DR Congo: Ebola claims over 1,000 lives, Guterres commits ‘whole’ UN system, to help ‘end the outbreak’

Now in its tenth month, the Ebola epidemic in the Democratic Republic of the Congo (DRC) has claimed more than a thousand lives, prompting Secretary-General António Guterres to throw the support of “the whole United Nations system” into stemming the spread of the deadly virus.

International Federation of Red Cross and Red Crescent Societies:
Clinic in Mbandaka, Democratic Republic of the Congo, where health care workers treat Ebola patients.

Mr. Guterres expressed concern over the number of new Ebola cases in the east of the DRC on Wednesday, reiterating UN support “for efforts to end the outbreak”.

“With important shifts in the response now being implemented, the Secretary-General has emphasized his commitment to a collective UN-wide approach, both in Kinshasa, where the UN is led by his special representative, and in the areas affected by the virus, where the response is led by WHO [World Health Organization], all in close liaison with Congolese leaders both in Kinshasa and eastern DRC”, said his Deputy Spokesperson, Farhan Haq, in a statement on behalf of the UN chief.

Mr. Guterres expressed his condolences to the victims’ families and reiterated that the full involvement and engagement of local people “remains the key to successfully controlling the outbreak”.

He also urged “all Congolese leaders to work together across parties and across communities to tackle the outbreak”.

“At this critical juncture”, Mr. Guterres underscored the need for “additional resources” and called on Member States and partner organizations “to ensure the responding agencies have the resources needed to succeed”.

The Secretary-General commended the Government, institutions and Congolese people themselves on the overall response so far, which has contained the outbreak to within parts of two provinces, which are home to multiple armed groups, which have been battling each other and Government forces for years.

He also applauded “the bravery of security, health and humanitarian workers who have put their lives on the line in a challenging environment marked by conflict and insecurity”, including attacks on Ebola Treatment Centres and healthcare facilities and recognized their work in vaccinating more than 100,000 people and saving the lives of hundreds who have contracted the disease.

A World Health Organization (WHO) worker prepares to administer a vaccination during the launch of a campaign aimed at beating an outbreak of Ebola in the port city of Mbandaka, Democratic Republic of Congo May 21, 2018. REUTERS/Kenny Katombe

Meanwhile, amidst continuing violence, WHO experts (SAGE) have recommended new Ebola Vaccination Guidelines to address the challenges in stemming the virus.

Since the outbreak was declared in August 2018, WHO has said that despite the use of a highly efficacious vaccine, the number of new cases continues to rise, in part due to repeated violence, which has prevented response teams from immediately identifying and creating vaccination rings around all people at risk of contracting Ebola.

“We know that vaccination is saving lives in this outbreak,” said WHO Director-General Tedros Adhanom Ghebreyesus, but “we still face challenges in making sure the contacts of every case receive the vaccine as soon as possible”.

“These recommendations account for ongoing insecurity and incorporate feedback from experts and from the affected communities that will help us continue to adapt the response”, he affirmed.

Among other things, new SAGE recommendations endorse pop-up and targeted geographic vaccination approaches, when appropriate; advise vaccinating the next level of people who may be exposed, such as in neighborhoods where cases have been reported within the past 21 days; and adjusting the current dose to ensure that the vaccine continues to be available to those at greatest risk of Ebola.

NIH begins testing Ebola treatment in early-stage trial

Scientists developed monoclonal antibody from Ebola survivor.

A first-in-human trial evaluating an experimental treatment for Ebola virus disease has begun at the National Institutes of Health Clinical Center in Bethesda, Maryland.

 

A healthy volunteer receives an IV infusion of mAb114—an experimental treatment for Ebola virus disease—in a Phase 1 clinical trial held at the NIH Clinical Center in Bethesda, Maryland. NIAID

The Phase 1 clinical trial is examining the safety and tolerability of a single monoclonal antibody called mAb114, which was developed by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH, and their collaborators. Investigators aim to enroll between 18 and 30 healthy volunteers aged 18 to 60. The trial will not expose participants to Ebola virus.

