An Ebola epidemic has been growing in Africa since mid-2018. This outbreak follows the devastating Ebola epidemic that swept through West Africa between 2014 and 2016, resulting in more than 28,600 infections and 11,000 deaths.
The latest epidemic’s first case was reported in the Democratic Republic of the Congo (DRC) in August 2018. Since then, more than 2,200 people have died. The World Health Organization (WHO) reported that the outbreak crossed national borders into Uganda in late June 2019, where three deaths due to Ebola were confirmed. In August 2019, Uganda saw another death when a nine-year-old girl passed away from Ebola after crossing the border from the DRC.
On 25 June, 2020, the WHO officially declared DRC’s deadliest outbreak over, although the DRC is still fighting a separate, smaller Ebola outbreak that started in the northwestern city of Mbandaka.
A number of heroic groups — nurses, doctors, governments, and international organisations — are on the front lines fighting the epidemic. But their efforts in DRC have been hindered by violence, political instability and local suspicion of medical assistance.
The WHO declared the outbreak a “Public Health Emergency of International Concern” on 17 July 2019, after a case was confirmed in Goma, a Congolese city on the border with Rwanda that is home to over 2 million. By declaring an emergency, WHO signaled that Ebola in the DRC is a serious threat to public health globally.
Then in late 2019, the WHO approved an Ebola vaccine, paving the way for it to be made available wherever Ebola is a threat. As of February 2020, four African countries will begin administering the new vaccine — the Democratic Republic of Congo, Burundi, Ghana, and Zambia — and other countries are expected to follow soon. February also brought news that the outbreak had been reduced to just one health zone, Beni, in the DRC.
At ONE we are tracking this Ebola outbreak closely. Here is what you should know:
Q: What is Ebola?
A: It is a severe, often fatal, illness caused by infection of the Ebola virus. The first reported outbreaks occurred in 1976 in the DRC and in an area of the Sudan situated on the Ebola River. The disease has a death rate of up to 90%.
Q: How is Ebola spread?
A: The virus can be spread to a healthy person in three ways:
- Contact with the bodily fluids of an infected person. This can occur through blood or other bodily fluids or secretions.
- Contact with infected animals, usually through preparing, cooking, or eating.
- Contact with items or environments contaminated with bodily fluids from an infected person. These may include soiled clothing, bed linens, gloves, protective equipment, and medical waste.
Q: Who is most at risk of contracting Ebola and why?
A: Since it’s transmitted through contact with infected bodily fluids, the people facing the greatest risk are health workers, family members or others in close contact with infected people, and mourners who have direct contact with bodies during burial rituals.
Q: How can Ebola outbreaks be controlled?
A: There have been over 20 Ebola outbreaks since it was first identified in 1976. Community action, support from the local government and timely safety messaging kept many of these outbreaks from becoming epidemics. Effective control measures include using protective equipment, practicing safe burials, tracking down possible new cases, and providing education to the public to reduce stigma. Additionally, research shows that more than 90% of people infected with Ebola can survive if they are treated early with the most effective drugs. The drugs attack the Ebola virus with antibodies so the patient can fight off the disease.
Q: What caused the 2018 outbreak?
A: In August 2018, the DRC notified the WHO of a cluster of 26 cases of Ebola, including 20 deaths, in North Kivu Province. The location of this outbreak poses a particularly high public health threat at the national and regional levels because the province has a big population, shares several national and international borders, and has been experiencing intense conflict and a worsening humanitarian crisis.
In June 2019, the WHO confirmed a case of Ebola in Uganda after a 5-year-old boy traveled with his family from the DRC to Uganda. The young boy, his brother and his grandmother have since died from Ebola.
Q: What are the major challenges preventing health workers from containing this outbreak?
A: Armed conflict and a local suspicion of both the government and of medical assistance have complicated response efforts. The very epicentre of the outbreak is in a conflict zone: dozens of armed groups are fighting over land, natural resources, ethnicity, and religion. There have been nearly 400 attacks in the DRC since the start of the epidemic, forcing health workers to suspend or delay vaccinations and treatments. Without adequate guarantees of security, health workers have not been able to efficiently reach all those affected or those at high risk of exposure, which gives the virus time and space to spread.
