Ebola Outbreak in the Democratic Republic of the Congo: A Snapshot of Community Engagement and Medical Interventions

According to the WHO, as of 17th June 2018, there were 62 cases of Ebola -confirmed, probable and suspected- including 28 deaths

It’s been almost six weeks since the declaration of the ongoing Ebola outbreak in the Northwestern part of the Democratic Republic of Congo. According to the World Health Organization (WHO), as of 17th June 2018, there were 62 cases of Ebola -confirmed, probable and suspected- including 28 deaths. There has been considerable effort by the Ministry of Health, the WHO and several organizations such as Médecins Sans Frontières (MSF) and the International Red Cross Federation in order to scale up interventions and reach the remote regions of the Equateur province, in the Northwest of the country.

Community engagement and awareness of the disease continue to be a challenge as most people don’t want to go to health facilities to be tested

Community engagement and awareness of the disease continue to be a challenge as most people don’t want to go to health facilities to be tested, thus risking spread of the infection. This could be attributed to the mistrust of the health system. Furthermore, geographical and physical access to individuals remains a challenge due to poor infrastructure and remoteness of the outbreak region. To address these challenges, innovative participatory people-centered interventions and engagement of community health workers in these regions will play a crucial role.

World Health Organization. Graphic from the External situation report (June 17). 

Medical technologies

This Ebola outbreak has seen the massive use of new tools for controlling the outbreak

This Ebola outbreak has seen the massive use of new tools for controlling the outbreak. This includes the rapid diagnostic tests such as GeneXpert, an automated PCR device, commonly used for diagnosis of Tuberculosis and most importantly, an investigational Ebola vaccine, which is being administered under the “compassionate use” principle, which allows unlicensed but probably effective drugs to be used in the event of emergencies. The vaccine is being offered to close contacts of Ebola patients, contacts of contacts, and frontline health care workers, after their informed consent.  

Additionally, two other rapid diagnostic tests (RDTs) are being field-tested. They are ReEBOV and OraQuick, which are dipstick immunoassays that, like widely used malaria and HIV RDTs, require pin prick blood samples and can be used by field workers with basic training in biosafety. In spite of the need for further testing, these tests have the potential to facilitate early detection and isolation which is critical in outbreak scenarios.  

On June 4 2018, an ethics committee in the Democratic Republic of the Congo (DRC) approved the use of five investigational drugs to treat Ebola, under the framework of compassionate use/expanded access. They are Zmapp, Remdesivir, REGN monoclonal antibody combination, Favipisavir and mAb114. According to the WHO, clinicians working in the treatment centres will make decisions on which drug to use as deemed helpful for their patients, and appropriate for the setting.

Most of these drugs are at the early stages of development and have limited patient safety, efficacy and effectiveness data

Most of these drugs are at the early stages of development and have limited patient safety, efficacy and effectiveness data. Given the few patients currently in care, testing these new drugs will be difficult. But if they are used, it should be done correctly. The intentions, risks and expected outcomes when using these drugs need to be clear and transparent, while maintaining upmost respect and integrity of the patients. The patients should at all times remain the key priority! Future trust between the community and the health system will much depend on how the situation is handled now.

The use of new medical technologies presents promising interventions for the Ebola outbreak control. However, the participation, understanding and respect of communities affected by outbreaks remains a cornerstone to the successful control of the Ebola outbreak.