DRC Ebola response focuses on awareness campaigns, border controls

ABIDJAN — As humanitarian workers gain steam in the fight against the Ebola outbreak in western part of the Democratic Republic of the Congo — which has left 27 dead — a multi-pronged containment effort and new rounds of funding hope to prevent the highly contagious virus from spreading to the capital, Kinshasa, or to other neighboring countries.

Two weeks after the World Health Organization confirmed the appearance of Ebola on May 8, efforts are underway to contain the virus and limit its spread.

First appearing in the rural villages near Bikoro, many aid workers were originally confident that the virus would be contained quickly — as has been the case in the past eight outbreaks in DRC.

However, the appearance of cases in Mbandaka, a town of 1.2 million located a four-hour drive from the initial outbreak location, has drawn international concern that due to heavier population density and higher population mobility, the virus could make its way to bordering countries, including along the nearby Congo River.

To address this concern, the United Nations’ International Organization for Migration deployed teams of epidemiologists and medical staff earlier this week to 16 designated points along the DRC border in support of WHO.

“All it takes is one sick person to be transported down that river,” WHO deputy director-general of emergency preparedness and response, Dr. Peter Salama, told Devex earlier this week at the World Health Assembly in Geneva.

“Think of it as a highway — because it’s the only real transportation mode in that area of DRC — so, it only takes one sick person to go down that highway on a boat and end up far away for another epicenter of infection to be established.”

Sensitization efforts at border crossing points along the Congo River will communicate health risks to ensure travelers take precautions against the disease. In a statement released by IOM, the agency said it will also monitor flows at border crossing points and key congregation points to quantify cross-border and internal movements and obtain the demographic and movement profile of travelers. The objective is to “increase surveillance and ensure operational readiness for early detection, investigation, and response to potential cases,” the statement read.

The Ebola virus is highly contagious and is spread through direct contact with bodily fluids — saliva, sweat, tears, breast milk, urine, feces — of a person who has developed symptoms of the disease. Ebola can lie dormant within the body and has an incubation period of up to 21 days before the onset of symptoms, which is when it becomes contagious. Although Ebola is not spread through air or water, it can be spread by handling infected bushmeat.

As of May 21, the DRC Ebola outbreak has reached 58 total recorded cases, including 28 laboratory confirmation, 21 probable cases, and 27 deaths.

Cultural practices that include handshaking and kissing during greetings can be a major factor in the spread of Ebola, said Katherine Overcamp, deputy DRC country representative at Catholic Relief Services.

“Touching is a major part of the culture; it’s a natural part of social interactions here. When someone gets sick, taking care of the sick involves touching, and that can keep spreading the virus,” she said.

Beyond health workers and international aid workers, local religious leaders have also been targeted to deliver safety messages to local congregations, schools, and community gatherings, Overcamp said. Overcamp urged all actors to use the ministry of health-vetted sensitization materials to prompt behavioral changes — as well as help minimize the fear and mounting anxieties among local populations.

Coupled with grassroots awareness campaigns, an initial stock of 7,500 doses of the rVSV-ZEBOV Ebola vaccine has been made available for frontline healthcare workers and contacts of confirmed Ebola cases. A “ring vaccination” strategy, which relies on teams to trace all contacts and contacts of contacts, will be used in an attempt to vaccinate any possible carriers of the virus — currently estimated at 600 people.

Although the vaccine is not yet licensed, emergency responders are banking on its success based on prior experience. In a major trial in 2015, the vaccine was shown to be highly effective against Ebola in Guinea. However, in DRC, difficulties communicating its protective properties and potential side effects to some populations with little education have led to pushback.

Salama told Devex that the goal is to vaccinate roughly 1,000 people in the coming week, but that logistical challenges such as unpaved terrain and the requirement to keep the vaccine at -60 degrees Celsius poses a threat to the distribution plan.

In addition, initial quarantine efforts have had mixed results. There have been media reports that two people died after leaving an isolation ward at a local hospital with the help of family members. WHO and Médecins Sans Frontières have said that they cannot force patients to stay in the hospital and hope that growing awareness campaigns would convince residents to follow medical advice.

DRC remains a country plagued by political instability with an ongoing humanitarian crisis in the Kasai region. Overcamp told Devex that now advocacy has begun in Kinshasa, the spread of the virus to the nation’s capital of about 10 million people would be a “devastating hit.”

A meeting led by WHO last week determined that the current outbreak had not yet reached levels to be of “public health emergency of international concern.” But donors are being proactive in providing funding and continued support for the response.

In the past week, the United States Agency for International Development announced an additional $7 million to the fight against Ebola in DRC. The United Kingdom pledged an additional £5 million ($6.7 million) to the Ebola response. The European Union also announced the activation of its EU Civil Protection Mechanism, which immediately dispatched medical teams and personnel, as well as transport shuttles for rural communities.