Health
Five Lessons Learned During Latest Ebola Outbreak in DRC
By MSF
Four people died in the most recent Ebola outbreak that occurred in a remote, forested area of the Democratic Republic of Congo (DRC).
This small outbreak (five laboratory-confirmed and three probable cases) was quickly curtailed. The international humanitarian organisation Doctors Without Borders (MSF) shares lessons learned from this first occurrence of the deadly virus since the end of the large-scale Ebola outbreak that devastated West Africa in 2014-2015.
Train frontline health teams
The scale of this outbreak was minimised, thanks in no small part to a nurse named Dieumerci. With a name that literally translates to ‘Thank God’ in French, Dieumerci works at a Ministry of Health centre in northeast DRC, where the first Ebola cases started emerging.
He detected the risk of Ebola in a seriously ill man at the hospital, and rang the alarm. This man turned out to be the second confirmed case during the recent outbreak. Unlike in West Africa prior to the last major outbreak, Ebola is known in the DRC: the Ebola River, where the virus was first discovered, runs 100 kilometres away from where Dieumerci works.
That doesn’t mean that it is common disease in the area, but still, Dieumerci recognised the symptoms. His quick actions should not be taken for granted. Healthcare workers play a crucial role not only for patients, but also for general epidemiological surveillance. However, in many developing countries human resources within the health sector remain starkly inadequate.
On that fateful day where the Ebola patient came to the health centre, Dieumerci could have easily been on a sick leave, or visiting family somewhere else in the country. One cannot rely on a single individual to play the crucial role of on-the-ground surveillance.
What is needed are proper surveillance systems in resource-poor countries, which were clearly lacking in West Africa at the time of the epidemic. So all in all: thank you Dieumerci. We should all hope that during the next outbreak – be it Ebola or any other infectious disease – there will be another Dieumerci to ring the alarm bell for everyone’s sake.
Finally, a forgotten disease is taken seriously
The word “Ebola” doesn’t ring the same after 2014-2015’s devastating epidemic. At least 11,300 people were killed, and over 28,000 were infected. As a result, Dieumerci’s alarm bell sent shock waves across the world. Congolese authorities immediately activated their outbreak response team and had strong support from WHO and other organisations.
Henry Gray, MSF’s project coordinator during this recent outbreak, has worked on seven haemorrhagic fever interventions in DRC, Uganda and West Africa, to name a few. “The pressure we felt was very different from previous comparable outbreaks: it was clearly at the top of the agenda,” he says. “When it comes to Ebola, we have all learned that it’s better to be safe than sorry in order not to repeat the disaster of 2014-2015.
“However, it is sad to still see that other outbreaks in countries do not trigger the same mobilisation, even in regards to the main killer diseases like cholera or measles.
“Once the Ebola outbreak was over, we were able to re-assign some of the MSF staff towards a serious cholera outbreak on the other side of the country. Our teams went on to treat 1,100 cholera patients. “Considering the dire health needs in many parts of the country, additional support is always welcome”.
Old tricks are timeless – back to basics
The promise of new drugs or vaccines should not overshadow the necessity of putting in place the basic pillars of outbreak control.
It all starts with good surveillance, followed by the five pillars of outbreak control:
Safely isolating and treating the sick.
Actively looking for potential new cases and surveilling those who have been in contact with them.
Burying the dead safely.
Engaging and mobilising the affected communities.
Offering psychological support.
In West Africa, the havoc wrecked by Ebola on the entire health system created more indirect than direct victims of the virus: children became prone to infectious diseases because they weren’t vaccinated; Childbirth complications led to the deaths of mothers and/or children because there were no healthcare workers to care for them; untreated cases of malaria became fatal…
International health actors need to do more to support local health facilities that often have much smaller means and equipment: training staff, ensuring there is basic protection equipment available, and that their pharmacies are stocked with first aid supplies and basic medicines. Our experience in DRC has shown that training frontline workers, even when done ad-hoc, can bring sustained effects to improve their performance in surveillance.
Location, location, location
Like the majority of haemorrhagic fever outbreaks prior to West Africa, the recent one occurred in a very remote, forested area.
Here, the virus was already known to exist within an animal reservoir (assumed to be fruit bats) that is occasionally transmitted to apes, monkeys or men. Some people are very mobile in the region, but can only go as far and as fast as their available transportation; which is pretty much nothing beyond walking and the occasional motorbike.
Dieumerci’s village is 45 kilometres from Likati, the closest town. It is home to 18,000 people, with a majestic cathedral and large, but under equipped, hospital serving as remnants of a time when a railroad was still linking plantations across the country. Today that railroad has been eaten by the encroaching jungle. By contrast, in Guéckédou, Guinea – where the West Africa outbreak started – people can jump on a motorbike and be in the heart of the capital Conakry and its 2.5 million people within two days.
These contrasting examples show how isolation from major cities can keep the spread of deadly disease under control.
