Health workers carry a coffin containing a victim of Ebola virus in Butembo in May. Photo: John Wessels/AFP/Getty Images

One year ago today, the Democratic Republic of the Congo declared an outbreak of Ebola. Since then, more than 1,800 people have died, the virus has been carried to the large city of Goma on the border of Rwanda and to nearby Uganda, and violence has killed health workers.

The big picture: Politics, violence and community suspicion are thwarting efforts to contain the virus, which shows no signs of abatement. Experts say this cycle could easily spiral out of control.

The latest: Three more cases of Ebola were confirmed this week in Goma, bringing the total to 4 in the city.

There are several experimental vaccines for Ebola, but only one — made by Merck — is currently approved for use in DRC.

  • Preliminary results indicate it has a high effectiveness but there are limited supplies for now. (Merck tells Axios it has donated more than 210,000 doses to WHO since last year, and forecasts providing another roughly 900,000 over the next 6 to 18 months).
  • WHO and other groups have been recommending DRC test other vaccines, including one made by Johnson and Johnson's.
  • But, while Merck's one-dose vaccine takes about 10 days to provide immunity to most people, Johnson and Johnson's two-dose vaccine isn't completely effective for about 56 days and presents logistical problems.
  • The DRC agreed to halve each dose of Merck's vaccine (to 0.5mL), which doubled the supply while still being effective.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, tells Axios that by halving the doses "we're not going to run out of vaccine for a while."

"The biggest challenge is insecurity," says Ben Dahl, who returned recently from the DRC where he served as response lead for the Centers for Disease Control and Prevention.

  • It stems in part from skepticism in the community about the existence of the outbreak, suspicion of sudden international interest in the much-neglected region and rampant misinformation about Ebola treatment centers.
  • This hinders efforts to contain the deadly virus by quarantining suspected cases and tracing, vaccinating and monitoring anyone who had contact with a person infected with the virus.

Another issue is the lack of financial tracking of funding for an outbreak "rumored to cost $1 million a day," says Jennifer Nuzzo, a senior scholar at Johns Hopkins' Center for Health Security.

  • Uncertainty over how the new leadership at the ministry and the Ebola effort also complicate the scenario, although she says people are "optimistic so far."
  • But, the strife over adding a second vaccine is "creating a worrisome scenario," she adds."There's a [vaccine] battle being set up here .... It will only fuel skepticism and exacerbate vaccine hesitancy."

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Editor's note: This piece was corrected to show Oxfam is an international nonprofit group (not a consortium of NGOs).

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