Efforts to contain the latest deadly Ebola outbreak in the Democratic Republic of Congo (DRC), which had infected 381 people and claimed 64 lives as of June 3, face significant hurdles, starkly illustrated by the challenge of families conducting their own funeral rites, a practice with the potential to spread the virus to dozens.
For Marie Roseline Belizaire, WHO Africa Region Director for Emergency Preparedness and Response, the virus itself isn’t always the most difficult adversary. Engaging with families who believe the disease is caused by witchcraft, persuading traditional healers to cooperate with health teams, or managing the reintegration of health workers returning to communities that only days prior posed a threat are all complex processes.
“We are not trying to override their culture. We are trying to integrate science into their beliefs,” Belizaire stated.
Progress Made, But Not Yet Controlled
The epidemic, caused by the rare Bundibugyo strain of the Ebola virus for which there is no vaccine or cure, continues to spread in eastern DRC, with cases also reported in neighboring Uganda. Belizaire, speaking from Bunia in Ituri province, noted significant gains in the response, particularly in testing capacity, over recent weeks.
At the outbreak’s onset, laboratories could process approximately 40 tests daily. This capacity has since expanded to 800 tests per day, allowing for much quicker confirmation or exclusion of suspected cases. “We are using almost all the tests we receive on the same day. The waiting time for results has decreased. We get results within 24, at most 48 hours,” Belizaire added.
Alerts from communities are investigated on the ground, and those matching the case definition are tested to confirm or rule out the outbreak. This allows suspected cases to be cleared from the system more rapidly than at the beginning of the epidemic.
Enhanced Surveillance
While contact tracing rates have increased from 25% to 45%, they remain significantly below the 90% to 95% coverage needed for effective control of transmission. “We still have many challenges,” Belizaire acknowledged, highlighting that the regional dimensions of the epidemic continue to be a source of concern.
Uganda has recorded 15 confirmed and one probable case linked to the outbreak. The travel history of a Congolese national through the United Arab Emirates before arriving in Uganda underscores how rapidly infectious diseases can cross borders. “When there is an epidemic and there is mobility, it is always a concern,” Belizaire said, emphasizing that mechanisms like the WHO International Health Regulations help countries share information rapidly and coordinate responses.
Public Health Trust
One of the most intricate tasks for WHO teams on the ground is building trust. Many communities in affected areas have endured years of conflict and insecurity. Cultural beliefs and misinformation also shape how people interpret illness and death. “The symptoms of the disease are very similar to the symptoms of malaria in the community,” Belizaire explained.
Some families attribute deaths to witchcraft or poisoning rather than infection. Health workers therefore focus on coexistence rather than confrontation. “We are not stopping them from believing in witchcraft or other things in their culture. We just want them to also believe in the existence of the disease,” Belizaire said.
Ancient and Modern Approaches
Traditional healers are also being included as partners rather than excluded. “We are not stopping them from going to traditional healers. We tell the healers, if you see someone with these symptoms, please refer them to us too,” Belizaire stated. This approach reflects lessons learned from previous Ebola outbreaks, where mistrust could be as dangerous as the virus itself.
WHO Director-General Tedros Adhanom Ghebreyesus, who recently visited the epicenter of the outbreak, warned, “Misinformation is as dangerous as the virus, and it spreads just as fast.”
Reasons for Hope
Despite the challenges, there are also encouraging signs. Seven individuals, including six health workers, have recovered from Ebola. Most received intensive supportive care, such as early treatment and rehydration, along with symptomatic management, as their immune systems fought the infection. “They recovered because they went to the hospital early,” Belizaire said.
Candidate Vaccines Under Development
Currently, there is no licensed vaccine or approved treatment for the Bundibugyo strain, but candidate vaccines are in development. Belizaire stressed that even a vaccine would not replace the need for early diagnosis and treatment. “The important thing is to go to the health center as soon as you have symptoms,” she said.
A Survivor’s Resolve
One of Belizaire’s most memorable encounters involved a female health worker who contracted Ebola while treating a patient. The health worker subsequently recovered. She expressed her intention to continue serving others rather than leave her profession. “She said she would not stop. She said she was born to take care of others and she would continue to do so,” Belizaire recalled. This story reflects the resilience of health workers and communities confronting the epidemic daily.
