The Ebola outbreak in the Democratic Republic of the Congo is the second worst on record, having topped 600 cases. But the case count would be much higher still if an experimental Ebola vaccine were not being used to contain spread of the disease, the director-general of the World Health Organization said Thursday.

“One thing I am really certain of now is: If it wasn’t for the vaccine we’re using, the number of cases we have could have been really high, high, high,” Tedros Adhanom Ghebreyesus told STAT upon his return to Geneva from the DRC after spending three days meeting with Ebola response teams and assessing the situation.

The vaccine, which is being developed by Merck, is being given to health care workers, others on the front lines of the response effort, and people who are contacts of cases — and contacts of the contacts — to protect them and prevent onward spread of the virus. To date, more than 54,000 doses of vaccine have been administered in this outbreak.

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The assessment of vaccine’s effectiveness by Tedros, as he is known, is based on the fact that the case count hasn’t grown exponentially, not on modeling calculations. He suggested, though, that the WHO should explore the question through modeling studies.

The director-general’s visit to the DRC coincided with a period of widespread and violent unrest in the affected parts of the country, triggered by contentious and long-delayed national elections.

The violence has prompted some of the WHO’s response partners — Oxfam and the International Rescue Committee — to suspend operations. Other groups, including Doctors Without Borders, have reduced the number of staff members they have in the region or moved non-Congolese personnel out of the region temporarily.

The WHO has not lowered staff levels, and Tedros urged partners to stick with the fight.

“This is a very dangerous enemy and we have to stay,” he said. “If we leave … the virus will get an advantage and will spread freely. Not only for DRC, it will be bad for the neighboring countries and even beyond.”

Tedros traveled to the region — against the advice of security personnel, he said — with Dr. Jeremy Farrar, director of the Wellcome Trust, the world’s second richest medical charity. The director-general said he wanted to spend New Year’s with people working to quell the outbreak, to express his appreciation and respect for their efforts. “They have been there for months, risking their lives,” he said.

While Tedros was visiting one of the transmission hot spots, a health zone called Komanda, a team of Ebola responders working to vaccinate people were attacked with stones. One, a woman, was briefly kidnapped. Another, a man, was injured; he was flown out for care in the helicopter that transported Tedros and the people accompanying him. He is recovering, Tedros said.

The national elections, which were held Dec. 30, have stirred up the violence, but the region has been a conflict zone for decades, and sporadic rebel attacks on government forces or United Nations peacekeepers have hampered the outbreak response from the start. A violent incident in August prompted the State Department to order U.S. government employees, including experts from the Centers for Disease Control and Prevention, out of northeastern DRC. They haven’t been allowed back since — though there are some Americans in the region working for charities and non-governmental organizations.

That position has led to criticism that the U.S. isn’t doing enough to help contain the outbreak. But Tedros said the criticism is unwarranted and that other countries have decided not to send government workers to help with the outbreak response.

“It’s not specific to the U.S. government,” he said. “[It’s] almost everybody. Especially all the high-income countries.”

Tedros said he met with President Trump at the G20 Summit in Buenos Aires at the end of November. The president spoke openly of his support for what the WHO is doing in DRC, the director-general said.

Tedros said he speaks regularly with Health and Human Services Secretary Alex Azar; Mark Green, who heads USAID; and Dr. Robert Redfield, the director of the CDC. “We are getting the support we need from them,” he said.

The U.S. is supporting, financially, the operations of some NGOs in the field and has deployed staff to WHO headquarters in Geneva, to Kinshasa in the DRC, and to other places in East Africa, he added. Some CDC staff have been working with countries neighboring the DRC to help them prepare to quickly spot and safely treat Ebola cases, should the disease cross their borders.

As for the question of whether the outbreak should be declared a global health emergency, Tedros said he would consider reconvening an advisory group of experts to look at the issue if the situation worsens. When members of the group met in October, they decided the outbreak did not constitute a public health emergency of international concern — a PHEIC, in global health law parlance.

“I don’t worry, to be honest, whether we call it a PHEIC or not. Because we’re following it 24/7,” he said.

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