Tuesday August 20, 2019

Deep Distrust Severely Undermines Efforts by Public Health Authorities in Congo

Until his last breath, Salomon Nduhi Kambale insisted he had been poisoned by someone and that was the reason he was vomiting blood

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Parents and children wait to be vaccinated in Beni, Congo, July 13, 2019. VOA

Until his last breath, Salomon Nduhi Kambale insisted he had been poisoned by someone and that was the reason he was vomiting blood. The 30-year-old man wouldn’t give community health teams his phone number, and when they found it, he hung up on them.

Health workers were desperate to persuade him to get vaccinated for Ebola after a friend fell ill with the lethal and highly contagious disease.

But within days, Nduhi was dead. His widow and their four young children were given his positive Ebola test result and a chilling warning from a team of health workers: “If you don’t accept vaccination, you can prepare to die.”

Deep distrust — along with political instability and deadly violence — has severely undermined efforts by public health authorities in Congo to curb the outbreak by tracing and vaccinating those who may have come into contact with infected people.

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A child is vaccinated against Ebola in Beni, Congo, July 13, 2019. VOA

Health experts agree the experimental Ebola vaccine has saved multitudes in Congo. But after nearly a year and some 171,000 doses given, the epidemic shows few signs of waning. The virus has killed more than 1,700 people and has now arrived in the region’s largest city, Goma. The World Health Organization last week declared the outbreak a global health emergency.

During the 2014-16 Ebola epidemic in West Africa, which left more than 11,300 people dead, health workers could only dream of a vaccine with a 97.5 percent effectiveness rate that could improve the odds of survival even in those already infected.

“We have it now and it’s not the miracle we wanted it to be,” said Dr. Joanne Liu, president of Doctors Without Borders. “The fact that we’ve used so much vaccine, and the epidemic hasn’t stopped, that shows us that contact tracing is not great.”

WHO says as many as 90 percent of those eligible for vaccination have accepted it, but that figure only includes those who gave contact tracers enough information to be included on a list. The success rate excludes those who distrusted health workers and fled, or those who couldn’t be found in the first place.

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Health workers have been using what is known as a ring vaccination strategy: The vaccine is first given to those who were in close contact with a sick person. Then a second so-called ring is created by giving the vaccine to those who were in contact with those people.

Because of the difficulties in making that strategy work, some people didn’t get vaccinated until they had already been infected with the virus, and they developed Ebola anyway. That increased doubts about the vaccine in communities where the public health campaigns led by outsiders already were viewed with suspicion and hostility.

“The rumors were if you got vaccinated you would die,” said Liboke Kakule Muhingi, a 43-year-old farmer in Mangina, where the epidemic began last August.

His mother was among the first to die. Then, one by one, six of his sisters who had cared for their ailing mother were killed by Ebola. Kakule accepted the vaccine and made sure his wife and eight children got it, too.

Distrust, Public, Congo
Burial workers dressed in protective gear carry the remains of an Ebola victim in Beni, Congo, July 14, 2019. VOA

“If I hadn’t, we’d all be dead,” he said.

In some cases, health teams have been unable to reach certain areas because of violence or rebel activity. Earlier this month, the head of the Congolese health ministry’s response efforts in Beni was at one point unable to return from a field visit while the military battled ADF rebels, who are linked to the Islamic State.

More often, though, contact lists have fallen apart simply because people have deliberately evaded health workers or did not understand they shouldn’t travel after being exposed. A pastor who became the first confirmed case in Goma had apparently put down fake names at health checkpoints to avoid detection. He had been sickened in the town of Butembo and then took a bus while ill.

WHO and the Congolese health ministry have now switched tactics and are offering the vaccine to anyone who wants it.

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With Ebola’s arrival in Goma, a city of more than 2 million people, some wonder whether there will be enough of the vaccine if the outbreak continues.

The vaccine’s manufacturer, Merck, said it has 245,000 1-millileter doses on hand and that could rise to 900,000 over the next 18 months. The dose in Congo also has been reduced to 0.5 mL, effectively doubling the supply.

“Whether or not the available doses are sufficient to fulfill the demands depends on the evolution of the outbreak, the access to the communities and the successful expansion of the production of additional doses by Merck in early 2020,” WHO said.