Medical innovations are not the magic bullet
At the time of the latest outbreak, MSF was willing to use Ebola treatments which were still in development. However this window closed as the outbreak stopped before the process to allow the use of the experimental treatments was complete. However, this event acted as a ‘booster’ – speeding up the process of preparing medical protocols so that new drugs (still in the experimental phase) can be used in ways that are as safe and ethical as possible.
The rVsV-ZEBOV vaccine (the most advanced investigational vaccine candidate for an Ebola outbreak today) is in development, and needs to be implemented through a study protocol. This, and a vaccine strategy – including informed consent under good clinical practice – were mandatory requirements needed from us to access them.
Soon enough, a study protocol was developed and approved by the MSF Ethics Review Board a few months ago. It was ready for implementation should an outbreak occur. Additionally, a dedicated MSF research team was ready to be deployed. Unfortunately, our negotiations at the DRC Ministry of Health level only took place when the outbreak had already been declared.
It took some time for us to explain what we were planning to do, and how this would differ from a vaccination campaign. But, we managed to obtain authorisation from all the regulatory bodies to start activities in case of a future outbreak.
It is likely that the next outbreak (and trust us, there will be a next outbreak) will happen in a similar setting. We can continue to learn how to best tackle it, and ensure that the West Africa Ebola outbreak remains an isolated tragedy.
Since 1990 MSF has responded to over a dozen outbreaks in sub-Saharan Africa. During the devastating Ebola outbreak that struck mainly Liberia, Guinea, and Sierra Leone in 2014-2015, MSF launched one of the largest emergency operations in its 44-year history.
MSF admitted 10,310 patients to its Ebola management centres of which 5,201 were confirmed Ebola cases, representing one-third of all WHO-confirmed cases. During the first five months of the epidemic, MSF handled more than 85 percent of all hospitalized cases in the affected countries.
At the peak of the epidemic, MSF employed nearly 4,300 staff—most of whom were from the affected countries—who ran Ebola management centres, conducted surveillance, contact tracing, and health promotion, and provided psychological support.
By Kestér Kenn Klomegâh
Health authorities in the Democratic Republic of Congo (DRC) and the Africa Centres for Disease Control and Prevention (Africa CDC) have bitterly complained over their inability to track down new cases of Ebola, which has spread into the Republic of Uganda. An estimated 1,635 Ebola cases have been confirmed, and 127 people have died from the dangerous infectious disease in the DRC.
The Ebola outbreak is increasingly impacting social interaction and people-to-people movements, as scepticism toward the disease appears to accelerate among the population, and cross-border movements are being controlled daily. Alarm was sounded last week as the virus moved into new areas of the DRC. In some instances, patient routinely escapes, and limited contact tracing undermines containment efforts. Contact tracing coverage has plummeted to 56.5 per cent, a sharp decline from the 95 per cent target, Health Ministry officials said.
“We remain committed to supporting affected countries until transmission is stopped. We call on partners and donors to urgently mobilise resources to strengthen the response and save lives,” Jean Kaseya, director general of the Africa Centres for Disease Control and Prevention, said on Sunday.
Shortage of Medical Kits
The World Health Organisation (WHO) reported that the three major laboratories, in South and North Kivu, have run out of Ebola testing kits, as infections continue to rise daily. Teams are working through a large backlog of samples from suspected Ebola patients, many of which were collected several weeks ago, to confirm or rule out the presence of the deadly virus.
In a situation report released earlier this week, the global health agency said the labs in major cities including Bukavu and Goma were awaiting the arrival of reagents–substances ​ required to run the tests–to resume work on the backlog of samples.
“Running out of Ebola testing reagents during an active outbreak is a serious setback,” Dr Krutika Kuppalli, associate professor in the division of infectious diseases at the University of Texas Southwestern and former WHO officer, told The Telegraph.
“Diagnostics are the foundation of outbreak control; if cases cannot be rapidly confirmed, this may lead to delays in isolation, treatment, and contact tracing, which can allow transmission to continue unchecked,” said Dr Kuppalli.
The Race for Vaccines
Vaccine candidates are racing to fill the gap. The Coalition for Epidemic Preparedness Innovations (CEPI)—a multinational nonprofit organisation that finances vaccine development for emerging infectious diseases—has so far prioritised several vaccine candidates for development.
Two are Ervebo-like prototypes aimed at recognising Bundibugyo’s specific blend of glycoproteins, a platform that showed experimental potential years ago. In 2013, an early version of the vaccine protected 100 per cent of monkeys infected with Bundibugyo. However, because most Ebola outbreaks didn’t involve this species, the vaccine didn’t get the investment needed to become licensed. That’s an outcome CEPI aims to remedy with its latest investment.
The International AIDS Vaccine Initiative and Public Health Vaccines are developing the vaccines, which, like Ervebo, also rely on the vesicular stomatitis virus. WHO called this technology the most promising of the candidates.
VSV-based vaccines are front-runners because the weakened version of the virus used to produce them is so good at replicating itself inside humans—including the small chunk of whatever germ it’s been hybridised with—without causing harm. As a result, a single dose typically leads to a strong immune response.
