Terrifying "out of control" outbreak means we may never defeat Ebola

Just when you thought the world had retreated from the edge of the apocalypse, Ebola is back.

The terrifying virus, which can kill up to 90 per cent of those it infects, is now “out of control” in the Democratic Republic of Congo – three years after the disease devastated West Africa, leaving over 11,000 dead.

And experts are warning of a global outbreak even worst than the last one, with a “heightened risk” that the virus could spread beyond the DRC’s borders and into neighbouring countries and beyond.

The worst Ebola outbreak in history was declared over in April 2016, 42 days after the last case tested negative.

But it didn’t take long for Ebola to rear its ugly head once more.

New cases began to emerge in the northeastern parts of DRC 10 months ago, where armed militias in the war-torn country have been fighting each other.

The turbulent security situation means aid agencies and other international response teams have struggled to contain the disease, which has so far claimed the lives of 1,161 people.

More than 300 new cases have been reported in the last month alone, and transmission of the disease is soaring, with former home secretary David Milliband, from the International Rescue Committee, among those warning that the world is once again on the brink of a potential disaster.

“The danger is that the number of cases spirals out of control, despite a proven vaccine and treatment,” he said.

And Jeremy Farrar of the Wellcome Trust, said he was “very concerned – as concerned as one could be”, adding that “the numbers are frightening and the fact that they are going up is terrifying.”

Many might ask why Ebola has been allowed to return – this time with a vengeance – after three years in which the world had time to ensure the virus could never wreak death and devastation on such a massive scale again.

And if a proven vaccine does now exist, how has the disease reemerged in Africa, and in a country which has already seen previous Ebola outbreaks in the last 40 years?

The last, in August 2014, but unrelated to the West Africa epidemic, saw 66 cases and 49 deaths.

In fact despite the frightening possibilities of failing to eradicate the virus once and for all, experts have warned that Ebola may never be consigned to history, and the reasons are complicated.

Firstly, the chaotic situation in the Democratic Republic of Congo, as well as in other African countries vulnerable to Ebola, hasn’t helped efforts to eradicate or contain the disease.

In fact, more than 111,000 people have been vaccinated in the DRC since the outbreak was declared In August last year, but the volatile political situation in the east of the country, with dozens of rebel groups fighting each other over land, natural resources, ethnicity and religion, has frustrated efforts to fight the virus.

In March, medical NGO Doctors Without Borders suspended its work at the epicentre of the new outbreak after rebels attacked and burned down two of its clinics.

And last month last month several gunmen from a local militias killed a doctor fighting the disease, Richard Mouuzoko, an epidemiologist from Cameroon, after raiding a hospital in the city of Butembo, one of the epicentres of the Ebola outbreak.

The attackers were reportedly targeting foreigners because they incorrectly believed conspiracy theories taking hold in the region that foreigners had brought the Ebola virus to Congo.

Many in the region, an opposition stronghold 1,000 miles away from the capital Kinshasa, believe that Ebola has been deliberately imported by the national government, in order to decimate the population.

Before the arrival of the disease, 800 people had been killed in a series of massacres carried out by unidentified assailants which many believed had links with the Congolese army.

The attacks on Ebola workers have led to many NGOs and health professionals suspending their work, which have given the virus time to spread.

Distrust among locals has also meant that the Ebola response team are often turned away when they arrive at a grief-stricken home, or even attacked by relatives.

One team member, Philemon Kalondero, said that while at the start of the outbreak police would remove the bodies from homes, at gunpoint if necessary, “the new protocol is that we just abandon the body.

They will learn their lesson when they get sick.”

Similar occurrences have been seen in other Ebola outbreaks in the region, such as in Sierra Leone when thousands tried to burn down the country’s main Ebola hospital in Kenema, claiming the deadly virus had been invented to cancel “cannibalistic rituals” there.

But the complicated political situation and propensity towards conspiracy theories in many countries vulnerable to Ebola isn’t the only reason many are pessimistic about one day emerging victorious in the fight against the virus.

Richard Preston, an author and infectious disease expert, points out that scientists have not yet developed a form of the Ebola vaccine which doesn’t need to be kept refrigerated.

He said: “Ebola vaccine has to be kept cold. But in tropical areas where little refrigeration is available, the vaccine can quickly become useless.”

Another reason, he said, is the failure of the countries’ health systems to use a technique called ‘ring vaccination’ which has successfully halted other viruses in the past.

He said: "In 1966, during a large outbreak of smallpox virus, vaccinators tried ring vaccination with great success.

“They vaccinated people in a ring around the infected person. This trapped the virus inside a wall of immune people and stopped it from spreading.

“But attempts to use the technique with Ebola have run into problems. Ring vaccination requires a stable government or other authority maintaining civil order.

“The areas with Ebola outbreaks in the Democratic Republic of the Congo are controlled by violent militias that won’t let vaccinators do their work.”

Perhaps the most compelling reason Ebola may never be defeated, however, is that there simply isn’t the will among the world’s richest countries to do so.

Because the current form of the virus requires very close contact with another human to spread, Western governments know the likelihood of the epidemic spreading outside of Africa is low.

Professor Peter Piot, the Belgian scientist who helped discover the Ebola virus, said recently: “Spreading in the population here, I’m not that worried about it.

“I wouldn’t be worried to sit next to someone with Ebola virus on the Tube as long as they don't vomit on you or something. This is an infection that requires very close contact."

It means that Western governments have not made finding a cure for Ebola a priority, while private companies are less inclined to invest millions in developing a vaccine for poor African countries struggling with war and economic collapse.

Most of the money destined to the fight against Ebola comes from philanthropists, such as Microsoft co-founder, billionaire Paul Allen, who donated £100 million in 2014.

Another problem with the development of vaccines is that there are five or more strains of the virus – once an effective vaccine for one strain has been developed, other variations of the virus may already have emerged, making containment even more difficult.

And as much as the scientific community has tried to understand Ebola, they still many gaps in that knowledge.

As Richard Preston says: “Ebola remains mysterious. It is unbelievably aggressive in the human body, but scientists still don’t understand all the virus’s mechanisms.

“The great military strategist Sun Tzu said, ‘Know your enemy.’

“We’re still getting to know Ebola. When we finally do, we’ll know the paths to defeat it.”

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