 

Ebola virus disease is a serious and often fatal illness that can cause fever, headache, muscle pain, weakness, fatigue, diarrhea, vomiting, stomach pain and hemorrhage (severe bleeding). It was first discovered in humans in 1976 in the Democratic Republic of the Congo (DRC) and has caused periodic cases and outbreaks in several African countries since then.

The largest outbreak, which occurred in West Africa from 2014 to 2016, caused more than 28,600 infections and more than 11,300 deaths, according to the World Health Organization. In May 2018, the DRC reported an Ebola outbreak, located in Équateur Province in the northwest of the country. As of May 20, health officials have reported 51 probable or confirmed cases and 27 deaths. There are currently no licensed treatments available for Ebola virus disease, although multiple experimental therapies are being developed.

“We hope this trial will establish the safety of this experimental treatment for Ebola virus disease — an important first step in a larger evaluation process,” said NIAID Director Anthony S. Fauci, M.D. “Ebola is highly lethal, and reports of another outbreak in the DRC remind us that we urgently need Ebola treatments.”

“This study adds to NIAID efforts in conducting scientifically and ethically sound biomedical research to develop countermeasures against Ebola virus disease,” added Dr. Fauci.

MAb114 is a monoclonal antibody — a protein that binds to a single target on a pathogen — isolated from a human survivor of the 1995 Ebola outbreak in Kikwit, a city in the DRC. Nancy Sullivan, Ph.D., chief of the Biodefense Research Section in NIAID’s Vaccine Research Center (VRC), and her team, in collaboration with researchers from the National Institute of Biomedical Research (INRB) in the DRC and the Institute for Biomedical Research in Switzerland, discovered that the survivor retained antibodies against Ebola 11 years after infection.

They isolated the antibodies and tested the most favorable ones in the laboratory and non-human primate studies, and selected mAb114 as the most promising. Professor Jean-Jacques Muyembe, director general of INRB and one of the scientists involved in the original detection of the Ebola virus in 1976, played a key role in discovering mAb114.

In collaboration with the VRC, scientists at the Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, illustrated that the monoclonal antibody binds to the hard-to-reach core of the Ebola virus surface protein(link is external) and blocks the protein’s interaction with its receptor on human cells. A single dose of mAb114 protected non-human primates days after lethal Ebola virus infection. The antibody was developed in partnership with the U.S. Army Medical Research Institute of Infectious Diseases and the Defense Advanced Research Projects Agency. It was manufactured for clinical studies by the company MedImmune based in Gaithersburg, Maryland.

“The discovery and development of this experimental Ebola treatment was a collaborative process made possible by Ebola survivors and the DRC scientists who first encountered the virus, as well as through collaboration with our colleagues in the Department of Defense. We are pleased to announce the start of this Phase 1 trial of mAb114,” said NIAID VRC Director John Mascola, M.D.

Martin Gaudinski, M.D., medical director in the VRC’s Clinical Trials Program, is the principal investigator of the new trial. The first three participants will receive a 5 milligram (mg)/kilogram (kg) intravenous infusion of mAb114 for 30 minutes. The study monitoring team will evaluate safety data to determine if the remaining participants can receive higher doses (25 mg/kg and 50 mg/kg). Participants will have blood taken before and after the infusion and will bring a diary card home to record their temperature and any symptoms for three days. Participants will visit the clinic approximately 14 times over six months to have their blood drawn to see if mAb114 is detectable and to be checked for any health changes.

Investigators expect that the trial, called VRC 608, will be fully enrolled by July 2018.

NIAID conducts and supports research at NIH, throughout the United States, and worldwide to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses.

The nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.

Strong Clinical Research Capacity in At-Risk Countries Key to Global Epidemic Prevention

New report outlines urgent need and opportunities in low- and middle-income countries where disease outbreaks most often strike

Robust clinical research capacity in low- and middle-income countries is key to stemming the spread of epidemics, according to a new report from the International Vaccines Task Force (IVTF).

