Lessons from previous outbreaks helped DRC end Ebola

NAIROBI — The World Health Organization declared the end of Ebola in the Democratic Republic of the Congo on Wednesday, marking the first time in about 2 1/2 years that the country is free from any reported cases of the deadly disease.

The most recent outbreak in Équateur province was contained within six months — much more quickly than the outbreak in the eastern part of the country, which lasted for nearly two years.

The success of this response is credited to early community engagement and rapid vaccination efforts, as well as a cold chain technique that made it easier to distribute vaccines in parts of the country without electricity. These strategies were built off lessons learned from previous domestic outbreaks, according to responders.

The outbreak in Équateur province included 119 confirmed cases and 55 deaths.

“Overcoming one of the world’s most dangerous pathogens in remote and hard to access communities demonstrates what is possible when science and solidarity come together,” said Dr. Matshidiso Moeti, regional director for Africa at WHO, in a press release.

This Ebola outbreak — the country’s eleventh on record — was declared in June, less than two years after a previous outbreak ended in the same province. A few weeks later, the country’s longest outbreak of the disease in the eastern part of the country was declared over after nearly two years and 2,300 deaths. Genetic sequencing determined the two outbreaks were not related.

The government and its partners contained the disease by responding to communities scattered across large expanses of dense rainforests, as well as crowded urban areas. Some communities were only accessible by boat or helicopter, calling for a decentralized response.

Crucial to the success was engaging early with community members, convincing contacts of confirmed cases to remain at home during the disease’s incubation period so they could be monitored, and providing them with food and other forms of support to do this, said Dr. Mory Keita, Ebola incident manager in Équateur province for WHO. The responders were then able to vaccinate these people quickly.

These strategies evolved during the outbreak in eastern Congo but were not implemented early enough there, Keita said.

An Ebola vaccine received approval from the U.S. Food and Drug Administration in October, which also helped to create a more effective response. This allowed teams to deploy the vaccine more efficiently by providing it to probable contacts rather than just confirmed contacts. The approval also meant that responders did not have to use the consent forms required in the eastern Congo outbreak, when the vaccine was still in clinical trials. Responders inoculated more than 40,000 high-risk individuals.

Another important element was the use of a cold chain system to keep the vaccine at temperatures as low as minus 80 degrees Celsius, allowing responders to immunize people in communities without electricity. When teams went to remote communities, they were able to pack the vaccine in portable Arktek freezers that kept them cold for up to a week.

“The technology used to keep the Ebola vaccine at super-cold temperatures will be helpful when bringing a COVID-19 vaccine to Africa,” Moeti said.

The announcement of the end of the outbreak follows a 42-day period since the last patient tested negative. But there is still a need for surveillance to ensure that any possible new Ebola cases are responded to quickly. Survivors of Ebola can harbor the virus in bodily fluids such as semen. Because of this, health workers will continue to monitor survivors for 18 months, including with monthly tests.

“Bringing Ebola to zero is a huge achievement, but now we are faced with our next challenge: keeping it there,” said Dr. Jacques Katshishi, secretary general of the DRC Red Cross, in a press release. “This is not a moment to be complacent: the world cannot afford a resurgence of Ebola in DR Congo.”