The international president of Doctors Without Borders issued a scathing analysis on Thursday of the efforts to control the 7-month-old Ebola outbreak in the Democratic Republic of the Congo, saying the community hostility that is undermining the work is the fault of the response, not the people in the region.
And Dr. Joanne Liu, who was in the affected area of DRC last week when two MSF-run Ebola treatment centers were destroyed by fire, said continuing the current approach — with ramped-up security — is unlikely to end the outbreak, which is already the second largest on record. (The organization’s acronym is based on the group’s name in French.)
“We’re not sure that if we keep doing what we’re doing [it] will lead us to the end of things,” Liu said in a press conference in Geneva, where MSF is based.
Relying more heavily on security backup from local police, the Congolese Army, or United Nations peacekeepers in the region is increasing the perception that the Ebola response workers are “the enemy,” Liu warned.
“The use of coercion adds fuel to this. Using police to force people into complying with health measures is not only unethical, it’s totally counterproductive,” she said. “The communities are not the enemy. Ebola is the common enemy.”
MSF pulled its staff from Butembo and Katwa last week after the attacks on the treatment centers. The two cities are in the southern part of the outbreak zone, and are where most of the Ebola cases are now being found.
The organization is still staffing Ebola operations in other parts of North Kivu and Ituri, the affected provinces. MSF is in discussions about whether it will return to Katwa and Butembo, though Liu said the organization needs to discern first whether those communities want the MSF staff to return.
Katwa and Butembo have seen 344 Ebola cases to date, more than a third of the outbreak total. So far there have been more than 907 cases in this outbreak, with 569 deaths.
Those cities are where the hostility to the response workers has been greatest. Liu said in the past month there have been at least 30 attacks on response workers and facilities.
She noted that at this point in the outbreak, 40 percent of confirmed cases are still dying in the community, having shunned Ebola treatment centers.
And in Katwa and Butembo in the past three weeks, 43 percent of new cases aren’t part of known chains of transmission, which means no one knows how they have become infected, she added.
Those are markers that the help being offered by the Ebola response isn’t what people feel they need, Liu said. She called the atmosphere towards the response “toxic.”
The difficulty in controlling the outbreak is ironic, she noted, because there are tools being used that people who worked on earlier Ebola outbreaks only dreamed of — experimental drugs and vaccine. “We were craving for vaccine” during the West African outbreak of 2014-2016, Liu said.
One problem, she said, is the fact that the vaccine is being used in a ring vaccination approach, offered only to frontline workers and people who are known to have been in the virus’s path — known contacts of cases and contacts of the contacts.
Supplies of the vaccine, being developed by Merck, are limited, and it takes about a year to make new batches. So the World Health Organization, which is overseeing the vaccination program, is being cautious with its use. To date, nearly 86,000 people have been vaccinated in this outbreak.
Liu said people living in the outbreak zone do not understand why only certain people can be vaccinated. She argued using some of the other experimental vaccines — there are several, though they are not as far along in the testing process as the Merck one — would help.
She also advocated tailoring the response to the needs of the people, saying many don’t want to be sent to treatment centers where health care workers are unrecognizable under layers of protective gear. “It means treating patients as humans, and not biothreats,” Liu said.
There should be options for training people in the community in how to safely care for Ebola patients at home if they are adamantly opposed to going to a treatment center, she argued. Likewise, people living in communities that Ebola response teams cannot easily reach because of security concerns could be trained on how to safely care for their sick, she said.