The report, entitled Money and Microbes: Strengthening Research Capacity to Prevent Epidemics, lays out how to develop the political support, financing and coordination required to build this capacity as a crucial component of global epidemic preparedness. The IVTF was convened by the World Bank Group (WBG) and the Coalition for Epidemic Preparedness Innovations (CEPI) in October 2017.

There have been many global and country-level efforts to strengthen pandemic preparedness and response since the deadly West African Ebola outbreak in 2014-2015 that killed 11,000 people—and the last few weeks have provided evidence of this.

During the current Ebola outbreak in the Democratic Republic of Congo (DRC) with 49 total cases and 26 deaths so far, the government of DRC has approved the use for trials starting this week of a new, as-yet unlicensed Ebola vaccine, the rVSV-ZEBOV. The vaccine has proven highly effective in a clinical trial conducted in Guinea in 2015. Nigeria had its worst Lassa Fever outbreak on record earlier this year, and also pushed forward with conducting clinical trials as the outbreak unfolded.

“Times of crisis present the opportunity to focus capabilities and energy on solving important problems,” said Marie-Paule Kieny, Director of Research at INSERM and co-chair of IVTF. “Robust clinical research capacity is the only way to ensure that we don’t face future outbreaks with the same knowledge gaps over and over again.”

Of the 96 countries that have conducted vaccine trials in the past 20 years, 56 have conducted only between 1 and 10 trials, according to a registry maintained by the World Health Organization (WHO). This is insufficient to advance promising new vaccines, therapeutics and diagnostics for epidemic infectious diseases at the scale that is needed. The report recommends building capacity at a national or regional level that can flexibly scale up to run clinical trials during outbreaks, and focus on ongoing high-priority disease research based on local needs in between outbreaks.

“There are now more robustly trained local researchers working in better equipped facilities in low- and middle-income countries, but their numbers remain far too limited,” said Richard Sezibera, Member of the Senate, Rwanda, and Co-chair of the IVTF. “We must urgently prioritize clinical research both to save lives in low-income settings, and to generate valuable information that is a global public good.”

Besides improving health outcomes, clinical research offers a strong return on investment—publicly-funded research and innovation delivers about a 20 percent annual return on investment, compared with an average of 6.8 percent for the S&P 500, which includes the 500 largest companies listed on the U.S. stock market, according to Science Business.

“Investment in strong clinical research capability is a win-win, paying for itself many times over,” said Tim Evans, Senior Director and head of the Health, Nutrition and Population Global Practice at the World Bank Group. “It saves lives and improves health, drives innovation, and creates high-quality jobs, and also builds global health security from the ground up, making us all safer.”

The IVTF recommends that low- and middle-income countries commit domestic financing to this agenda, building political support and a research-friendly culture. It recommends that WHO develops a global tool and robust indicators for assessing country research capacity, and that the WBG creates an investment framework for national and regional clinical research capacity, using many of its unique financing mechanisms to link clinical research to its overall investments in pandemic preparedness. IVTF also recommends strong private sector engagement through transfer of skills and expertise as well as financing.

“Closing the clinical research gap is essential to ensure that we have the capacity that can be mobilized quickly and effectively whenever and wherever it is needed during outbreaks,” said Richard Hatchett, CEO of CEPI. “Without this, we will not be better prepared for and able to response to current and future epidemic threats.”

UN Migration Agency, DR Congo Government Enhance Ebola Screenings at Border-crossings

IOM, the UN Migration Agency, is supporting the deployment of teams of epidemiologists and medical staff from the Ministry of Health and the National Programme of Hygiene at Borders (PNHF) in Kinshasa to 16 points of entry along the Democratic Republic of the Congo’s (DRC) borders.

This deployment is part of an effort to prevent and control the outbreak of Ebola in the DRC, supporting the World Health Organization (WHO).

