The Centers for Disease Control and Prevention was forced to withdraw its Ebola experts from an outbreak zone in the Democratic Republic of the Congo several weeks ago amid heightened security concerns, a decision that is fueling worry over the impact on efforts to contain the epidemic, according to U.S. officials and public health experts familiar with the matter.
The Ebola experts — among the most experienced on the planet — and other U.S. government employees have been told by the State Department that they cannot travel to eastern DRC to help with the on-the-ground response.
As a result, Dr. Pierre Rollin — a fixture of Ebola responses for decades — has been consigned to the capital, Kinshasa, more than 1,000 miles away, where he is advising the ministry of health. Other CDC staffers are helping DRC’s eastern neighbors beef up their health security operations and prepare in other ways in case Ebola spreads across DRC’s borders. Some have been detailed to the World Health Organization’s Geneva headquarters.
A number of other organizations — Doctors Without Borders, the International Federation of the Red Cross, the nonprofit medical group Alima — are also assisting the effort to contain the virus.
But the CDC has expertise the response teams need, said Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.
“CDC has responded to nearly two dozen filovirus outbreaks in its history and has people who’ve been working on these issues for 30 years. It doesn’t make sense to have those people hundreds or thousands of miles away from where the disease is actually spreading,” Inglesby said.
“It would provide a lot of value to have experienced leaders at CDC who’ve been in the situation before contributing what they can to the larger effort. I think it’s an important moment to think about that,” he said.
A handful of CDC officials were sent to eastern DRC early in the response to the epidemic, which began to spread in July. The agency’s director, Dr. Robert Redfield, briefly visited the region in August, stopping at the response headquarters in the city of Beni.
But the region is effectively a war zone, with over 1 million displaced people and scores of armed rebel groups that wage battle against government troops. A deadly attack on DRC forces near Beni in late August led to an order for U.S. staff to withdraw from the outbreak zone.
Initially they were pulled back to Goma, a large city south of the area where the outbreak is occurring. What was initially thought to be perhaps a temporary situation has become the status quo.
Public health experts familiar with the discussions over whether to deploy U.S. personnel to the outbreak zone said the decisions have been influenced by the long shadow of the 2012 attacks in Benghazi, Libya, which killed a U.S. ambassador and three other Americans.
“This outbreak is occurring in a highly insecure environment, which complicates public health response activities,” a State Department official, who spoke on condition he not be named, said Sunday.
It’s unclear whether or when the U.S. experts might be permitted to return to the outbreak zone. Talks are underway to determine whether they may safely do so, sources said.
“The United States remains committed to doing its part to help save lives and control the outbreak as quickly as possible. We continue to provide technical and financial resources to the DRC Government and the World Health Organization,” the State Department officials said.
So far there have been 211 confirmed and probable cases in this outbreak, making it the seventh largest Ebola outbreak on record. Of the total number of cases, 135 have been fatal.
Some public health experts believe that, while the current conditions are indeed dangerous, an out-of-control Ebola outbreak in a war zone would be exponentially more hazardous — and would ultimately require more U.S. responders on the ground in circumstances of even greater peril.
“The risk isn’t going to go away. And the risk of … an Ebola outbreak that can’t be stopped in that part of the world would be profound,” Inglesby said.
Lessons from the disastrous West African outbreak of 2014-2015, which engulfed three countries and reached case counts previously thought to be impossible, should be applied here, he insisted.
“I think there’s pretty wide agreement that if we’d been able to do more earlier, before the summer where things really took off, we may have been able to change the course of that outbreak,” he said. “Early strong public health response is important in keeping things from getting … out of hand and spiraling.”
The West African outbreak, which took over two years to extinguish, mushroomed to nearly 30,000 cases, killing more than 11,000 people in the process. The early mishandling of the outbreak led to multiple commissions of inquiry and to the reorganization of the WHO’s emergency response operation.
“We, the U.S., after the 2014-15 Ebola outbreak led the reorganization of WHO to put WHO in the lead so that they had surge capacity and … the financial resources to get them out into the field right away, authority to overrule the regional and country offices and take the lead in these responses,” noted Jimmy Kolker, a retired U.S. diplomat with years of experience in Africa who is now a non-resident associate at the Center For Strategic and International Studies.
Kolker gave high marks to the efforts of the WHO, saying the revised emergency response system is working. But it relies, he said, on the global health body being able to call on assistance from national public health agencies. CDC experts should be on the ground in Eastern DRC, Kolker said.
The current outbreak is occurring in the province of North Kivu — with some spillover into the neighboring Ituri province — which is on the border with Uganda. Rwanda and South Sudan are close by.
By the time DRC recognized there was an Ebola outbreak in North Kivu, at the end of July, there had already been 43 cases.
But a rapid response involving use of an experimental Ebola vaccine being developed by Merck created hopes that spread might be contained fairly quickly. From about 40 cases a week, the count dropped to about 10 a week in September, Dr. Mike Ryan, assistant director-general of the WHO’s emergency preparedness and response program, said recently.
That progress, however, has been halted. There have been more infections confirmed in the first half of October than in the whole of September. And the WHO is now openly talking about a response operation that will drag into next year.
The DRC ministry of health reported four new cases Sunday. Three were people who died in the community, meaning they were cared for when they were at their most infectious by loved ones who were not wearing the protective garb that prevents transmission.
Officials attribute the rebound in cases to a number of factors. In addition to security conditions making it difficult for responders to operate, community mistrust has led to vaccine refusal in some neighborhoods and the hiding of some infected people.
The longer the outbreak rages, the harder it will be to contain it, experts warn. In recent reports, the WHO and the ministry of health have acknowledged that “contract tracing” is falling behind. That’s the process by which all people who might have been infected by a case are identified, offered vaccine, and monitored during the period in which infection might develop.
Contact tracing allows for the quick isolation of people who become sick. And it allows responders to keep tabs on where the virus is spreading. If contact tracing fails, responders will lose sight of where the virus is transmitting — dangerous in any scenario and much more dangerous in a conflict zone.
“There is a clear risk to not getting involved,” Inglesby warned. “The risk is that the Ebola outbreak spreads in a more dramatic way in conditions that are already dangerous and make it harder and harder to contain.”
An earlier version of this story incorrectly described the target of an attack near Beni in late August.