Despite the availability of a vaccine that is known to be highly effective, the Ebola outbreak in the North Kivu province of the Democratic Republic of the Congo, which began in July 2018, is still accelerating. At the beginning, two or three cases were recorded per day, which then rose to four or five with the resumption of armed clashes in the region. However, over the past two months, the epidemic has entered a third phase, which is the deadliest yet. Now, the number of new cases is an average of 15 per day, two-thirds of them fatal. The overall death toll has now reached 1,218.
As a countermeasure, the WHO decided on May 7 to also administer the vaccine to those who have not had even indirect contact with the infected, but are living in a high-risk zone, and to reduce the administered dose in order to increase the number of available doses (without reducing the vaccine’s rate of effectiveness). In low-risk cases, they will administer a new vaccine made by Johnson & Johnson, which is more experimental than the one currently in widespread use, made by Merck.
The most recent acceleration of the epidemic can also be explained by the situation in North Kivu, a region torn by a civil war being waged by dozens of armed militias, which are often manipulated by the governments of the DRC and of neighboring countries. Even the hospitals often become targets for militia actions. One of these attacks, on April 19, killed the Cameroonian doctor Richard Mouzouko, who had been sent to the university hospital in Butembo by the WHO. The incident highlighted the conditions of insecurity in which the doctors in the region are forced to do their work.
The frequent attacks on health centers are disrupting the delicate procedure established by the WHO to stem the spread of Ebola. For each new case, the patient must be isolated and all the people with whom they have been in contact must be tracked down and vaccinated, up to two degrees of separation. When a hospital is attacked, the investigative procedures are interrupted for days, during which the virus spreads further undisturbed.
Beside the military attacks, health workers also face widespread hostility on the part of the civilian population. Conspiracy theories have become widespread in the region, as confirmed by a recent study published in the journal Lancet. One out of every four inhabitants of the North Kivu region believes that Ebola does not exist and that it is actually a government operation aimed at destabilizing the area. Local superstitions are fueling such suspicions, also helped by transmission via social networks.
But those on the ground tell a different story, and emphasize the responsibilities which lie with the humanitarian mission. The lack of trust in the doctors is growing also due to the limited capacity for dialogue between local people and medical operators. For example, it is problematic to combine preventative measures with the local rituals dedicated to the deceased. For safety reasons, in cases suspected of Ebola funerals are performed using procedures that do not allow families to respect their traditions for such occasions. This is a necessary practice for prevention, but in 80% of cases this involves people who did not have the virus at all, with the result of angering the local population.
Dialogue has been a decisive factor in containing the Ebola outbreak in West Africa between 2013-2016. Mosoka Fallah, the doctor who was coordinating the operations in Liberia at the time, told the online magazine The Conversation on Wednesday that he had not hesitated to go as far as to illegally supply controlled substances to members of a local gang in exchange for their compliance with anti-Ebola prevention procedures.
The suspension of local voting in the recent presidential elections, ostensibly due to Ebola, seems to have been motivated more by political reasons than medical ones: the street markets and religious services, activities with a high risk of contagion, have been allowed to continue undisturbed. The result of the distrust in medical professionals is that many who are ill are staying away from hospitals. According to the WHO, a full two-thirds of the victims were not among the contacts being monitored.
As local healthcare providers explain—under condition of anonymity—there are also some straightforward economic reasons behind this hostility. To combat the epidemic, the international community has made around $200 million available to the Congolese government, a large portion of which comes from the World Bank. This is a lot of money in a country where many basic needs remain unmet.
The lack of transparency with which these funds are being managed is having perverse effects. The local authorities are using the money to appease the people after protests break out, with so-called “quick impact projects.” This, in turn, functions as an incentive to stimulate new riots, which hinder the work of the doctors, facilitate the spread of infection and call for new provisions of humanitarian aid, at least as long as the donors are still willing to contribute. However, if the flow of aid funding were to cease, the situation might become even worse.
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