The DRC Ministry of Health, which is leading the response, announced an outbreak in the Equateur Province on 8 May. In recent days, Ebola cases have been confirmed in larger urban areas, making the risk of the disease spreading further even greater, due to heavier density of population and higher population mobility.

The essential deployment of these border health officials was made possible through USD 75,000 reallocation of funds from the Government of Japan and a release of internal emergency funds totalling USD 100,000. Border health officials will set up infection prevention and control measures at priority border crossings, travel routes and congregation points. A referral mechanism is being developed and will be used to help sick travellers. IOM and partners will also communicate about health risks at border crossings to ensure travellers take precautions against the disease.

IOM also plans to monitor flows at major border crossing points and key congregation points to quantify cross-border and internal movements, and obtain the demographic and movement profiles of travellers. In addition, IOM will assist the facilitation of cross-border coordination and information sharing with neighbouring countries to ensure surveillance and operational readiness for early detection, investigation and response to potential cases of Ebola.

IOM hopes to carry out population mobility mapping of the Bikoro Health Zone, neighbouring Health Zones and the whole Equateur Province to help the humanitarian community know which locations are the busiest points that people travel through and should have health measures strengthened, including risk communication, health screenings and setting up of infection prevention and control measures, among others.

“Helping combat the spread of Ebola over international borders will only be possible with further funding from donors,” said Jean-Philippe Chauzy, IOM DRC Chief of Mission. “Although Equateur is not affected by the country’s ongoing conflict, our teams and resources in DRC are stretched: responding to humanitarian needs as a result of both the conflict and the Ebola outbreak, while our work in the DRC remains one of IOM’s most underfunded operations. This is not the first time the DRC has experienced an Ebola outbreak. The country has proven experience in containing it and the humanitarian community has learned from previous responses. So, with enhanced support, we have a real chance to stop Ebola in its tracks in DRC,” added Chauzy.

IOM is appealing to donors for USD 1,000,000 to carry out population mobility mapping and cross-border coordination and support surveillance, health screening, risk communications and infection prevention and control activities at key border areas.

IOM is an active global health security partner in DRC, working closely with the Ministry of Health and WHO to set an international health regulation strategy in place and help implement it at the national and local levels.

Currently in Burundi and DRC, IOM is working on reinforcement of cross border coordination through development of joint contingency plans, while building community capacity to ensure they are ready to handle health emergencies.

WHO responds to a new Ebola outbreak in Democratic Republic of the Congo

The Government of Democratic Republic of the Congo has declared an outbreak of Ebola virus disease in the remote health zone of Bikoro, Equateur Province.

WHO is sending supplies for Ebola outbreak response in Democratic Republic of the Congo

The WHO is supporting the Ministry of Health and partners in the activation of an Emergency Operations Centre to coordinate the response and in deployment of rapid response teams to investigate cases and deaths.                                                                     US$1 million have been released from the WHO contingency fund for emergencies to support a rapid response.

 

On 8 May 2018, WHO was notified by the Ministry of Health of the Democratic Republic of the Congo of two confirmed cases of Ebola virus disease occurring in Bikoro health zone, Equateur province.

From 4 April through 9 May 2018, a total of 32 Ebola virus disease cases (among which two are confirmed, 18 probable and 12 suspected cases) were reported from Bikoro health zone, Equateur province, including 18 deaths. Three of the 32 cases were among healthcare workers. The patients presented with fever, diarrhoea, abdominal pain, myalgia and arthralgia, and some also showed haemorrhagic signs and symptoms. All cases were reported from the catchment area of the Ikoko-Impenge health facility, located 30 km from the central health zone office of Bikoro, which is 280 km by road from Mbandaka, the capital of Equateur province. Of the 21 initially reported cases on 8 May 2018, 17 had epidemiological links (potential contacts with another suspect case).

Five samples were collected from hospitalized patients, three from Ikoko-Impenge and two from Bikoro. These were sent to Institute National de Recherche Biomédicale in Kinshasa on 7 May 2018, where the two samples from Ikoko-Impenge were found positive by reverse transcriptase polymerase chain reaction (RT-PCR) assay for Ebola virus on the same day.

