In 1976, the laboratory of the Institute of Tropical Medicine in Antwerp received a Thermos from the Democratic Republic of Congo, a vast central African country then called Zaire. In it was the blood of a Flemish nun who had died of an unknown disease. The mysterious illness caused fever, uncontrollable diarrhoea and haemorrhagic bleeding. Most people who contracted it were dead within weeks. Only later was it given a name: Ebola.
Ebola is back, even if the world has barely noticed. What has become the second-worst outbreak in history is quietly felling victims in eastern Congo, one of the poorest regions of the world. This month, confirmed cases topped 1,000, with 639 deaths recorded by March 26, according to the country’s health ministry. That is a long way off the more than 11,000 who died in west Africa from 2014 to 2016 when the disease spread across Guinea, Sierra Leone, Liberia and beyond. But it is roughly the level reached by that epidemic in July 2014, just before it gained deadly momentum.
The latest outbreak is far from under control. Peter Piot, who was a 27-year-old microbiologist in 1976 when the flask containing Ebola landed in Antwerp, says there was a resurgence of cases just last week. Many were not linked to known transmission chains, meaning the disease is spreading beyond the scope of healthcare workers to contain it. If the outbreak cannot be brought under control, the danger is it could spread to urban centres — where it is harder to stop — or across the borders into Uganda, Rwanda or South Sudan. Given the ease of air travel, cases could start popping up in the west.
In 1976, though the virus was a mystery, it was relatively easy to snuff out. In the village of Yambuku, the epicentre back then, those who contracted Ebola came into contact, on average, with seven other people. With careful detective work, they could be isolated. Simple procedures — wearing gloves, washing hands, isolating patients and discarding corpses quickly and safely — did the rest. Within months, the first Ebola epidemic was over.
Forty years on, people are more mobile. In the west African outbreak, infected patients came into contact with between 100 and 200 people each, making the virus exponentially more difficult to control. That could happen again if Ebola reaches the city of Goma, a busy crossroads of some 1m people on the border with Rwanda.
This is the tenth recorded outbreak in Congo. Congolese authorities have a strong record in stopping its spread. But conditions this time are altogether more difficult. Eastern Congo is prey to dozens of armed militias, most of them scrappy extortionists. The Allied Democratic Forces, an Islamist terrorist group, operates in the region. Health centres run by Médecins Sans Frontières have come under armed attack, endangering the lives of health professionals and scattering infected patients back out into the community.
People’s lack of trust is the most serious issue. According to a study in the Lancet Infectious Diseases journal, conducted last September, a month after the outbreak began, a quarter of people in Beni and Butembo, the centre of the outbreak, do not believe Ebola exists. More than 40 per cent say the extent of the epidemic has been fabricated to destabilise the region. That belief was reinforced when authorities blamed Ebola for the need to cancel voting in December’s presidential election.
Attempts to gain trust through community outreach have had mixed results. Health workers have been trying to do without the space-age hazmat suits that can protect them from contagion but make them look like visiting aliens. All too often, medical interventions take place under the protection of armed soldiers, a sure-fire way to alienate an already jittery population.
Mr Piot, now director of the London School of Hygiene and Tropical Medicine, says the strategy needs to be adjusted. Health workers have been immunising people with an experimental vaccine produced by Merck. That has almost certainly slowed the disease’s spread. But Mr Piot says a different Johnson & Johnson-produced vaccine, of which there are a million doses, should be aggressively employed to form a “curtain” of immunised people.
Ebola circulates in bats. In the world’s poorest communities, the virus occasionally jumps over into humans. That is a problem not only for those directly affected, but for an interconnected world in which viruses can ricochet with the speed of a commercial aircraft. Heroic Congolese and foreign health workers are battling Ebola in the most hostile conditions imaginable. It is in everyone’s interest that they succeed.
