ABIDJAN — Fears are mounting that an outbreak of Ebola in the Democratic Republic of the Congo could spread after three cases were confirmed Friday in the populous city of Mbandaka, in the northwest of the country.
Until recently, the current Ebola outbreak in DRC — confirmed by the World Health Organization on May 8 — had been restricted to remote villages in the Bikoro region. However, the confirmation of cases in a major city situated along the Congo River is cause for alarm, experts told Devex.
“There is a lot of traffic on the river from DRC to other places. So we are very concerned and consider the [risk of] expansion of cases into DRC as very high, so it’s important to bring together all local efforts to control it rapidly,” explained Ibrahima Socé Fall, regional emergencies director at WHO Regional Office for Africa.
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According to Fall, this Ebola outbreak is the ninth of its kind in DRC. Previous outbreaks have typically been remote and easy to contain, but the appearance of cases in Mbandaka, a city with a population of 1.2 million that sits 95 miles from the area where initial cases were announced, has sparked concern.
As of Monday, the Congolese Ministry of Health had recorded 46 reported cases of hemorrhagic fever — a group of diseases of which Ebola is one — including 21 confirmed in a laboratory — and 26 deaths. Health workers are also monitoring roughly 600 contacts over a 21-day period to ensure the rapid detection of new cases.
To streamline the roles for each actor, responsibilities have been delegated to organizations that have a comparative advantage: MSF is working on case management and strengthening health facilities; the Red Cross on committee mobilization and safe burials; and WFP is providing logistical support and aircraft for supplies and human resource transport.
On Friday, WHO held an emergency meeting to discuss the risk of Ebola spreading. A panel determined the outbreak did not yet meet the conditions of “a public health emergency of international concern,” a classification that could have triggered a larger international response.
For now, daily humanitarian air services operated by the European Commission, known as ECHO Flight, will offer safe, free flights for humanitarian personnel and emergency supplies to remote locations while humanitarian groups work as quickly as possible to contain the outbreak.
Lessons learned from past outbreaks
“Speed is very important with this kind of outbreak. And with the organizations that have already responded, they have really put this lesson into practice by having people deployed on the ground with supplies within a few hours of the declaration of the outbreak by the Ministry of Health in Congo,” Ben Adikonyi, regional head of health and care for the International Federation of Red Cross and Red Crescent Societies, told Devex.
During the 2014 West Africa Ebola outbreak, which resulted in more than 11,000 deaths, a key criticism concerned the timeliness of the response. Since then, Fall told Devex that WHO has undergone “major reform” of their emergency program by introducing an incident management system and setting up a new contingency fund for emergencies to avoid a lag in response times during crisis situations.
Within hours of suspicion on May 5, the Ministry of Health along with MSF were en route to assess the situation in Bikoro region, and within 48 hours of confirming hemorrhagic fever on May 8, international funding from various donors was already being released.
The U.K. government pledged £1 million ($1.34 million) through their Joint Initiative on Epidemic Preparedness and the Wellcome Trust committed another £2 million to support rapid response. The United Nations released an immediate $2 million allocation from its Central Emergency Response Fund, while WHO released an initial $1 million from its Contingency Fund for Emergencies.
“The response is much more rapid than what happened in West Africa because WHO and the international system were not organized in a way that they could respond to an outbreak as an emergency situation — and we have a new mechanism to respond quickly,” Fall said.
“We cannot assume that DRC will be controlled easily based on past experiences here.”— Ibrahima Socé Fall, regional emergencies director at WHO Regional Office for Africa
On Friday, the European Commission announced a €1.5 million ($1.76 million) humanitarian aid package to provide logistical support to WHO and an additional €130,000 to assist with life-saving interventions provided by the Congolese Red Cross. The U.S. Agency for International Development also pledged an initial $1 million to support the WHO strategic response plan and provided personal protective equipment kits and diagnostic testing materials.
Many health workers died during the West Africa Ebola outbreak due to their close contact with the highly contagious virus. To avoid this catastrophe repeating, an estimated 4,000 Ebola vaccines will be made available to health workers and points of contact of the infected.
Health experts say the vaccine is proven safe and highly effective and is “an added value to the strategy we know up until now,” according to Axelle Ronsse, MSF’s emergency medical coordinator.
The situation remains fluid, evolving overnight. While cases in isolated villages seemed easier to contain and monitor, aid workers fear a widespread outbreak as more urban cases are confirmed.
“What is important is going to this new population, explaining to them what this disease is and how to protect themselves. And also we have to explain the specific way to behave with a dead body who died of the disease,” Ronsse explained.
Her advice is to garner the support of community leaders to sensitize communities along with health workers.
Another challenge is accessing populations. Not only is Bikoro region quite remote, the rainy season has made certain roads completely impassible. Currently, flights between the capital of Kinshasa via Mbandaka to affected areas have been the most successful way to deploy people and products.
However, Fall noted that to reach communities, additional vehicles and motorbikes are needed.
Humanitarians are hopeful that the lingering imprint of the West Africa Ebola outbreak will prompt appropriate and rapid response from the international community. WHO estimated it could require more than $20 million over the next three months to contain this outbreak and secure the region.
“We cannot assume that DRC will be controlled easily based on past experiences here,” Fall remarked.
Adinoyi agreed, saying response strategies and capacity to provide materials to affected areas must remain flexible with “no room for making rigid plans that don’t allow for expansion.”
“This dynamic requires constant thinking and analysis of the situation to ensure that the proper response is tailored to what is happening at the moment,” Adinoyi continued.
“The situation is evolving every day, so we cannot predict accurately what will be needed, so the essence is to continue to scale up and expand to new villages and communities where this is happening.”