recorded 10 days or more after vaccination. In comparison to those who were not vaccinated, there were 23 cases presented 10 days or more after vaccination.
However, the ongoing vaccination campaign in the DRC is facing serious issues, on top of the current tensions and distrust of aid.
Two weeks ago, the director of the Centers for Disease Control and Prevention (CDC), Robert Redfield, announced that they are currently facing an imminent shortage of the Ebola vaccine. The current manufacturer for the vaccine, MERCK, has closed its facility in Pennsylvania where the first lot of vaccines were produced.
Since then, they have moved the production facility to Germany, but have been unable to secure the necessary validation for those plants that would allow production to proceed, Redfield explained to the U.S House of Representatives hearing last Tuesday.
The CDC predicts that responders in the Democratic Republic of the Congo will exhaust the current supply of the Ebola virus vaccine before the manufacturer can produce more.
“Unfortunately, there’s going to be a six to 12-month lag before there’s adequate vaccine supply, so we do project that we are going to run out of vaccines,” Redfield said.
How can the Ebola crisis in the DRC be remedied?
This current multi-tiered crisis within the DRC has been a subject of huge concern for global healthcare organisations and governments at large. As this crisis has no one clear solution, many experts have been offering their insight into how different stages of the crisis may be contained. It cannot be fixed by just one organisation, such as WHO - it requires collaboration from many nations, foreign aid services, and charities.
In a statement to Parliament last week, current Conservative Party leadership candidate Rory Stewart spoke about the U.K’s current efforts toward the crisis, the potential threat that this poses to the DRC itself and to worldwide public health.
“The UK continues to be at the forefront of the response, but this needs to be a global effort with others stepping up their support. This outbreak is potentially devastating for the region. It could spread easily to neighbouring provinces and even to neighbouring countries,” he said.
Vaccination has proven to be a crucial tool in the fight against Ebola within the DRC. Dr Michael Ryan, during a WHO update in Geneva on the Ebola crisis two weeks ago, emphasised the necessity of ensuring that vaccinations are reaching the right people.
“We have a highly efficacious vaccine. But the vaccine can’t protect you if you aren’t vaccinated,” he said. “So, the overall effectiveness of vaccination is less than it could be as a strategy, because we’re not identifying everyone who needs to be vaccinated, and everyone who needs to be vaccinated is not accepting vaccination. We need to improve those two numbers. ”
This issue was noted earlier this year by aid workers within the Congo. Emmanuel Massart (MSF), spoke to Devex earlier this year about the importance of gaining the trust of local communities:
“If the response doesn’t manage to win the trust of the people affected by Ebola, it is impossible to care for patients, and impossible to contain the outbreak,” he said.
The United States Agency for International Development (USAID) currently has plans to include development activities that might help ease the tensions within the eastern regions of the DRC. At the same time, U.S aid services are waiting to see if a waiver on certain TVPA regulations would be permitted, allowing more aid to reach the DRC.
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