Efforts to contain the 10-month-old Ebola outbreak in the Democratic Republic of the Congo appear to be bearing fruit, with a decline in cases over the past two weeks and a shrinking of the geographic footprint of the zones of transmission, the World Health Organization said Thursday.
The cautious notes of optimism were in contrast to messages from earlier in the week from other partners in the response, including the Centers for Disease Control and Prevention.
The CDC’s director, Dr. Robert Redfield, warned Tuesday that the world needs to prepare for the possibility the epidemic could drag on for another year or two. And Tariq Riebl, an emergency response director for the International Rescue Committee, said the sharp rise in case in cases this spring, at a time when an outbreak ought to be coming under control, suggested drastic changes are needed. “This response requires a total and complete reset,” Riebl said.
The WHO’s Dr. Mike Ryan, who is executive director of the global health agency’s emergencies program, said Redfield’s estimation was a worst-case scenario. But he said other possibilities include halting spread in the Congolese provinces of North Kivu and Ituri much sooner than that.
“The outcome is effort related,” Ryan said. “Are we prepared to make immediate, sustained, comprehensive effort to bring this disease under control? And if we are, I believe the timelines can be much shorter than the ones stated.”
“But … I think Dr. Redfield is really trying to wake the world up to the fact that this is a very complex situation and that if we keep operating at less than perfect efficiency, we may end up being around dealing with this outbreak for a very long time.”
Ryan pushed back against the call for a total reset, saying that’s not an option available to the response.
“Adapt, yes. Learn, yes. Change things, yes,” Ryan said. “I’ve been through a lot of Ebola and other outbreaks. There are no magic bullets. There are no unicorns. It’s just hard work and learning from what we do.”
The outbreak, which passed the 2,000-case mark at the beginning of the week, is the second largest on record. As of Tuesday, there have been 2,025 cases and 1,357 deaths.
While the outbreak is still substantially smaller than the 2014-2016 West African outbreak — which spanned multiple countries, accruing more than 28,000 cases and more than 11,000 deaths — the WHO has said it might be the toughest the agency and its partners have had to fight.
The affected provinces have been embroiled in a more than two-decades-long conflict, making travel to and work in some communities difficult and dangerous. The years of fighting have left the people in the region highly distrustful of their own government and anyone deemed to be an outsider.
That has made the critical work of Ebola containment — finding cases, figuring out who has been exposed to the cases, persuading contacts to be vaccinated, and persuading people sick with the virus to be treated in specially equipped health centers — challenging to achieve. Since late February, the Ebola response teams and facilities have been the targets of multiple attacks, several of which have claimed lives of response workers.
While the response teams often need armed guards to travel about, people in the region move freely and often. Ryan noted that about one-fifth of the people who have been infected have traveled to another health zone from the one in which they live when they first seek care — often starting spread in new locations as a consequence, or reigniting transmission in a location where it had previously been stopped.
That tendency also complicates the job of figuring out who infected whom. Response workers need to figure out where the virus is circulating and who has been in its path, so that people who are at risk of contracting Ebola can be offered an experimental vaccine being used to help stop the outbreak.
Ryan acknowledged officials believe they are detecting only about 75% of cases. Improving that figure will involve persuading the affected communities to cooperate with containment efforts, he said.
Still, Ryan said there are signs of progress. There have been 88 cases a week in the past couple of weeks, down from an average of 126 cases a week in April. And the number of case contacts being monitored daily to see if they have developed symptoms dropped from a high of 20,000 a day to 15,000, he said.