Over the past five years, the two largest epidemics of the Ebola virus have occurred, first in West Africa and now in the Democratic Republic of Congo (DRC). Democratic Republic of the Congo is no stranger to Ebola and has been fighting the virus nine times since 1976.
However, the current outbreak, for many socio-political reasons, refuses to succumb to the efforts of an international team of healthcare professionals armed with vaccines and treatment systems that did not even exist in previous episodes. When the epidemic exceeds its annual level, the virus infected more than 3,000 people and killed more than 2,000 people.
In July, the World Health Organization announced the outbreak of the state of public health, but in recent weeks there have still been an average of 80 new cases. After each new case, contacts and ring vaccinations are tracked. To date, over 200,000 people have received the Merck rVSV-ZEBOV vaccine in this country.
In addition to the vaccine, two treatments are also being investigated that promise to prevent Ebola deaths if used early enough after infection. These drugs are based on the "neutralizing" antibodies of Ebola survivors that bind to the virus's proteins and prevent it from infecting cells.
The rapid increase in infections in this epidemic has been hampered by a rapid health response and the early use of an effective vaccine to immunize those at highest risk of exposure. On the other hand, 14 months later, the epidemic is not over yet.
At this stage of the epidemic, it is worth taking a step back and thinking about why the disease attracts so much attention – and whether it is justified. Secondly, to consider what the blockages were. And finally, what could be the direction.
Why so much attention?
Medical response to Ebola infection is much more difficult than many other diseases. It is one of the deadliest viruses with a mortality rate of 60% – 90% compared to 2% for measles.
The Ebola virus is extremely contagious and easily communicates. Treating the disease requires large resources. Patients should be kept isolated in specialized, well-designed treatment centers. Healthcare professionals are at high risk of exposure and must take extreme precautions to examine patients. Failure of personal protection and infrastructure can be fatal.
In fact, around 6% of victims were involved in patient care. These issues carry logistical constraints in the treatment of this disease, especially in the densely populated region where there is an unusually large share of the global burden of infectious diseases.
While the Ebola outbreak has survived, the DRC is also fighting major epidemics of measles and cholera. In fact, since January this year, more people have died of measles than of Ebola in the past year. Both measles and cholera are diseases that can be prevented with vaccines, but most of the population needs to be vaccinated to be effective.
Given that halting the Ebola epidemic would allow resources to be targeted against other infectious diseases, it also explains why it attracts so much attention.
Of course you can always do more.
This outbreak of the Ebola virus outbreak was a lesson on how infrastructure and the current socio-political climate can hamper the best efforts of doctors and scientists.
The region has been the center of harsh violence for two decades. It's a strong mix. Violence affected people's lives so much that the consequences of the disease were lost in everyday struggles. This increased the difficulty of forcing people to cooperate with medical teams and report cases on time.
For example, people are often afraid of response teams and run away, as the recent case from Ariwara shows, very close to the border with South Sudan and Uganda.
There were also attacks on infrastructure, which was observed when two treatment centers on the border with Uganda were burned.
In such situations, part of the solution is to disseminate knowledge about the disease and gain confidence in the system.
In addition, the effectiveness of the response is hampered by the difficulty of administering the vaccine to as many people as needed, suboptimal rates for clinics, new disease hot spots and periodic waves of violence, some directly focused on health care units.
Leaders and international health teams discussed the possible need to change strategies.
DRC has finally agreed to try the Ad26.ZEBOV / MVA-BN booster from Johnson & Johnson. This is an addition to the Merck vaccine that was introduced. This strategy promises to provide an alternative if supplies from Merck deteriorate or the vaccination network needs to be expanded within the community.
But, as with all vaccination activities, building trust is key. This will require practical cooperation between medical and humanitarian workers in the region.
In addition to vaccination campaigns, decentralization and enabling local clinics to diagnose and manage patients early on is a much needed investment to raise the level of healthcare.
However, overcoming everything is that more effort is needed to increase trust between communities, response teams and the government, so people report early if they have symptoms. Only this can ensure that the virus stops before transmission.
We have a long way to go. Over the past 21 days, only 14 of the 47 Ebola virus health zones have been reported free from Ebola. This number must increase quickly.
Shirin Ashraf, postdoctoral degree, MRC-Center for Virus Research, University of Glasgow and Emma Thomson, professor of infectious diseases, MRC-Center for Virus Research, University of Glasgow