The World Health Organization announced Friday that it hopes to deploy an experimental vaccine against the developing Ebola outbreak in the Democratic Republic of the Congo, even as the agency plans for the “worst case scenario.”
There have been 32 probable and suspected cases of the deadly hemorrhagic fever reported since April 4, including 18 deaths, according to WHO. Ebola takes sophisticated lab tests to confirm, so only two cases have been confirmed thus far.
Three affected patients, one of whom has died, were health care workers. That’s especially worrisome to experts because medical professionals come into close contact with many people. During the major Ebola outbreak of 2014-2016, local health care workers were instrumental in alerting authorities to the outbreak but also played a role in spreading the disease early on. That outbreak ultimately killed some 11,300 people and infected 28,600 across West Africa. WHO was deeply criticized for its “egregious failure” to respond sooner to the large-scale tragedy.
WHO and the DRC are taking a multi-pronged approach to contain this new outbreak in a remote northwestern part of the country, including moving vaccines at sub-zero temperatures. They’re also monitoring for any signs that the disease is spreading along the Congo River and across borders.
Meanwhile, U.S. President Donald Trump has worried global health experts by proposing to rescind agencies’ Ebola funding left over from the last major outbreak and ousting his top global health security adviser the same week as the new outbreak was declared.
A Logistical Nightmare
Cases are clustered at three locations within a roughly 37-mile area near the town of Bikoro, said Peter Salama, WHO’s deputy director-general of emergency preparedness and response, during a United Nations briefing on Friday in Geneva, Switzerland. It’s been described as a “dire scene,” he said.
“This is going to be tough, and it’s going to be costly to stamp out this outbreak,” Salama warned. Dr. Tedros Adhanom Ghebreyesus, the director-general of WHO, is traveling to the DRC this weekend to oversee the response.
The global health organization is looking to establish an “air bridge” to move supplies by plane into the affected area. Helicopters are also being deployed to get experts and medical care to the scene. All of that, WHO spokesperson Tarik Jasarevic told HuffPost, is expensive, with the agency announcing Friday that the cost of the estimated three-month operation could run to $18 million.
To that end, WHO has already approved $1 million of funding through its Contingency Fund for Emergencies. The London-based Wellcome Trust, a global health charity, has also pledged 2 million pounds ― about $2.7 million ― which will be matched by another million pounds from the British government. The U.S. has not announced any standalone contributions as yet.
Trying To Transport A Vaccine
WHO is talking with the DRC government about using the still-experimental Merck vaccine, which showed great promise during a trial conducted amidst the 2014-2016 Ebola outbreak. Health Minister Oly Ilunga said health care workers would be a priority if the vaccine is deployed, according to Reuters.
The DRC government had previously approved use of the vaccine during a small Ebola outbreak last year. But by the time officials were ready to go, the infection had been contained by traditional measures such as quarantine and contact tracing.
“This is not a simple logistical effort ― this is a highly complex, sophisticated operation in one of the most difficult terrains on Earth.”
For Ron Klain, who served as Ebola czar under President Barack Obama during the last major crisis, the question is why there aren’t already “standing arrangements in place” between WHO and the DRC to deploy the vaccine following last year’s outbreak.
“The fact that, in two consecutive outbreaks, in two consecutive years, this process is starting from scratch is problematic, and puts health care workers particularly at risk,” Klain told HuffPost in an email.
After all, vaccine deployment is a logistical feat in itself. The Ebola vaccine needs to be kept at extremely cold temperatures of negative-60 to negative-80 degrees Celsius at all times in order to be effective ― a tall order when transporting it to a remote area without much electrical or other infrastructure.
It takes 15 hours by motorbike to arrive at the outbreak area from the nearest town outside that area, according to Jeremy Konyndyk, a senior policy fellow for the Washington-based Center for Global Development who previously led parts of the 2014 Ebola response for the Obama administration.
Salama said that WHO is working to mobilize the “cold chain” logistics by the weekend and that Gavi, the public-private international Vaccine Alliance, will pay for the vaccine’s deployment if the DRC approves its use.
Even when the proper logistics are in place, effective distribution will require extensive tracing of the individuals the infected patients came in contact with. The goal is to vaccinate a “ring” of protected people around the patients and their contacts. That tracing can take a week or two, according to Salama.
“This is not a simple logistical effort ― this is a highly complex, sophisticated operation in one of the most difficult terrains on Earth,” Salama said.
Along The Congo River
While WHO says the risk of Ebola spreading internationally is low, experts worry that the location of Bikoro on the Congo River could lead to outbreaks elsewhere, the STAT news site first pointed out.
“The biggest thing to watch is just the location around the Congo River because it’s the superhighway of Central Africa,” Konyndyk told HuffPost. “If you start to see disease spread to other cities up and down the river ... and if it were to hit a major population, then we’d be in real trouble,” he added.
The Congo River creates a possible pathway for the disease to reach the DRC’s capital, Kinshasa, which is home to over 12 million people. To the immediate north, there’s the capital of the Republic of the Congo, Brazzaville, whose population is 3 million. And then there’s the capital of the Central African Republic to the north, Bangui, where 730,000 people live.
WHO also warned of the risk to Mbandaka, the capital of the DRC’s Equateur province, which is home to nearly a million people and located just a few hours north of Bikoro.
Gambia, Guinea and Nigeria said they’re on the lookout for the virus, according to Reuters, and Kenya’s Health Ministry is thermo-scanning travelers at its airports for fever.
An Unclear Timeline
While there were some reports about suspected cases with Ebola-like symptoms in December and January, WHO has pushed back on the implication that those were linked to the current outbreak. Many diseases manifest with the same symptoms ― fatigue, fever and vomiting ― that accompany the early stages of Ebola, including malaria and other hemorrhagic fevers. WHO said it was tracking the count for this outbreak since April 4.
Konyndyk echoed doubts that the DRC outbreak could have begun in December or January. “If it had been floating around for 5 months [in the DRC], then it would have [already] spread up and down the river,” he said.
However, Klain cautioned against simply accepting WHO’s neat timeline.
“The mistake WHO is making is providing overly reassuring communications about the status of its information, the outbreak, and the response,” Klain said. “All that we know right now is that we don’t know: we don’t know when the outbreak started, if the response is timely, and whether early communication from the DRC was accurate.”
Playing Politics In The U.S.
All this news comes at the same time Trump is seeking to cut the remaining $252 million in Ebola response funds for U.S. agencies and has disbanded the global health security division within the National Security Council.
Senate Minority Leader Nancy Pelosi (D-Calif.) slammed Trump’s rescissions proposal in a Friday statement. She said that the Republican president was essentially making global health “foot the cost for their GOP Tax Scam” and that his plan “eliminates life-saving funding for responding to outbreaks.”
Global health experts noted that Trump has consistently pushed for spending reductions at the Centers for Disease Control and Prevention, the U.S. Agency for International Development and the Global Fund.
A National Security Council spokesperson defended the rescissions proposal on Wednesday, telling HuffPost that USAID had sufficient funds to respond to an outbreak and that the State Department could move funds among its own programs if needed. The spokesperson also stressed that other donor countries would be expected to chip in.
Global health experts also decried the loss of Rear Adm. Tim Ziemer, who oversaw global health issues at the National Security Council, and the disassembly of his division. Beth Cameron, who previously held that job under Obama, said Ziemer’s departure leaves the U.S. without a clear point person to tackle pandemics.
“It’s critical that we know who will have the lead for handling the coordination of a U.S. government response during an actual global health emergency here or overseas,” said Cameron, who now works for the nonprofit Nuclear Threat Initiative.
Klain said the decision to collapse Ziemer’s division and reportedly move it under the weapons-of-mass-destruction portfolio at the National Security Council was a mistake, arguing that the White House needs a team “focused on epidemic and pandemic prevention and response.”
And Konyndyk echoed that view, saying the dismantling of the global health section was “a bad idea in a normal week and a week like this just highlights how bad an idea it is.”