Congo's Ebola Outbreak Reaches an Eighth Province as Response Trails the Virus
Congo's Ebola outbreak has spread to an eighth province in the country's north, the Health Ministry said on Sunday, October 18. The announcement came as the world's fastest-growing Ebola outbreak on record continues to outpace the response built against it.
The ministry recorded two cases, one of them fatal, in Nord-Ubangi province, which borders the Central African Republic. Both patients were men in their 20s living in the Wapinda health zone, on the border with Bas-Uele province, where cases had already been reported. Nord-Ubangi sits between Sud-Ubangi and Bas-Uele, the last two provinces the virus reached as it moved along the Central African Republic frontier, where recurring armed violence has pushed thousands of people into Congolese border communities.
Reuters reported on October 15 that a local health official had described a series of suspected deaths in a mining area of Wapinda, prompting samples to be sent to a provincial laboratory and to Kinshasa. The European Centre for Disease Prevention and Control had already logged cases from media reports before the ministry spoke: as of October 14, its page listed 13 confirmed cases and four deaths in Bas-Uele, plus two cases and one death in Sud-Ubangi. Neither the ministry account nor the ECDC says whether those cases are connected to the two men in Wapinda.
Authorities have recorded at least 9,400 cases, including more than 4,500 deaths, since the outbreak was declared in mid-May, making it the deadliest in Congo's history. Xinhua put the count at 9,415 confirmed cases and 4,536 deaths as of Friday, a case fatality rate of 48.2 percent. Kenya Today reported 67 new confirmed cases and 26 deaths in the 24 hours to October 16, with eastern Ituri accounting for most of the new infections.
Government data show 66 health zones have been affected since the outbreak began, with Ituri still accounting for almost three-quarters of confirmed cases. The eight affected provinces are Ituri, North Kivu, South Kivu, Haut-Uele, Tshopo, Bas-Uele, Sud-Ubangi and Nord-Ubangi.
"We see pockets of Ebola generally going down, but unfortunately geographically it's spreading out," Mohamed Yakub Janabi, the World Health Organization's regional director for Africa, told the Associated Press in an interview in Beni, eastern Congo, on Friday.
Congo's state news agency ACP reported Sunday that North Kivu — where the WHO says substantial transmission continues — will bar people arriving from Ituri for one week from Monday. Other measures include limiting motorcycles to two passengers and cars to four, and suspending large public gatherings such as mass sports events, nightclubs and political demonstrations.
This outbreak is caused by the Bundibugyo strain of Ebola, for which there is no fully validated vaccine or specific treatment. Ervebo, licensed for the more common Zaire strain, is still being studied for possible cross-protection, and WHO's vaccine advisers have recommended that it be used for research purposes initially, with its unknown efficacy clearly communicated. The outbreak was declared in mid-May and is Congo's 17th; experts believe the virus may have emerged weeks or even months earlier. Responders point to funding cuts, gaps in surveillance, armed conflict and the absence of approved countermeasures for this strain.
WHO experts said on October 14 that the first clinical trial of an Ebola vaccine is expected to begin in Congo by the end of October. Doctors Without Borders is running a data-gathering study, not a full trial, on Ervebo's effectiveness in frontline health workers, offering the jab to volunteers as an interim measure. Two Bundibugyo-specific candidates — from the University of Oxford and US-based Moderna — are in early trials; the Oxford shot began Phase Ib testing in Uganda on October 6.
Africa CDC Director-General Jean Kaseya said in Kinshasa on October 14 that donors reported disbursing about $962 million to implementing partners, but a joint verification exercise with Congolese health authorities could trace only slightly more than $200 million, leaving more than $700 million unaccounted for. He said it was too early to speak of embezzlement but called the gap a serious transparency and financial reporting problem. The World Bank said on October 13 it has committed $426.6 million to the overall Ebola emergency response, including $80 million newly earmarked for Congo's national response and $13 million to help neighbouring countries and regional bodies tighten cross-border health security.
A Kenyan citizen who had been living in Congo flew through Kampala and tested positive after arriving in Nairobi, dying on October 5. Kenya confirmed a second case on October 15 — a 39-year-old male relative of the first patient who developed symptoms on October 13. Uganda says it has no local transmission; its own outbreak was declared over on July 28 after 20 confirmed cases and two deaths. WHO said on October 16 it has scaled up Ebola readiness in 22 countries across three continents, warning that conflict, insecurity and restricted access make the work harder.
The next few weeks turn on three things: whether the vaccine trial starts on schedule by the end of October, whether the missing donor money can be traced, and whether North Kivu's one-week entry ban and gathering restrictions slow the virus. WHO has already declared the outbreak a public health emergency of international concern and keeps repeating that the binding constraint is not vaccine supply but whether money reaches the staff running treatment centres.