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

The Ebola outbreak in the Democratic Republic of the Congo reports more than 1,000 confirmed and probable cases, and experts warn this could continue for the long haul unless the community starts trusting public health workers and participates in identifying contacts of infected people.

Why it matters: The outbreak cannot be stemmed until each contact of an infected person is vaccinated and monitored until they are declared free of the deadly infection — something the World Health Organization has been characterized as challenging. Some worry that the haemorrhagic disease could become endemic in the area, although most say it hasn't reached that point yet.

What's happening: Violent attacks on Ebola Treatment Centers (ETCs) and health-care workers have forced Doctors without Borders to suspend its operations in some hotspots of the disease (although they continue working elsewhere in DRC) and placed incredible pressure on local and international health-care workers struggling to respond to the communities in need.

DRC's Ministry of Health (MOH) continues providing daily updates, which show continued deaths of people who were not known to be infected, illustrating the precariousness of the situation. MOH spokesperson Jessica Ilunga, tells Axios that the disease has spread to another zone over the past 21 days, in Lubero, and it has resumed in other areas where it had been contained already, like Beni. She adds...

"After the attacks of the ETC, we organized community dialogue sessions in some areas to let the community express its concerns regarding the response in a peaceful way. Based on their comments, we started working on ways to adapt some Ebola response activities." 

What they're saying:

  • UCLA professor Anne W. Rimoin tells Axios, "Unfortunately, it is not surprising to see these case counts go up after the attacks. In an outbreak, community trust is key. It’s hard to get the community to trust the system and take advantage of the treatment centers when they are viewed as targets of violence."
  • UC Berkeley professor Arthur Reingold tells Axios, "My guess is that all of the actors involved in this would reject the notion [of Ebola being endemic] for now. We still feel like we can get the number down to zero."
  • The International Rescue Committee, which says it's supporting 59 health clinics to help Ebola prevention efforts, calls the 1,000-mark a "tragic milestone." Per their website, "Working to combat the stigma and misunderstanding is the key to getting this outbreak under control."
  • WHO said it will keep its 700 personnel on the ground to help local public health officials, but adds that it needs more funding from donor countries. The global agency says they need at least $148 million for the next 6 months but as of March 19 had only received $74 million. See their feature stories.

Yes, but: Some good news: Per WHO, "Independent analysis of vaccination data indicate that the vaccine is protecting at least 95% of those who receive it in a timely manner." As of March 24, 91,523 people had been vaccinated.

The big picture: Rimoin, who also directs the UCLA Center for Global and Immigrant Health, says the outbreak would be "significantly worse" if the MOH and its partners hadn't been taking the right steps. She adds...

"What is going to stop the outbreak is the whole host of response activities that are currently being deployed — infection control measures in health facilities, vaccination, safe and dignified burial practices, dialogue with the community. These tactics will eventually bring the outbreak under control, but it’s an uphill battle."

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