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Two cases of Ebola in the Democratic Republic of the Congo have raised alarm bells. It is not for less: this disease has an average mortality rate of 50%, although it can be even higher. It is the sixth outbreak in five years of a virus that is reappearing with increasing frequency in regions of sub-Saharan Africa.
Again, the same news: in the Democratic Republic of the Congo Two cases of Ebola have been detected. It has happened fourteen times since the disease was discovered precisely in this country in 1976. The deadliest outbreak was between 2018 and 2020, with more than 2,200 victims, but since then there have been small reappearances of the virus that have claimed a few dozen lives. in several years.
In this case, Ebola was found again in two people in the city of Mbandaka, in the northwest of the country. Both patients died days after starting to show symptoms. Local and international authorities are now ready to respond, as they have done six times in five years in the Democratic Republic of the Congo.
“WHO is supporting the government to strengthen testing, contact tracing and public health measures. Ebola vaccine stocks in Goma and Kinshasa are already being transported to Mbandaka for vaccination to start,” said Tedros Adhanom Ghebreyesus, director of the World Health Organization, on April 26.
The scope and risk of this outbreak is still unknown. Perhaps, as has happened on recent occasions, it will be brought under control after a short time and will not take on tragic dimensions as in 2018, or as in the first major Ebola epidemic in 2014 that affected Liberia, Guinea and Sierra Leone and caused more of 11,000 fatalities.
However, the alarm remains: while there have been 14 outbreaks in the Democratic Republic of the Congo since 1976, the pace has recently accelerated. Six shoots in five years is proof.
Why is the Ebola virus reappearing?
There are four different species of Ebola virus detected to date that can infect humans. The microorganisms have lived in wild animals in sub-Saharan African regions, probably since long before 1976, and sometimes jump to people through contact between bodily fluids, something that can happen in humans who work closely with wildlife.
On the one hand, the virus can hide in survivors and reactivate years later, although the mechanism through which this happens has not been completely clarified to date, since this possibility was recently discovered. On the other hand, it may happen that there are new “spillovers”, “spills” from wildlife to humans. This is what has happened in Mbandaka this time, and it is the most common Ebola re-emergence pathway.
This risk increases as contact between humans and fauna grows: major drivers of this contact are climate change and deforestation, for example, which causes changes in animal habits, or mining, which pushes humans to little explored areas.
The dynamics of recent decades have favored this rapprochement and have increased the risk of Ebola outbreaks. Nor does it help prevention not yet knowing which group of animals is the original reservoir of the virus: it is suspected that it could be bats, although there are still no conclusive certainties.
How to prevent this disease?
In addition to avoiding contact between possible reservoirs of the virus in fauna and taking care of human-to-human interactions, for now the other alternative to prevent Ebola outbreaks is vaccination. There are two approved drugs, one developed by the pharmaceutical company Merck called Ervebo, for a single dose, and another from Johnson & Johnson, which requires two doses applied eight weeks apart.
International organizations have prioritized Ervebo to respond to emergencies, since the other vaccine is not suitable for a rapid reaction. As will happen during these weeks in Mbandaka, the immunization strategy in the case of Ebola consists of vaccinating the close contacts of the cases and also the contacts of the contacts, a formula called “ring vaccination” and that seeks to cut the chain of transmission to contain the outbreak.
However, this has worked in recent cases, where a few thousand people have had to be inoculated. Several experts fear that this will change in cases of larger outbreaks and that people will not be immunized: in fact, there are only a few thousand Ebola vaccines worldwide.
In January 2021 a world reserve of this drug was created managed by the International Coordination Group, which integrates the WHO and other organizations such as Doctors Without Borders. The idea is to store the vaccines and move them to the places where they are required in an emergency. The reserve aspires to have half a million doses, but at the time of its creation it had less than 7,000. Of this, 4,800 have been distributed to the Democratic Republic of the Congo.
The problem? The money. The demand for the Ebola vaccine is very small, compared to the billions of doses against Covid-19 that are being sold. For private companies like Merck, for example, it doesn’t pay to produce them. Doctors Without Borders also denounced in January 2021 that the international reserve had a purchase agreement with the pharmaceutical company for almost 100 dollars a dose, a prohibitive price to acquire the vaccine in a massive way.
With accelerating climate change, the discovery of latent viruses in ancient survivors, and a shortage of vaccines, many warn that it is only a matter of time so that the next Ebola outbreak reaches feared dimensions and that we do not have the tools to contain it.
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