By: Deanna Altomara

One of the world’s most terrifying diseases is once again at large—and no one’s talking about it.

Ebola is a deadly virus that took the lives of over 11,300 people and sickened over 17,000 more in the 2014-2016 West African outbreak.[1] The virus, which was originally discovered in 1976 near the Ebola River in the present-day Democratic Republic of Congo, is a zoonotic disease, meaning it has mutated to infect different species.[2] Ebola usually only affects monkeys and nonhuman primates, but certain spill-over events can cause the pathogen to jump species.

This is what happened in December 2013, when a toddler in Guinea was likely infected by the fecal matter of a local fruit bat. Spread by body fluids like blood, the virus quickly infected several of the boy’s neighbors and relatives, sparking the largest Ebola epidemic of all time.

“We have significantly contained the virus in a much smaller geographic area. Now we have to kill the virus.” – Dr. Michael Ryan, the Executive Director of the WHO Health Emergencies Program

When the World Health Organization (WHO) officially declared the epidemic over in June 2016, the world held its breath in the hopes that this would be the last of the virus. But a new outbreak was declared in the Democratic Republic of Congo in August 2018, and has sickened 3,243 people as of October 21, 2019.[3]

On June 13, 2019, shortly after a few cases of Ebola were reported in Uganda, the US Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center to better support the international response.[4] When the first Ebola case was diagnosed in Goma—a Congolese city of almost two million people—only a month later, the WHO declared the outbreak a Public Health Emergency of International Concern. [5]

There are currently no licensed vaccines to prevent Ebola, but an experimental vaccine orchestrated by Merck is being tested on people in the outbreak zone. This vaccine, known as rVSV-ZEBOV, was originally developed by scientists at the Public Health Agency of Canada in the early 2000s. While investigation initially floundered due to lack of funding, interest in the vaccine spiked during the 2014 outbreak. Merck began distributing the vaccine to West African countries despite the fact that the drug had not yet finished the rigorous testing regime required for pharmaceuticals.[6]

As a result, it was unknown (and still is unknown) if the vaccine being deployed has any long-term side effects. The ethics of this decision are controversial, with many people wondering if it is morally acceptable to test a vaccine on such a vulnerable population. That being said, the vaccine has been shown to have a 97.5% efficacy, which is a positive sign for controlling the outbreak.[7]

A white man and a black man stand inside a large white tent. There is boxy laboratory equipment and several wires on the ground.
“Setting up a laboratory” by CDC Global Health is licensed under CC BY 2.0 

As of late September, 223,000 people had been given the vaccine. Many of these vaccinations took place at pop-up clinics, which provide greater anonymity in an environment in which Ebola is feared and stigmatized. Johnson and Johnson is also in the process of developing and delivering a new vaccine to Congo, which will be made available in Goma in mid-November before being opened to other provinces.[8]

In September, rumors that Ebola had spread to neighboring Tanzania erupted. Although the Tanzanian government declared that it had not found any positive cases, it refused to divulge any other information. But over 40 days have passed—Ebola incubates in only 21— easing international fears about a Tanzanian outbreak.[9]

WHO officials are cautiously optimistic about the outbreak, noting that mortality within treatment units has dropped to a third. In recent trials, two new drugs are also giving promising results—patients who took either REGN-EB3 or mAB114, shortly after infection had a 90% survival rate.[10] The disease has been pushed into a relatively small area, a promising development in the midst of the chaos plaguing the Congo.[11] However, officials expect the public health emergency will last at least another three months. Fifty new cases were reported from late September to mid-October, many of which have occurred in the Biakato Mine area. In this area, workers toil in dangerous and sometimes illegal mining operations. Violence is common and public education is limited.[9] “We have significantly contained the virus in a much smaller geographic area,” says Dr. Michael Ryan, the Executive Director of the WHO Health Emergencies Program, “Now we have to kill the virus.”[11]

References:

[1] Researching Ebola in Africa. (n.d.). Retrieved from https://www.niaid.nih.gov/diseases-conditions/researching-ebola-africa. 

[2] What is Ebola Virus Disease? | Ebola (Ebola Virus Disease) | CDC. (n.d.). Retrieved from https://www.cdc.gov/vhf/ebola/about.html. 

[3]Ebola health update—DRC, 2019. (n.d.). Retrieved October 21, 2019, from https://www.who.int/emergencies/diseases/ebola/drc-2019

[4] CDC. (2019, August 14). What CDC is Doing | Democratic Republic of Congo | Outbreaks | Ebola (Ebola Virus Disease) | Retrieved October 21, 2019, from https://www.cdc.gov/vhf/ebola/outbreaks/drc/what-cdc-is-doing.html

[5] Ebola outbreak in the Democratic Republic of the Congo declared a Public Health Emergency of International Concern. (2019, July 17). Retrieved October 21, 2019, from https://www.who.int/news-room/detail/17-07-2019-ebola-outbreak-in-the-democratic-republic-of-the-congo-declared-a-public-health-emergency-of-international-concern

[6] Pinchin, K. (2019, August 13). Behind the Life-saving Ebola Vaccine is a Story of Missed Opportunity. Retrieved from https://www.pbs.org/wgbh/frontline/article/behind-the-life-saving-ebola-vaccine-is-a-story-of-missed-opportunity/.

[7] WHO. (2019). Preliminary results on the efficacy of rVSV-ZEBOV-GP Ebola vaccine using the ring vaccination strategy in the control of an Ebola outbreak in the Democratic Republic of the Congo. https://www.who.int/csr/resources/publications/ebola/ebola-ring-vaccination-results-12-april-2019.pdf.

[8] Schnirring, L. (2019, October 14). As Ebola cases climb, launch of 2nd vaccine in works. Retrieved October 21, 2019, from CIDRAP website: http://www.cidrap.umn.edu/news-perspective/2019/10/ebola-cases-climb-launch-2nd-vaccine-works

[9] McNeil, D Jr. (2019, October 18). W.H.O. Continues Emergency Status for Ebola Outbreak in Congo. The New York Times. Retrieved from https://www.nytimes.com/2019/10/18/health/ebola-congo-who.html

[10] Maxmen, A. (2019). Two Ebola drugs show promise amid ongoing outbreak. Nature. https://doi.org/10.1038/d41586-019-02442-6

[11] Ebola on the run in DR Congo, ‘now we have to kill the virus’: UN health agency. (2019, October 10). Retrieved October 21, 2019, from UN News website: https://news.un.org/en/story/2019/10/1048951

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