Those most at risk of contracting Ebola may see more immediate threats in their life, like violence. Many are suspicious of “why the international community is pouring hundreds of millions into the Ebola response, when people have been dying in this region for decades.” This suspicion fuels conspiracy theories about the Ebola crisis and and leaves communities vulnerable to the spread of the disease. From the outside looking in, it may seem as though controlling the Ebola outbreak should be everyone’s number one priority. But for some people living in these communities, Ebola may be just one more thing to worry about.
Q: What about the Ebola vaccine?
A: There was big news in November 2019: an Ebola vaccine was approved for quality, safety, and effectiveness by the World Health Organization, paving the way for it to be made available wherever Ebola is a threat. The vaccine, known as Ervebo, was used to protect more than 250,000 people in trials and has proved effective after a single dose. It can now be stockpiled and, potentially, distributed more widely. This is the first time any immunisation against Ebola has passed this hurdle.
Up until November, an experimental Ebola vaccine — that was not yet authorised for widespread use — was distributed on a “compassionate basis” to protect the people that are at highest risk of the Ebola outbreak. The vaccine was only available to health workers and others that were in contact with those infected with Ebola. For example, over 1,300 people who potentially came into contact with Ebola in Goma were vaccinated, which has helped contain what many feared would be a rapid spread in an urban centre.
As of February 2020, four African countries will begin administering the new vaccine — the Democratic Republic of Congo, Burundi, Ghana, and Zambia — and other countries are expected to follow soon.
Q: Who is working to contain the outbreak?
A: Health workers are at the frontlines of this outbreak, working day in and day out to contain the outbreak. Funding to contain the outbreak comes from the countries impacted as well as other donor countries, the World Bank, the Bill & Melinda Gates Foundation, and other non-governmental organisations.
Q: What are these organisations and governments doing to prevent it from spreading further?
A: To improve understanding around the virus and fight misinformation, governments and local community members are stepping up. For example, in the DRC, a radio program that reaches people even in the most remote areas of the country has been reassuring and educating listeners on Ebola. In another part of the country, community members go door-to-door in every neighbourhood to explain Ebola vaccines, contact tracing, the treatment of Ebola, and the vulnerability of women and children to the disease. In just two weeks, the campaign reached over 600,000 people. At the Africa Against Ebola Forum in November, held at the African Union Commission in Addis Ababa, the DRC pledged US$1 million towards the fight against Ebola, signalling the country’s commitment to ending the epidemic. Private sector donors and international partners pledged another US$55 million.
In Uganda, the government and the WHO have dispatched a rapid response team to identify others at risk of infection and to follow up on possible cases. The country has already vaccinated about 4,700 health workers against the disease, according to a joint statement by WHO and Ugandan health officials.
Other countries, like Tanzania and Kenya, regularly conduct cross border disease outbreak simulations to prepare for the possibility of the spread of Ebola.
Q: What does foreign aid do in the face of a contagious disease outbreak?
A: Both development assistance from donors for health programs and dedicated resources within affected countries are critical to strengthening health systems and improving health infrastructure: these efforts help prevent, detect, and mitigate disease outbreaks. When there is a disease outbreak, additional funding is needed to rapidly scale up prevention and treatment measures, and support the healthcare workforce.
Q: How does Ebola affect a country in the long run?
A: The 2014 Ebola epidemic is a staggering illustration of the economic consequences of just one outbreak of the disease: in 2015, Guinea, Liberia and Sierra Leone lost US$2.2 billion in gross domestic product, threatening economic stability and private sector growth in the region.
Ensuring our global community is healthy, educated and empowered leads to major benefits, like economic growth. Failing to protect health could quickly thwart this potential. If individuals are infected with Ebola, they cannot invest in bettering their community, kids cannot attend school and adults cannot pursue careers. Yet quality of life skyrockets when prevention and treatment are affordable and accessible.
Q: How can I stay informed and what can I do to help?
A: Watch this space. We are tracking the Ebola outbreak in DRC and Uganda and will provide updates on the response as it evolves.
Follow the World Health Organization on Twitter for the latest updates.
All images via DFID.