DR Congo's relentless fight against Ebola

An Ebola outbreak in the eastern part of the Democratic Congo, which has been going on for nearly two years, was almost contained when another outbreak was confirmed at the far end of the country in the northwest. The two regions are about 1,200 kilometers (745 miles) apart.

Four people have died so far, the Ministry of Health said on Monday. The United Nations Children's Fund, UNICEF, said five have so died of the virus. Four more people have also been infected.

The country's minister of health, Eteni Longondo, told DW there have 12 suspected Ebola cases as of Tuesday. The affected area is Mbandaka, the capital of Equateur Province. It boasts important transport routes, such as the navigable part of the Congo River, through which Ebola could spread further.

Read more: Ebola: Congo declares new epidemic

Dealing with Ebola is not new for the province. An outbreak in the region two years ago lasted about two and a half months. In that outbreak, 54 people contracted the virus and 33 of them died.

Getting better at tracing Ebola

The 2018 experience is now paying off.

"It's a very positive sign how quickly the [2020] outbreak was noticed," Natalie Roberts of the medical charity Medecins sans Frontieres (Doctors without Borders) said. "The people who work in the region understand the signs of Ebola much better. They have access to testing and can get results quickly."

Roberts said she is optimistic that the outbreak in the northwest can quickly be contained.

According to UNICEF, the people killed by the virus died between May 18 - 30. In the two largest Ebola epidemics in the world, in West Africa outbreak from 2013 to 2016and the one that has been going on in eastern Congo since 2018, much more time passed before an outbreak was declared, Roberts said. "We lost control of the spread before an outbreak was even noticed," she added.

Read more: WHO sounds alarm over new Ebola case in Congo

The time factor is crucial. The sooner a cluster is known, the smaller the chances infected people would have moved, and, ideally, the smaller the network of contacts that need to be isolated or prophylactically treated.

First time Ebola vaccine

In addition, developments in the medical field are much further along than during previous epidemics. At the end of 2019, both the United States and the European Union had approved the Ervebo vaccine. According to the manufacturer, Merck, the Democratic Republic of Congo, Ghana, Zambia and Burundi have now also authorized the vaccine. The Congolese Ministery of Health has already declared that vaccines and medicines are to be brought to Equateur.

Irrespective of the vaccine approval, the drug has already been used in emergencies during outbreaks. For example, two years ago in the province of Equateur,  a few thousand people including contact persons of infected people and health personnel were vaccinated.

Professor Marylyn Addo, research head of infectious diseases at the University Medical Center Hamburg-Eppendorf, led one of the studies on the effectiveness and tolerability of the vaccine. "Those who were vaccinated in 2018 may still have some protection," the physician said. However, there is little data on how long the immunization really lasts after receiving the vaccination.

Up to now, the vaccine has been administered to prevent the disease from spreading: "You vaccinate all contact persons and the neighbors. One tries to close a vaccination bar around an outbreak," Addo explained.

Challenges of containing Ebola

That is how the vaccine was tried in the eastern part of the Congo. Since the outbreak in early August 2018, there have been 3,463 cases of Ebola, almost two-thirds of those infected have died of the infection. More than 300,000 people have received the vaccine there. Natalie Roberts spent about half a year in North Kivu in 2019, working with Doctors Without Borders' vaccination program. She said they faced some challenges.

The vaccine must be stored at -80 degrees Celsius (-112 Fahrenheit). "This is not easy in a country like the Democratic Republic of Congo, where electricity or roads are not always reliable," Roberts said. Since it was still an experimental vaccine at the time, the number of doses of the vaccine was limited.

Since Ebola symptoms resemble those of malaria, which is prevalent in the region, malaria cases had to be carefully filtered out. Another problem was that some people got Ebola even though they were vaccinated. This means that they were already infected at the time of vaccination, but the disease had not shown symptoms.

"A lot of people didn't really understand this," Roberts said.

The human factor

There is another important factor in the fight against Ebola in DR Congo: the citizens. There were reports that parts of the population did not trust the aid organizations, there were repeated attacks on Ebola centers and in some cases, Ebola patients fled.

Roberts added that aid organizations also made mistakes. "We are building a system that is only for Ebola patients, " Roberts said. "Doctors without Borders need to understand that patients tend to go to their health service of trust. This can be the local pharmacy, the traditional healer or a local private clinic. They don't necessarily go to a non-governmental organization that comes from outside and say: 'I think I might have Ebola; can you take me to your center?'". Aid agencies should adapt to people's behavior, not the other way around, she added.

Research on the Ebola virus is continuing in the medical field. According to Infectiologist Addo, a second vaccine is currently being developed, but it must be administered in two doses, 56 days apart. Therefore, it is not suitable for an acute outbreak and could rather be used for the immunization of health personnel. According to Natalie Roberts, there is hope that this vaccine will provide longer protection against infection. In addition, there are still studies underway on drugs for treatment when the disease has broken out.

Ebola will keep returning

But no matter how hard the virus is fought: Ebola will always return, Addo said, because the virus is also found in animals: "From there the disease can always be transmitted to humans." The technical term for such diseases is zoonosis. As counterexamples, Addo cited measles: "In measles, there is only the human being as a reservoir. That means if we eradicate measles from humans the way we've eradicated smallpox, it won't come back."

Read more: Coronavirus: From bats to pangolins, how do viruses reach us?

Addo said the DRC is generally prepared for further outbreaks: "Until the 10th outbreak [in eastern Congo], they were all relatively small. The Congo has always managed to control these outbreaks by itself — even without a vaccine."

Roberts said she expects more outbreaks to be detected in the future. For them, however, this is "a positive thing." 

"I think the outbreaks have always been there, only in two or three cases people didn't even notice it," she said, adding that she thinks it's likely that people are now much more sensitized and therefore more likely to detect an epidemic.

But the fight against other diseases cannot be ignored: In 2019, more than 6,000 people in the Democratic Republic of the Congo died from measles, more than from Ebola.

Eric Topona contributed to this article.

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