A year into DRC Ebola outbreak, control eludes the response while funding remains in question

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On the eve of the day marking one year since recognition of the current Democratic Republic of Congo Ebola outbreak, in measured, if largely familiar words, two of the World Health Organization’s response leaders discussed the ongoing spread of the virus and the state of the response.

That included confirmation of the virus in a second person in Goma, a densely populated city bordering Rwanda with an international airport described as the country’s “gateway to the world.” The patient, who died Tuesday, had no contact with the previous Goma patient, or with his contacts, and had traveled from an area with no known cases. At the same time, new confirmations of the virus continue to be made in towns and communities where the outbreak was considered controlled, Dr. Matshidiso Moeti, WHO Africa regional director noted.

She commemorated the “seven of our own,” health workers who have lost their lives to violence in a current total of 198 attacks against responders that have highlighted, she added, the unprecedented factors complicating responses to the 10th outbreak of the virus in the country. Those factors include political instability and armed conflict, which, in turn, contribute to widespread community distrust of health officials while widening already devastating gaps in public health resources that challenge disease surveillance, monitoring, and access to multiple essential services. (While more than 1800 people in the DRC have died from Ebola since the outbreak began, nearly a third of them children, more than 2000 children there have died of measles, a disease the country was targeting for elimination.) At least 41 health workers have died from Ebola during the current outbreak.

The Merck vaccine, administered to more than 170,000 people, among them more than 3,000 health workers, has played an critical role, Dr. Michael Ryan, WHO emergencies program executive director, said, controlling the spread of disease where it could be administered, and replacing terror of the disease with hope. Violence as well as suspicion in some areas surrounding the response, however, continues to interfere with vaccination efforts, he added. Those challenges, in turn, led to proposed changes to the vaccination strategy, and following contention about the use of an additional investigational vaccine produced by Johnson and Johnson, Health Minister Dr. Oly Ilunga Kalenga, whose office had produced daily updates on the outbreak response in anecdotes as well as numbers, resigned July 22.

About 622 WHO responders have worked in the field each day of the response, putting in a combined total of “250,000 person days,” Dr. Ryan said, adding that contribution “pales in comparison to [that made by] brave Congolese staff.”

The response, and parallel efforts to bolster preparedness in nine neighboring countries, particularly in Rwanda, South Sudan, Burundi and Uganda where the virus has already spread and apparently been contained continue, requiring, overall, at least $350 million in donor funding.

“In terms of cash on the table,” Dr. Ryan said, “we’ve received well short of $50 million to cover that. You can characterize that donor response as you will.”

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