Politics and mistrust of foreigners slows fight against Ebola

The Zaire Ebola virus, the deadliest type with a 90 percent mortality rate, seems unstoppable in its tenth invasion of the conflict-hit Democratic Republic of Congo (DRC)'s North Kivu and Ituri provinces.

A total of 1,586 people, including dozens of health workers, have succumbed to the disease out of 2,354 registered cases (2,260 confirmed and 94 probable) and 654 people have been cured, according to the this month's figures from the DRC health ministry.

The current outbreak is the second-largest after the one that struck West Africa between December 2013 and January 2016, killing 11,323 people out of a total 28,646 registered cases.

If the international community succeeded against all the odds in neutralising the worst Ebola outbreak in West Africa last time, this time, the situation is quite different.

The virus has struck at the heart of resource-rich areas ravaged by decades of armed conflict, political instability, grinding poverty, and gang-rape against the backdrop of a huge humanitarian crisis. All these factors have complicated the efforts to stop the virus from spreading further, and cases of the virus have already been documented across the border in Uganda.

Like in the province of Equateur last year, community mistrust has come back to haunt the World Health Organization (WHO) and international non-governmental organisations involved in the fight to stop the deadly virus. 

Now, hopes to stop the disease from spreading to other countries have begun to fade as the DRC government and the international community face challenges on all sides and seem to be running out of ideas. This has prompted many observers to believe that the battle is far from over amid what looks like a sea of insurmountable challenges.

"The response has been interrupted and hampered by combat, strikes, protests, the nonpayment of government workers’ salaries, and the communities’ mistrust, which was exacerbated by the decision in December to delay elections in cities affected by Ebola. Since then, attacks on healthcare facilities and workers have risen markedly," WHO spokesperson Christian Lindmeier told TRT World this week.

Unwelcome

Isaac Amisi, 40-year-old businessman told me that the postponing of the December 30 elections in Butembo for "so-called health and security reasons" marked a turning point in the fight against Ebola.

He says that many people in the DRC subscribe to the theory that the international community teamed up with former president Kabila to deny people a crucial moment in history to exercise their constitutional duty to vote.

"Forget about the armed groups, Kabila knew he would not win here, that's why he told the white people to bring Ebola and use it an excuse to break our hearts. The white people put him in power and have been supporting him for 18 years even if they knew he was acting as a dictator using brutal methods towards his people," Amisi told TRT World over the telephone from the city of Butembo.

Butembo and Beni, two strategic cities in the North Kivu province, are opposition strongholds.

"Hence, the hostile attitude towards the white people's Ebola response. We don't want the useless UN to tell us to calm down. We want politicians to come here in Butembo to apologise for what they did to us and tell us that it was not a deliberate plot," Amisi added.

Last week, a former exiled opposition politician, rebel leader and staunch Kabila rival, Antipas Mbusa Nyamwisi, visited Butembo and held a public meeting where he urged the people of Butembo to stop their anti-Ebola stance and trust teams responding to this disease.

"We are happy that he came to see us and speak to us because we felt abandoned by Kabila and his people," Amisi said.

Critical to the response

Medecins Sans Frontieres (MSF) communications adviser Francesco Segoni, whose organisation seems to have borne the brunt of the anti-Ebola politicisation in North Kivu province, told TRT World that the community's trust was vital in the fight against the outbreak.

"We have been facing major challenges in the intervention and eleven months after its declaration, the outbreak is not under control. We know we have to improve on several fronts, beginning with our ability to engage effectively with the population: we have to earn their trust and facilitate their participation in the efforts," Segoni explained.

He says that they have to listen to the needs of these communities as the people have endured armed conflict for over twenty-five years and have suffered from many other health issues, without drawing the level of attention that the Ebola outbreak has brought.

"We have valuable tools in the battle against the disease, including now the possibility of strengthening the vaccination program, as announced recently by the ministry of health. We have to double our efforts, we cannot afford to be discouraged."

First time in northeastern DRC 

UNICEF spokesperson Marixie Mercado, who is currently visiting the Ituri province told TRT World from the city of Bunia that a fundamental challenge was to get communities who have never experienced Ebola to understand and accept what looks and feels to them like an alien and overwhelming, maybe even unnecessary, response.

"This may be DR Congo’s tenth and largest outbreak, but it is the first in the northeast. We’ve made important headway, but success ultimately hinges on going from community acceptance of the response to community ownership."

Mercado stressed that the community needs to be driving the crucial work of bringing knowledge and awareness into households. They need to be the ones supporting grieving families, and helping to find "culturally appropriate and bio-medically safe burials, and helping to decontaminate households."

He stressed that defeating Ebola in a context like that of northeastern DRC, which was in crisis long before the Ebola outbreak, also requires far more than outbreak control.

"Too many children are still being infected in health centres because health workers aren’t equipped with the skills and resources they need. Access to safe water is a massive challenge. Schools – which are so critical in helping to protect children from disease, need to be more empowered. We need to help create the broader environment that not only defeats Ebola but strengthens the community’s resistance to disease in general," she explained.

Insurmountable?

The International Federation for Red Cross and Red Crescent Societies (IFRC) says the challenges are not insurmountable despite the extremely complex obstacles.

"Critical to ending this outbreak is building community trust by addressing their fears and concerns. This takes time and resources. But we have seen our investment pay off when it comes to acceptance of Red Cross safe and dignified burial teams. Volunteers have conducted more than 5,000 burials for families who have lost loved ones suspected of Ebola," Euloge Ishimwe, IFRC communications manager for Africa region, told TRT World.

According to the Red Cross, the success rate of burials has remained high at 80 percent. He also concedes that a greater emphasis needs to be focused on community fears and concerns.

"Health outbreaks begin and end in the communities. This is why it is critical that more investments are needed in locally-led response approaches," he added.

A new approach

One strategy to prevent the spread of the virus is 'ring vaccination', a process where only those who are most likely to be infected will be vaccinated. 

"We are also pinning our hopes on ring vaccination, which we strongly believe will go a long way toward stopping the disease from spread further and spill over to neighbouring countries," a health ministry official told TRT World on condition of anonymity as he was not authorised to speak to the media.

A total of 146,316 people have already been vaccinated against Ebola in the DRC, according to recent figures from the health ministry.

The ministry said that it recently held a two-day meeting with national and international experts on Ebola and vaccination to gather scientific evidence and technical data on the four most advanced Ebola experimental vaccines.

The meeting's resolutions will help the ministry make decisions about their use in the DRC.

"Developers and manufacturers of these four vaccines were able to expose their product and scientific research advances to the government and its technical and financial partners involved in the response to the ongoing Ebola outbreak," the ministry said, adding that the currently used rVSV-ZEBOV-GP vaccine was the best option for the current outbreak.

"Other vaccines could be used in non-affected provinces in clinical trials after approval by the relevant authorities," it added.

The way forward

Asked if the people of the African continent should fear the worst as all roads do not seem to be currently leading to Rome, the MSF's Segoni said: "All actors are working hard to avoid a worsening of the situation. The way forward, as indicated, is to improve our community engagement, earn their participation in the response, and continue to deliver the fundamental pillars of the Ebola response. There is no magic formula."