Over the last four decades, the Democratic Republic of Congo has experienced eight Ebola outbreaks. The most recent epidemic took place in May 2017 in the health zone of Likati, province of Bas-Uele. The ongoing epidemic is located in the Bikoro health zone, located in Equateur province, in western Democratic Republic of the Congo and on the border with the Republic of Congo. This is the fourth time that an Ebola outbreak has been reported in the former province of Equateur, following those of 1976, 1977 and 2014. However, this is the first time that the Bikoro health zone is facing an Ebola outbreak.

The province of Equateur has an estimated population of 2.5 million people with 284 registered health facilities. Bikoro health zone has a population of around 163 000 people with three hospitals and 19 health centres covering the population, most with limited functionality. Medical supplies are provided by international bodies, but stock outs are frequent.

• The Ministry of Health in the Democratic Republic of the Congo deployed Rapid Response Teams to investigate cases and deaths reported in Bikoro health zone in the Equateur province.
• One million US dollars from the WHO contingency fund for emergencies have been mobilized.
• WHO has provided technical and operations support to the Ministry of Health and Partners in the activation of multi-partner multi-agency Emergency Operations Centre to coordinate the response at all levels.
• Médecins Sans Frontières is setting up a treatment centre for the management of cases in Bikoro health zone.
• WHO has shared risk communication materials in French and Lingala with the WHO country offices.
• Active surveillance activities among the community, the Ikoko-Impenge health centre team and Bikoro General Reference Hospital are being undertaken.
• Immediate logistical capabilities and needs are being established.
• Wellcome Trust is providing two million pounds sterling for the critical research needed to support the operational response which is now underway in the country.

To date, the outbreak is reported in a remote area and appears to be geographically limited. However, in view of the available data, the overall risk is considered high at the national level due to the nature of the disease and the lack of epidemiological and demographic information to estimate the magnitude of the epidemic.

The overall risk at the regional level is considered moderate because of the proximity to the Congo river, which links with both the capitals of the Republic of the Congo and the Central African Republic.

Information is currently limited and investigations are ongoing to assess the full extent of the outbreak. Based on the information currently available and the rapid response measures implemented by the Ministry of Health in collaboration with WHO and partners, the event does not meet the criteria of a public heath event of international concern as defined in the IHR (2005)¹, and does not warrant the convening of an Emergency Committee under the IHR (2005).

WHO advises against any restriction of travel and trade to Democratic Republic of the Congo based on the currently available information. WHO continues to monitor travel and trade measures in relation to this event, and currently there are no restrictions of the international traffic in place.

The story published courtesy of the WHO

Resolve differences peacefully, Security Council to DR Congo political actors

Voicing serious concern over the continued political impasse and violence in the Democratic Republic of the Congo (DRC), the United Nations Security Council has called upon all political actors to exercise maximum restraint and to address their differences peacefully.

A view of downtown Kinshasa, the capital of the Democratic Republic of Congo (DRC). Photo: MONUSCO/Myriam Asmani

In a statement issued to the press on Tuesday, Council members reiterated that effective, swift and timely implementation of the 31 December 2016 Agreement and the recently adopted electoral timeline, are essential for a peaceful and credible electoral process, a democratic transition of power, and the peace and stability of the DRC, as well as in supporting the legitimacy of the transitional institutions.

The Council underscored the need “to do everything possible to ensure that the elections on 23 December 2018 are organized with the requisite conditions of transparency, credibility and inclusivity, including the full and equal participation of women at all stages, as well as the importance of youth engagement.”

Further in the statement, the Council underscored the need for the Government to swiftly and fully investigate the killing of the two members of the Group of Experts and bring those responsible to justice.

Experts Michael Sharp (United States) and Zaida Catalan (Sweden) were abducted in the DRC on 12 March. Their remains were recovered by peacekeepers from the UN Mission in the country (known by its French acronym, MONUSCO) on 27 March outside the city of Kananga in the Kasaï-Central province.

