Foreign Policy: Nearly 600 people have contracted Ebola since last August in eastern Democratic Republic of the Congo, making the ongoing outbreak the second largest in the 43-year history of humanity’s battle with the deadly virus. And there is a genuine threat that this Congo health crisis—the 10th the African nation has faced—could become essentially permanent in the war-torn region bordering South Sudan, Uganda, Rwanda, and Burundi, making a terrible transition from being epidemic to endemic.
Despite having a tool kit at its disposal that is unrivaled—including a vaccine, new diagnostics, experimental treatments, and a strong body of knowledge regarding how to battle the hemorrhage-causing virus—the small army of international health responders and humanitarian workers in Congo is playing whack-a-mole against a microbe that keeps popping up unexpectedly and proving impossible to control. This is not because of any special attributes of the classic strain of Ebola—the same genetic strain that has been successfully tackled many times before—but because of humans and their behaviors in a quarter-century-old war zone.
The sheer duration of the present epidemic means that the 4.5 million people in the currently affected North Kivu province of Congo are no longer the only ones in danger. The rest of the country and populations in the bordering nations of Uganda, Rwanda, South Sudan, and Burundi are now at risk, too.
Like homicide detectives tracking murder clues, teams of Ebola hunters are scouring urban areas and remote villages across North Kivu province, trying to catch the culprit before it claims more victims. But all too often, this killer, which causes the deaths of 60 percent of those it infects, is leaving no useful clues. In past brushes with Ebola, humanity has won out by tediously, and often perilously, finding an infected individual and then tracking backward through the person’s recent life to reckon who might have had contact with the ailing patient, building a chain of transmission that not only leads back to the first case introduced into a given location but also steers the disease detectives toward the killer’s next likely targets. By building chains of transmission, the Ebola fighters know who to quarantine, where to target their searches for other patients, and how best to deploy limited supplies of vaccines and diagnostic equipment.
But day after day, cases are popping up all over North Kivu that don’t connect to any known chains of transmission—it’s as if they popped out of thin air. The problem: North Kivu is one of the most violent places on Earth, rife with distrust, rumors, conflicts, and multigenerational hatreds. Investigators can’t find the links in the disease chains because the people there do not trust anything, even the very idea that a virus called Ebola exists, and refuse to comply with investigations.
On Jan. 11, for example, villagers in Marabo rose up in protest against the construction of an Ebola treatment center in their community after three high school students were diagnosed and placed in quarantine to stop a local chain of transmission. When international disease fighters tried to vaccinate all of the high school students, rumors spread that the vaccine was dangerous, students fled, and their three infected colleagues were helped to escape quarantine. Such events have been repeated throughout the area since the outbreak began.
An Ebola disease that became endemic in Congo would pose many novel dangers. The disease can be transmitted sexually up to 18 months after an individual’s cure, and, like Zika and HIV, it can also pass from pregnant mothers to their fetuses. It can also spread within military units that refuse scrutiny from virus detectives and among groups involved in illegal war-related activities such as arms smuggling. Even immune survivors might be at risk in an endemic context, as a recent study found that Ebola survivors carry two types of immune responses—one that will protect them against future exposures to the virus and another that perversely enhances infection, worsening their odds of dying if re-exposed.
Peter Salama, who heads up the World Health Organization’s Ebola effort, predicted in December that the epidemic would last at least another six months. And that’s likely an overly optimistic forecast. “It’s an outbreak I describe as a perfect storm — a combination of this deadly disease in one of the most difficult, protracted crises we have around the world,” he told Vox last month…
The world thought it knew how to deal with Ebola outbreaks—but it’s never dealt with one like this before. Deadly diseases like Ebola and the avian flu are only one flight away…
Health officials in Uganda, South Sudan, and Rwanda see the writing on the wall: This epidemic won’t end anytime soon and constantly threatens to cross their borders. They’re preparing their health teams, giving them vaccinations and Ebola training. Vigilance is high across the region.
If Ebola hitchhikes its way in an unwitting human carrier across Lake Edward into Uganda, down the highway to Goma and Rwanda, or up the Semliki River toward South Sudan, the world community will face tough choices. Option one: Keep on muddling through with the tools, personnel, and funding that have carried the response to date. Option two: Declare a global public health emergency, escalating financing and on-the-ground response to the multibillion-dollar scale seen in West Africa. Option three: Dedicate massive financial resources to pushing Merck and other vaccine-makers to rapidly manufacture millions of doses, and deploy literal armies, acting as security alongside an enormous public health deployment to immunize tens of millions of people in the region…
Imbedded in Bible promise are prophecies of dire circumstances. Pestilence will eventually overtake at least some regions of the earth. The only sure safety in any such region is to come under the shadow of the Almighty.
“He that dwelleth in the secret place of the most high shall abide under the shadow of the almighty… Thou shalt not be afraid of the… pestilence that walketh in darkness… A thousand shall fall at thy side and ten thousand at thy right hand, but it shall not come neigh thee.” Psalm 91:1, 5, 6, and 7.