Jan 31, 2019

There are tools to fight Ebola — but first people need to trust them

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

Despite having more tools to combat Ebola than ever before, the disease continues to spread to new parts of the Democratic Republic of the Congo — partly as a result of continued lack of trust from the public, according to several experts from Doctors without Borders (MSF).

Why it matters: Many now believe the outbreak will last at least a year from its Aug. 1 start, with some saying it could become endemic to the area. But public health officials are hoping that once they earn the population's trust, they'll be able to halt the outbreak with old-fashioned contact tracing combined with new tools like fast diagnostics, experimental treatments and an experimental vaccine.

What they're saying: Several experts with MSF, which has more than 200 staff members working on the ground in the DRC, spoke at a press conference earlier this week. They said the combination of the security situation, nasty disease and community distrust amounts to a "very frustrating" situation.

  • MSF project coordinator Karin Huster said that while this is DRC's 10th Ebola outbreak and its federal public health officials are experienced, the communities where this outbreak is centered have never seen Ebola before, and often mistake it for malaria.
  • Another issue is that this region of DRC has suffered from instability and rebel-related violence for quite some time, and the influx of federal officials and foreign organizations recently has fostered a suspicion of their motives.
  • MSF physician Brian D'Cruz, who has worked on Ebola outbreaks elsewhere, said he hasn't seen this level of distrust before, and that it's leading people to seek treatment too late in the infection process.
  • In a video testimony, a Congolese woman told her story of contracting Ebola but delaying her visit to the Ebola Treatment Center because she had heard rumors that the ETC "zipped you up in body bags before you were even dead."

The treatment trials have also been hampered by the security situation, Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, told Axios.

  • Currently, the trial is actively accruing patients and administering experimental treatments under close observation.
  • The study is designed to enroll 125 patients in each arm of the study, for a total of 500 participants. The trial may be adapted to continue enrollment across more than one outbreak and in several countries if necessary, so the researchers can gather enough data to evaluate safety and efficacy, Fauci said.
  • However, the trial in DRC only has 56 patients so far. "The security issues currently encountered in DRC have made it difficult to conduct the trial at the pace we had hoped," Fauci said.

But, the ring vaccination appears to be helping, although no one is 100% sure since it's not part of a randomized trial, Fauci tells Axios.

  • "It's likely things would be much more out of control" without the vaccine, Fauci said.
  • As of Jan. 30, there had been 70,611 people innoculated with Merck's rVSV-ZEBOV vaccine, the only experimental vaccine approved for use in DRC, according to the Ministry of Health.
  • However, that could change in the future, as an official from the World Health Organization indicated in a tweet that they are considering starting two randomized trials with other vaccines.

Meanwhile, a group of scientists in a Nature opinion piece say that Ebola diagnostics tests must be made more easily available.

Go deeper: Read Axios' full Ebola coverage.

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