There is a second experimental vaccine, produced by Johnson & Johnson, but health officials in Congo have said it will not be used because it needs further testing and would cause too much confusion. It requires two doses given one month apart.

It’s unclear how long the Merck vaccine will protect people. Scientists know from early studies that it lasts for at least a year, but the epidemic is approaching that limit. The only study to report longer vaccine durability tracked only a small number of healthy volunteers in Geneva for two years.

The new strategy of giving shots to anyone who wants them involves setting up “pop-up” sites in the neighborhoods most affected. Last week a vaccination team headed to the neighborhood in Beni where Nduhi’s wife had stayed after he died.

Outside the mud-brick home where his children still lived, a pickup truck full of plastic tables and chairs pulled over. Soon a tent was set up, and vaccination teams donned eye protection and yellow surgical gowns. Neighborhood children climbed the trees to watch.

Baraka Kathembo Makasi, a 22-year-old motorbike taxi driver, brought his wife and two children with him.

“At first I refused,” he said, “but I started seeing people die and decided to go.” (VOA)

Next Story

Two of Four Experimental Ebola Drugs Tests in Congo Saving Lives

The preliminary findings prompted an early halt to a major study on the drugs and a decision to prioritize their use in the African country

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Ebola, Drugs, Congo
FILE - Health workers wearing protective gear check on a patient isolated in a plastic cube at an Ebola treatment center in Beni, Congo, July 13, 2019. VOA

Two of four experimental Ebola drugs being tested in Congo seem to be saving lives, international health authorities announced Monday.

The preliminary findings prompted an early halt to a major study on the drugs and a decision to prioritize their use in the African country, where a yearlong outbreak has killed more than 1,800 people.

The early results mark “some very good news,” said Dr. Anthony Fauci of the U.S. National Institutes of Health, which helped fund the study. With these drugs, “we may be able to improve the survival of people with Ebola.”

The two drugs — one developed by Regeneron Pharmaceuticals and the other by NIH researchers — are antibodies that work by blocking the virus.

Ebola, Drugs, Congo
FILE – A man receives a vaccine against Ebola from a nurse outside the Afia Himbi Health Center in Goma, July 15, 2019. VOA

While research shows there is an effective albeit experimental vaccine against Ebola — one now being used in Congo — no studies have signaled which of several potential treatments were best to try once people became sick. During the West Africa Ebola epidemic several years ago, studies showed a hint that another antibody mixture named ZMapp worked, but not clear proof.

So with the current outbreak in Congo, researchers compared ZMapp to three other drugs — Regeneron’s compound, the NIH’s called mAb114 and an antiviral drug named remdesivir.

On Friday, independent study monitors reviewed how the first several hundred patients in the Congo study were faring — and found enough difference to call an early halt to the trial. The panel determined that the Regeneron compound clearly was working better than the rest, and the NIH antibody wasn’t far behind, Fauci explained. Next, researchers will do further study to nail down how well those two compounds work.

The data is preliminary, Fauci stressed. But in the study, significantly fewer people died among those given the Regeneron drug or the NIH’s — about 30% compared to half who received ZMapp. More striking, when patients sought care early — before too much virus was in their bloodstream — mortality was just 6% with the Regeneron drug and 11% with the NIH compound, compared to about 24% for ZMapp, he said.

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Among people who receive no care in the current outbreak, about three-fourths die, said Dr. Michael Ryan of the World Health Organization. All of Congo’s Ebola treatment units have access to the two drugs, he added, saying he was hopeful that the news would persuade more patients to seek care — as soon as symptoms appear.

Quick care ‘vital’

Tackling Congo’s outbreak has been complicated both by conflict in the region and because many people don’t believe Ebola is real and choose to stay at home when they’re sick, which spurs spread of the virus.

“Getting people into care more quickly is absolutely vital,” Ryan said. “The fact that we have very clear evidence now on the effectiveness of the drugs, we need to get that message out to communities.”

Ebola, Drugs, Congo
Two of four experimental Ebola drugs being tested in Congo seem to be saving lives, international health authorities announced Monday. Pixabay

Fauci said Regeneron and Ridgeback Biotherapeutics, which has licensed the NIH compound, told authorities enough doses are readily available.

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One issue researchers will have to analyze: Occasionally people who receive the Ebola vaccine still become sick, including some in the treatment study, which raises the question of whether their earlier protection inflated the drugs’ survival numbers. (VOA)