The Ebola Outbreak in DRC Isn’t Going Well. The Strategy Has to Change.

In May I wrote that Ebola was back in the Democratic Republic of the Congo and could still be stopped. In June I wrote that the numbers were understating how fast it was moving, and that this was a stress test the world was failing. Three months on, this is a humanitarian disaster and epidemic rolled into one, and it’s getting worse. If we don’t address the needs of communities and health care workers in DRC, the Ebola emergency will continue.

Earlier this week, DRC confirmed more than 5,000 cases and nearly 2,400 deaths, making it the deadliest Ebola outbreak in the country’s history, and the fastest-growing ever recorded anywhere. The 2014 West Africa outbreak took nearly five months to reach 1,000 deaths. This one got there in under three.

None of this is for lack of effort. Health workers in Bunia and Goma in eastern DRC are running treatment units inside an active conflict zone. Some have had to bury colleagues who caught the virus and died from caring for patients. WHO has reported that at least 155 health workers have been infected and 45 have died. Hundreds of thousands of people have been displaced by fighting in the same provinces where the virus is spreading. People on the ground are doing extraordinary work in dangerous conditions.

There’s no licensed vaccine for this strain, and the response has focused on case finding and isolation, contact tracing with 21-day follow-up, safe and dignified burials, supportive clinical care, and community engagement—all part of the classic playbook. That playbook stopped Ebola before, in 2014, without a vaccine either. But we need an even more robust strategy, focused on building trust and meeting people’s basic needs, to stop this one.

As bad as the reported numbers are, the numbers behind the numbers are worse. Between six and seven of every ten people who die in this outbreak are dying at home, not in a treatment center. Part of the reason is conflict, limiting where contact tracers and burial teams can safely go, and because of backlogs getting tests done. But most of it is trust: unfortunately, many people aren’t choosing care. They may not know what symptoms to look for until it’s too late or what treatment options are available. Families may not trust that authorities will be sensitive to their needs during the worst moments of their life.

This outbreak is doing damage beyond its case count. Maternal deaths in the Ituri province have roughly doubled since May, as pregnant women skip prenatal visits and hospitals reroute staff to Ebola care. Women are dying of preeclampsia and obstructed labor, conditions we know how to treat, because the health system, never strong in this area, has been badly disrupted.

There is real reason for hope on the science. Three efforts are moving at once: a Phase 1 trial of a Bundibugyo-specific vaccine, a treatment trial that’s already enrolled 100 patients, and a Phase 3 trial testing whether Ervebo—a vaccine licensed only for the Zaire strain—also works against Bundibugyo. Africa CDC has also approved limited useof Ervebo for the frontline workers most at risk, even before that trial reports results. Because trial protocols were written before this outbreak was declared, testing has moved unusually fast.

But building trust in communities is likely to make the most difference now. Providing essential health services and addressing the underlying humanitarian crisis is essential. People at risk must receive clear guidance from leaders they know and respect about how to recognize symptoms, report concerns, and seek care, as WHO notes. They also need to be offered holistic support by government and partners, including food, water, protection from violence, and when tragedy strikes, safe and dignified burial.

Because Ebola can still be spread after a person infected with the virus has died, burials and funerals must be handled with extreme care. In Guinea, U.S. CDC epidemiologists found that contacts of Ebola patients who had died were three times more likely to develop Ebola themselves. This has become a point of conflict for friends and relatives of Ebola victims who want to honor their loved ones according to tradition. Providing safe and dignified burials is one of the most powerful tools we have to stop Ebola, but it’s also one of the hardest jobs. When handled well, safe and dignified burials can limit spread and open new opportunities for community engagement.

Ebola can be stopped and people who seek care can recover. Uganda declared its own linked outbreak over on July 28, after 20 cases and two deaths, by moving fast and keeping communities at the center. DRC and Uganda’s continued partnership on contact tracing and data sharing across their border is crucial.

Stopping this outbreak requires an African-led response, with DRC’s government, Africa CDC, and WHO’s African region setting the strategy and the rest of the world supporting it. The people who know how to stop this outbreak—Congolese and Ugandan clinicians, contact tracers, community health workers—are the same people who just stopped it next door and have stopped Ebola outbreaks in the past.

Time is lives. Every day this humanitarian crisis grows is a day more mothers, more health workers, more children are at risk. The virus is moving fast and efforts to build trust have to move just as fast—that means expanding outreach by trusted voices, ensuring safe and dignified burials, and providing communities with the support they desperately need and fully deserve.

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