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Data: Ministry of Health DRC; Chart: Andrew Witherspoon/Axios

Health officials' longstanding fears about the potent mix of armed conflict in weak states — combined with a highly infectious disease outbreak — are being realized. In the Democratic Republic of the Congo (DRC), an Ebola virus outbreak is now at a tipping point and threatens to expand.

Why it matters: The current outbreak began Aug. 1 and appeared to be slowing down, as most of the new cases were contacts of known infected people. However, as security deteriorated, new cases surged — with 25% of all suspected and confirmed cases being recorded in the first 2 weeks of this month alone. Experts say a combination of ongoing violence in North Kivu's Beni town, community distrust, population density and other factors are hampering containment efforts.

Between the lines: Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, tells Axios that this outbreak is the "kind of scenario that many people who care about epidemic response, pandemic response have been worried about for a long time.”

The latest: The World Health Organization met on Wednesday and decided not to declare the outbreak a "Public Health Emergency of International Concern," which could've triggered international travel restrictions. But the security situation in DRC continues to deteriorate — with 8 major security incidents in north Kivu in the last 8 weeks, per WHO.

  • The violence has led to an interruption in public health initiatives — including efforts to quarantine those who may be infected, to vaccinate all "contacts" of people who were infected, and to educate pockets of people who are suspicious of health care workers.
  • This has led to a spike in cases — with special concern voiced that roughly half of them are not on contact lists of previously known patients, meaning the outbreak is definitely spreading.

Details: The violence has been serious enough to cause the CDC to withdraw its Ebola experts from field work in that area, as first reported by STAT News and confirmed by Axios.

  • The CDC says it moved an Ebola expert adviser, a vaccine expert and a border health expert to Kinshasa, which is more than 1,500 kilometers from Beni.
  • Since the start of the outbreak, the U.S. has deployed more than 2 dozen experts from USAID and the CDC to support preparedness and response in the DRC and neighboring countries.

Vaccination's impact: The DRC's Health Ministry mobilized an experimental ring vaccination campaign a week after the first case was reported. Between Aug. 8 and Oct. 17, nearly 19,000 people have been vaccinated, DRC ministry says.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), tells Axios the Ebola outbreak in DRC is "obviously a difficult situation."

"We're all concerned about it because we want to have optimal response to the outbreak but we're restrained because of the security issue."
— Anthony Fauci, NIAID director

Julie Fischer, co-director of the Center for Global Health Science and Security at Georgetown University, tells Axios there's a "real risk this outbreak is ready to explode locally."

  • "Contact tracing is absolutely essential to the ring vaccination campaign," Fischer says, but this requires face-to-face meetings that can't be completed without workers feeling secure.

The bottom line: This outbreak is nowhere near over. The longer it lasts, the greater the chances of it spreading. However, the WHO says it has confidence that at-risk neighboring countries are prepared.

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