Also in the statement, the members of the Security Council expressed concerns over the humanitarian situation in the DRC and noting that it had reached “catastrophic levels” in some parts of the country, called on UN Member States to scale up funding to urgently respond to the pressing humanitarian needs in the country.

The statement by the 15-member Council follows a briefing it heard by Jean-Pierre Lacroix, the UN Under-Secretary-General for Peacekeeping Operations, last Tuesday on the political, human rights, security and humanitarian situation in the country.

DR Congo: Over a dozen UN peacekeepers killed in worst attack on ‘blue helmets’ in recent history

At least 14 United Nations ‘blue helmets’ in the Democratic Republic of the Congo (DRC) have been killed and many more injured, in what the Secretary-GeneralAntónio Guterres described as the “worst attack” on UN peacekeepers in recent history.

North Kivu province, DR Congo: Malawian soldiers of the Force Intervention Brigade on patrol between the localities of Oicha and Erengeti, in Beni territory. Photo MONUSCO/Anne Herrmann

Late Thursday, a MONUSCO (the UN Stabilization Mission in the DRC) Company Operating Base at Semuliki in Beni territory, North Kivu, was attacked by suspected Allied Democratic Forces (ADF) elements, resulting in a protracted fighting between the suspected armed group elements and MONUSCO and Armed Forces of the DRC, known by the French acronym, FARDC.

According to the UN Operations and Crisis Centre (UNOCC), MONUSCO advised on Sunday that 14 Tanzanian peacekeepers were killed, 44 others were wounded and one peacekeeper remains missing. Earlier reports of 15 peacekeepers killed reflected uncertainty in accounting for personnel. Similarly, of three soldiers who were initially reported missing, two have since returned and only one peacekeeper remains missing.

“These deliberate attacks against UN peacekeepers are unacceptable and constitute a war crime” said Secretary-General António Guterres, adding: “I condemn this attack unequivocally.”

Further, calling on the DRC authorities to investigate the incident and swiftly bring the perpetrators to justice, the UN chief stressed: “There must be no impunity for such assaults, here or anywhere else.”

In his remarks, he also said that the attack is another indication of the challenges faced by UN peacekeeping operations around the world and acknowledged the sacrifices made by troop contributing countries in the service of global peace.

“These brave women and men are putting their lives on the line every day across the world to serve peace and to protect civilians,” he noted, offering condolences to the families and loved ones of those killed and a speedy recovery to those injured.

All of the peacekeeping troops killed in the brutal attack which reportedly lasted some three hours were from Tanzania. In addition, three members of the contingent are reported to be missing in action.

According to UNOCC Director Ian Sinclair, initial figures indicate that 53 peacekeepers been injured, of whom three critically, but the numbers could rise.

VIDEO: Director of the UN Operations and Crisis Centre, Ian Sinclair, describes the attack as the worst on UN peacekeepers in recent history.

Members of the FARDC have also been killed and injured in the attack but numbers are yet to be confirmed, Mr. Sinclair told reporters at a news briefing at the UN Headquarters, in New York.

“Our reinforcements have arrived on the scene and a search is ongoing for the missing soldiers,” he said, noted that the wounded have been evacuated from the area, among whom some have been further evacuated to more advanced medical facilities in Goma, DRC.

“Further medical evacuation is possible for seriously injured,” he added.

Also Friday, in a strongly worded statement, the UN Security Council condemned the attack.

“There can be no impunity for such acts,” stressed the 15-member Council, calling upon the Government of the DRC to ensure that the perpetrators of such attacks are swiftly brought to justice.

In the statement, the Security Council also reiterated their full support to the Special Representative of the Secretary-General in the DRC and to MONUSCO to fully implement their mandate.

The volatile North Kivu region, located in eastern DRC, has witnessed a number of attacks on UN peacekeeping forces. In October, two UN ‘blue helmets’ were killed and another 18 were injured their base was attacked by the ADF armed group.