As Ebola outbreak grows, Congo puts public health lessons to the test
| Johannesburg, South Africa
When a deadly outbreak of the Ebola virus began creeping across communities in West Africa in early 2014, many on the ground quickly sounded the alarm.
鈥淲e are facing an epidemic of a magnitude never before seen,鈥� said Mariano Lugli, a coordinator for M茅decins Sans Fronti猫res (MSF), that April.
It would take nearly four more months and nearly 900 more deaths, however, before the World Health Organization declared the outbreak 鈥渁 public health emergency of international concern,鈥� and a massive global humanitarian response shuffled into place. By the time the epidemic was eventually contained in late 2015,聽.
Why We Wrote This
In the wake of the West African Ebola epidemic, there was both anger and grief over claims that the world had responded too slowly. But today, as new cases are reported in Congo, many public health groups are determined not to repeat the past.
But in the past few weeks, as Congo faces an Ebola outbreak, there seems to be a new refrain 鈥� 鈥淣ot this time鈥� 鈥� as local and international responders scramble to apply lessons learned from the West African epidemic.
Within two days of the first two confirmed cases, Minister of Public Health Oly Ilunga聽 with Tedros Adhanom Ghebreyesu, the director general of the World Health Organization, arranging to ship thousands of doses of an Ebola vaccine to the affected region. Two days after that, Dr. Tedros, as he is known, had landed in Congo and was posing with Dr. Ilunga聽 (to avoid the skin-to-skin contact of a handshake that can help spread Ebola) and touring hospitals where patients were being treated.
Meanwhile, as news of Africa鈥檚 latest Ebola outbreak spread through major Western news outlets, countries including Britain, Canada, Germany, and the United States lined up to donate money. And the World Bank聽 from its Pandemic Emergency Financing Facility, a fund created after the 2014-15 West African epidemic to help prevent disease outbreaks from spreading in poor countries.
鈥淚n 2014, it took Westerners getting sick and dying for a lot of the world to wake up,鈥� says Donna Patterson, the director of Africana Studies at Delaware State University, who has studied the West African epidemic. 鈥淚鈥檓 happy to say that鈥檚 not been the case this time around.鈥�
鈥淭he response was very quick from the beginning,鈥� says Tarik Ja拧arevic, a spokesperson for the WHO. 鈥淸Two weeks] into the [declared] outbreak we have a vaccination campaign, we鈥檙e tracing everyone who鈥檚 had contact with those who are sick, and we鈥檙e conducting safe and dignified burials鈥� 鈥� NGO-speak for burials that conform to local cultural norms but avoid skin-to-skin contact 鈥� 鈥渟o we are preparing for all scenarios.鈥�
So far, 22 deaths have been reported, and , according to figures provided by the Congolese Health Ministry.
The situation, however, has become more complicated since last Thursday, when authorities announced that the outbreak had migrated more than 100 miles from Bikoro, the rural area where it began, to Mbandaka, a city of more than a million people situated on the Congo River.
鈥淭here鈥檚 obviously increased risk of spread now,鈥� Mr. Ja拧arevic says, particularly given the fact that Mbandaka is a port city and has a direct flight connection to Kinshasa, Congo鈥檚 capital.
But the 2014-15 West African epidemic also offered a useful primer into how to keep Ebola from spreading in dense urban areas, Dr. Patterson says.
As an example, she points to Lagos, Nigeria鈥檚 sprawling mega-city of 20 million. When the first case of Ebola was confirmed there in August 2014, many observers were apocalyptic in their predictions. This was an overcrowded city with wobbly public health care, and to top it off 鈥� the city鈥檚 doctors were on strike. But only two months later, the country was officially declared Ebola-free. In the end, just 20 people had contracted the virus, and only eight had died.
Part of the reason for that, Patterson says, is that Nigerian health authorities quickly identified the source of the disease in the city 鈥� a Liberian man who had arrived by flight from Monrovia 鈥� and tracked down everyone he had come into contact with. Every time they found a new case, they tracked down all that person鈥檚 contacts, too. In all, healthcare workers聽 to just under 1,000 people to make sure the disease didn鈥檛 spread. And it didn鈥檛.
That tactic 鈥� known in the medical world as 鈥渃ontact tracing鈥� 鈥� has been a centerpiece of the effort to end the outbreak in Congo too, with one twist.
Now there鈥檚 a vaccine.
鈥淎 vaccine improves the message you鈥檙e able to send to people about Ebola enormously, because you鈥檙e telling people if they come forward to say they鈥檝e had contact with the disease, there鈥檚 something proactive that can be done to help them,鈥� says Eric Osoro, a Kenyan epidemiologist who worked with the WHO in Sierra Leone during the outbreak there. 鈥淭hat鈥檚 a real game changer.鈥�
Before that outbreak, a vaccine had been in development for decades, but there was little money 鈥� or urgency 鈥� to try to cure a disease that tended to only hit remote, poor communities in rural Africa.
The severity of West Africa鈥檚 outbreak changed that. The most promising vaccine聽, and聽 in Guinea and Sierra Leone who had been in touch with people infected with Ebola. None of them got sick. Technically, however, the vaccine is still experimental, with its current use in Congo its first real-world application.
Of course, many experts note, even apart from what it鈥檚 learned from West Africa, few places know more about dealing with Ebola outbreaks than Congo. Since the virus was first identified after an outbreak in rural Zaire 鈥� as Congo was then known 鈥� in 1976, there have been聽 of the disease there.
鈥淭hey鈥檙e experienced, they know how to take the measures to reduce transmission,鈥� Dr. Osoro says. 鈥淎nd now, with this vaccine, we have a new addition to the fight.鈥�
