News of the 2014-2016 Ebola outbreak in western Africa shocked the world and took international media by storm. Despite international efforts to contain the virus, in the largest outbreak of its kind, the virus took the lives of 11,300 people in Guinea, Liberia, and Sierra Leone. Although no stranger to Ebola and the devastating effects the disease can have on its population, the Democratic Republic of Congo (DRC) escaped the 2014-2016 outbreak relatively unscathed, and in 2017, the DRC received widespread praise for ending an outbreak just a mere two months after the first initial case was reported. This year, however, the country has not been as fortunate.
On August 1, 2018, the World Health Organization (WHO) declared a new outbreak of Ebola marking the 10th outbreak of the virus in the country since 1976. Less than 2 weeks after the declaration of the outbreak, the WHO released a national response plan to combat the outbreak. Despite rapid response, the virus has yet to be contained – 5 months after the initial outbreak, As of this week, there have been more than 458 cases (396 confirmed) and 263 deaths. In addition, local health officials are investigating an additional 73 cases. Though these numbers pale in comparison to the 2014-2016 outbreak, in traditional Ebola outbreak terms, this public health event is still massive6
Compared to prior outbreaks, however, healthcare responders have never had so many tools at their disposal to fight the virus. To date, nearly 40,000 Ebola vaccines have been administered to outbreak hotspots. In addition, authorities in the DRC recently approved clinical trials for four experimental Ebola treatments. Following the 2014-2016 outbreak, officials released studies and after-action reports analyzing the containment strategies used. These reports go on to suggest what should be done in future outbreaks to further improve rapid containment. Despite the new vaccine, promising treatment options, and lessons learned from the recent 2014-2016 outbreak, the disease continues to spread rapidly and has become the second-largest Ebola outbreak on record in only four months. These facts beg the question “why is the 2018 outbreak so difficult to contain?”
Though humans have fought the deadly battle with Ebola for decades, until this point, the virus has never emerged in an active war zone. The 2018 outbreak began in the North Kivu and Ituri provinces. Both provinces continuously face the threat of multiple rebel and militia groups. These groups regularly interrupt the work of local and international aid workers that come to control the outbreak by threateningor injuring their staff.
After multiple attacks by these groups in early October, the US State Department pulled American aid workers out of the DRC due to safety concerns. Evidence points to a surge in reported cases as the response to the disease weakened without the US effort. The international community has noted that the United States has some of the most knowledgeable Ebola experts in the world. Since the withdrawal, global health experts have urged the Trump administration to allow the US specialists to return but have yet to be successful. Peter Salama, chief of emergencies at WHO, declared that “it will be very hard to stop the outbreak if this violence continues.” Unfortunately, cases have more than doubled since September and the outbreak has yet to peak. Without the aid from US experts due to safety concerns, one can only suspect that the outbreak will likely get worse.
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