It’s a hideously efficient disease, Ebola. Once entrenched in the body, it kills within days. In many cases, the agony it induces outstrips its speed. But treat it quickly – as Esperance Nabintu and her infant son did – and you’ve got a fighting chance. Eyes sparkling in the Congolese sun, her smile speaks of her deliverance, but hides an emotional scar – her husband didn’t make it. His illness was further along when treatment was sought, but haste alone didn’t save Esperance’s life. She and little Ebenezer had been given new, cutting edge medication – ‘monoclonal antibodies’ – drugs so effective scientists no longer deem Ebola incurable.
Esperance was among the 2,800 cases recorded in the Democratic Republic of Congo (DRC) since August 2018 – an epidemic so grave the World Health Organisation (WHO) has declared a global health emergency. A year into the outbreak, the death toll continues to rise – at least 139 new cases were confirmed in the first fortnight of August 2019, 85 of which proved fatal.
Ebola has haunted Africa since its mid-‘70s emergence. Savagely contagious, it spreads through contact with infected bodily fluids, such as the blood, vomit and diarrhoea it induces. A three-year epidemic tore through the continent’s west coast in 2013, claiming at least 11,000 lives. Frightening, fluorescent bio-hazard suits and containment tents are synonymous with the disease – but it’s the spraying of infected bodies that has become Ebola’s most horrific and enduring emblem.
The virus’s rock-bottom survival rates match every bit its grisly imagery – a full nine-tenths of victims die during the worst outbreaks. Two of the most oft-prescribed Ebola medications, ZMapp and Remdesivir, help put a dent in the contagion’s kill count, but they haven’t proved effective epidemic-enders. Medics are finding new faith in pharmaceuticals however, with the remarkable success of two experimental antibody treatments.
Trial doses of REGN-EB3 and mAb114 have been offered to hundreds of Congolese patients in recent months. Conventional medication saves around 50% of sufferers, test results suggests – that number leaps to two-thirds with the new ‘monoclonal antibody’ drugs. Among those who received the cutting edge treatment early, survival rates were as high as 90%. Enthralled at the results, medical teams have promptly ended the trial and are planning a wholesale roll-out.
“From now on, we will no longer say that Ebola is incurable,” said Prof Jean-Jacques Muyembe, the director general of the Institut National de Recherche Biomédicale in DRC, which has overseen the trial. “These advances will help save thousands of lives”.
But REGN-EB3 and mAb114 will only be as effective as the number of people they reach. Decades of colonial exploitation have embedded a deep distrust of foreigners in Congolese society, especially in rural communities. Sincere as their intentions are, international medics are outsiders – that alone prevents many sickly locals seeking their help.
But rumours also abound as to the authenticity of the epidemic. Many believe the Ebola outbreak to be a hoax devised to rob unknowing victims of their blood and body parts. The dizzying numbers of ill individuals entering treatment centres never to be seen again help sustain such notions.
The new drugs’ heightened survival rates should help dispel suspicion, however, with more and more patients living to tell the tale of their treatment. But even with local fears allayed, there’s a very tangible obstacle to seeking aid – DRC’s rampant violence. The nation’s civil war officially ended in 2003, but rebel groups and armed insurgents remain pervasive. Embroiled in a seemingly ceaseless cycle of conflict with anti-government militias, 16,000 UN peacekeepers fight to uphold order.
The desperate security situation bears heavily on the Ebola fight. Targeting of health workers is commonplace, with at least 200 assaults on treatment centres this year alone. Fearing the fate of their patients, besieged staff are often forced to attempt ward-by-ward evacuations. Fraught at the best of times, these precarious operations invariably end in the virus’s spread, hampering efforts to contain the outbreak.
“[Recent attacks have raised] concerns that armed groups are exploiting the epidemic for broader military or political ambitions,” noted DRC Minister of Health Dr Oly Ilunga Kalenga. “[The attacks] have resulted in recurrent temporary suspension of response activities in affected areas,” he and fellow experts added, writing in the New England Journal of Medicine.
Despite these titanic obstacles, disheartened Congolese officials need only look at neighbouring Rwanda’s public health turnaround. Traumatised by a mid-‘90s genocide, the Rwandan population had little faith in national institutions, medical or otherwise. Desperate to win back their disenchanted citizens – less than 30% of which volunteered for basic immunisation coverage – the government engaged tirelessly with local communities to rebuild trust. In time, the strategy started to pay off. Polls now show 97% of the public have confidence in Rwanda’s health system, and basic immunisation coverage is at 95%.
Attaining such levels of trust may seem fanciful to DRC’s beleaguered healthcare community, but if they’re to prevail in their epidemic battle, public faith has to be won. Effective new medication can help with this – better outcomes inspire greater confidence – but superstitious notions and misplaced fears must be challenged head on. In the Ebola fight, as in any war, only once hearts and minds are won can real victory be achieved.