Congo's health minister says the Ebola peak is behind us. The people working the hardest-hit places aren't so sure. If you're new here, a quick catch-up. Since May 15, the Democratic Republic of the Congo has been fighting an outbreak of Bundibugyo virus, an Ebola species with no approved vaccine or treatment. Ituri province is the epicenter, North Kivu is the hotspot, and the virus has reached seven provinces and 63 health zones. This is Ebola Watch. Today: a minister declaring the worst is over, a town in Ituri that says help came months too late, Kinshasa demanding receipts from its partners, and a pill that might stop infection after exposure. This story isn't over, so follow us wherever you're listening and the next chapter comes to you. We start with the minister.
From Ghana Eye Report, carrying Friday's briefing in Bunia:
DRC Health Minister Roger Samuel Kamba said the country’s Ebola outbreak had passed its peak and authorities were gaining control of its spread, speaking at a press briefing in Bunia on Friday.
Okay, that's a big claim. Peak behind us. Is he right? Here's his exact wording: 'You have seen the curves; the peak is truly behind us, so the epidemic can no longer get away from us.' He cited South Ubangi, where he says teams arrived within two days with vaccine and treatment. One note. There is no licensed vaccine for Bundibugyo. Ervebo is being used only under research protocols, because there isn't yet evidence it protects against this strain. And the newest numbers? The Emirates News Agency, citing Congolese health authorities, reported Monday morning 8,376 confirmed cases, including 4,042 deaths. On Thursday, the Health Ministry's figures were 8,300 cases and 4,018 deaths. Note that Thursday's count was described as cases recorded, and today's as confirmed, so I'd hold off on reading too much into the small gap. Either way, deaths sit at a little over 48 percent of cases. Last week Africa CDC told us a falling curve might mean surveillance got worse, not transmission. So who do I believe? You hear both, and you watch North Kivu. Doctors Without Borders says the province now accounts for nearly 40 percent of newly confirmed cases, up from 24 percent at the end of August. And on Friday evening, the M23/AFC rebel movement said six new cases were confirmed in Alimbongo and Kayna, in Lubero territory, four of them found through post-mortem samples from people who died in the community. So four of six were found after they'd already died. That doesn't sound like an epidemic that can't get away from you. It sounds like Ituri may be easing while North Kivu isn't. A national peak and a provincial surge can be true at the same time.
The New York Times, reporting from Ituri province:
In other towns in Ituri Province, the epicenter of the outbreak, Ebola treatment centers were set up weeks after the World Health Organization declared a health emergency in May. In Mangala, the Ebola response only started ramping up in August.
August. Three months in. What happened there? Local health workers say many lives could have been saved had a sustained effort started in June. A senior nurse, Godefroy Banzani, told the Times, 'There was no help, not even a bit.' The reasons given: a three-hour drive from Bunia on a rutted road, insurgent checkpoints, and foreign aid cuts forcing hard choices, per WHO's Luca Fontana. Privately, some international health workers said Mangala was simply overlooked. And inside the hospital? Staff said people with signs of the virus moved freely across a central courtyard. The medical director, Dr. Jacques Savo Bamuhiga, put it bluntly: 'Everywhere is a red zone here.' He says five nurses and a doctor have been infected at the hospital, and one nurse has died. And let me guess. The staff weren't being paid. The Times reports the government stopped paying the hospital's staff at the start of the crisis. Health Minister Kamba acknowledged some workers hadn't been paid, and said the government is working to fix it and will add a bonus. What's the toll there? Dr. Bamuhiga puts the town's official Ebola death toll at 165, and says it misses many deaths at home. The UN's Julien Harneis gave the lesson in one line: 'With an epidemic, the slower the response, the bigger it grows.'
From an Africa CDC statement issued in Kinshasa on Sunday:
In line with these principles, Africa CDC supports the application of national accountability mechanisms, including, where appropriate, administrative measures against organisations that do not comply with applicable transparency and reporting requirements, in accordance with national laws and procedures.
Translation, please. Who's in trouble? Partners in the response who can't account for their money. At a Friday briefing, Health Minister Kamba said only about 25 percent of the 97 partners on the ground had provided the required documentation, per Rita Zimé's reporting. He says he's acting on President Tshisekedi's instruction, and the government is threatening coercive measures against those that don't comply. And there's real money behind it. Africa CDC says announced commitments have reached 2.9 billion dollars, and it wants every dollar traceable from the donor's commitment to the services delivered to communities. Separately, Congolese health authorities presented a new 180-day response plan, estimated at 1.2 billion dollars. Here's my worry. Does a paperwork crackdown slow down the groups actually running beds? That's a fair tension, and the statements don't settle it. But this is a disease-control variable. Mangala's hospital staff went unpaid even as pledges climbed into the billions. Accountability is how you find out where the money stopped.
The Associated Press, via Daily Sabah:
More than 250 people have enrolled in a clinical trial testing a drug designed to prevent Ebola infection in Congo, a potentially crucial step as health authorities struggle to contain the country’s deadliest outbreak of the disease.
A pill that prevents Ebola. Is that what this is? That's what it's being tested for. It's Gilead's experimental antiviral, obeldesivir, given soon after suspected contact, before symptoms. That's called post-exposure prophylaxis. The trial, called EBO-PEP, is coordinated by the medical nonprofit ALIMA and began in July at a health center in Ituri. Who's eligible? Adults and children over 12 who've had contact with a confirmed case within the last five days and have no symptoms. The goal is nearly 1,000 people, and half will get a placebo. Participants are checked daily for 21 days. And how is it different from the vaccine study we covered last week? ALIMA's research coordinator, Dr. Guilavogui Jean Paul Yassa, explained it: a vaccine may take days or weeks to protect, and a treatment is for people already sick. This is for the gap in between. Any catch? Two. Results aren't in, so this is a question, not an answer. And it depends on contact tracing finding people within days of exposure, which, as we heard from Mangala and Lubero, is exactly the weak link.
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Next, we'll be watching for the DRC's next situation report, to see whether the minister's peak holds up in North Kivu, and for the U.S. entry ban on recent travelers from Congo, Uganda and South Sudan, which runs through October 11 unless amended. Links to every story are in the show notes. That's Ebola Watch for today. We'll be back tomorrow. This is a Lantern Podcast.