Another candidate, called ChAdOx1, operates using a similar concept: A virus shows the immune system part of a pathogen to generate a protective response. However, it uses an adenovirus that causes colds in chimpanzees—and is also harmless to humans—that University of Oxford scientists modified to keep it from replicating.
There’s also a vaccine candidate based on Moderna’s mRNA science, which was also used to produce the company’s COVID-19 vaccines. This vaccine employs tiny fat bubbles to deliver genetic instructions to cells on how to produce a small part of the Bundibugyo virus. The immune system generates a protective response, and the mRNA degrades quickly without causing lasting changes to cells’ genetic codes.
US-Backed Kenya’s Quarantine Centre
Health Cabinet Secretary Aden Duale has consistently defended the establishment of US-backed health centres in Kenya. The US says it will quarantine citizens exposed to the virus but not showing symptoms in a facility it is building in Kenya, and will not bring them home if they develop symptoms, instead sending them to a third country.
The CDC imposed temporary travel bans last month on people who have been in the DRC, Uganda, or South Sudan, including green card holders, who are typically exempt from such bans. It is also screening Americans travelling from those countries at three US airports. The strategy marks a sharp break from past practice as President Donald Trump’s administration seeks to keep all cases out of US territory.
There are 13 US treatment centres in a government-funded hospital network for severe infectious diseases ready to handle Ebola patients. Public health experts have, however, called on the government to bring any sick Americans home for treatment, and local protests at the Kenya site have led to at least two deaths. A Kenyan court has ordered a halt to the construction.
WHO Appeals for International Community Support
In a rapid and comprehensive response to WHO’s appeal to marshal resources for support of Ebola prevention, the United States has provided an additional $38 million. The additional funds brought the total amount committed by the U.S. to more than $200 million in direct funding, the State Department said in an official statement.
CDC model scenarios show that without strong public health interventions, the outbreak of the Bundibugyo strain of Ebola in the DRC could become as large as, or even larger than, the 2014-2016 West Africa outbreak, the agency said.
In modelled scenarios where the isolation of patients is limited, the outbreak could become one of the largest ever documented, said Jason Asher, director of the CDC’s Centre for Forecasting and Outbreak Analytics.
From Addis Ababa, the Africa Centres for Disease Control and Prevention (Africa CDC) also said it had received a €11.5 million renewed commitment from the European Union Commission (EU) to support a stronger preparedness and coordinated response to the Ebola outbreak. Dr Jean Kaseya, Director General, Africa CDC, described the partnership with the European Union as respectful and without any conditionality, a type of partnership the continent needs.
The package is aimed at reinforcing the EU Commission’s support through the Africa CDC emergency response to the Ebola crisis, within the long-standing and comprehensive AU-EU health partnership. This demonstrates the central role of Africa CDC in coordinating the continental response to health emergencies, as well as the EU’s action as the world’s largest humanitarian contributor.
This includes €6.5 million to strengthen the Africa Pathogen Genomics Initiative, to help equip frontline teams, train healthcare workers and improve surveillance through diagnostics and an in-kind contribution of €5 million worth of testing equipment, including rapid diagnostic devices and lab test kits, to be deployed quickly where they are needed most. The EU’s partnership with Africa CDC spanning technical expertise, capacity-building, and policy dialogue continues to play a key role in building resilient health systems.
Ebola epidemic at G7 summit
Amid the horror of the Ebola epidemic, world leaders gathered at the G7 summit in France were urged to find the “political will” to push through the final part of the Pandemic Agreement on Monday. In a joint letter, Brazil’s President Luiz Lula da Silva and WHO chief Dr Tedros Adhanom Ghebreyesus urged leaders gathered on the shores of Lake Geneva to get the “benefits sharing” annex of the deal signed with a “sense of urgency.”
The Pandemic Agreement, which seeks to ensure the world is better prepared for the next global outbreak, was agreed last year but a vital element of it was deferred because of arguments over its wording. It is unclear, and perhaps unlikely, that a truly global agreement on benefits sharing can be reached.
Nevertheless, an agreement between the remaining 192 member states of the WHO is possible and would represent a major step forward. “Every month this annex stays unfinished is a month the world is less ready than it could be, and people are less safe than they deserve to be,” say Mr Lula da Silva and Dr Tedros. “Finalising this Agreement, through a shared commitment to one another, is our collective promise to protect humanity.”
The epidemic, caused by the rare Bundibugyo strain of the virus, for which there is no approved vaccine or specific treatment, was declared on May 15. It has since spread across Ituri, North Kivu and South Kivu, regions marked by insecurity, displacement and cross-border movement.
The Democratic Republic of the Congo (DRC), also known as the DR Congo, is situated in the central African region. With a population of around 124 million people, it shares borders with the Republic of Congo and Angola to the south, the Atlantic Ocean, and the Central African Republic and South Sudan to the north, and also with Uganda, Rwanda, Burundi, and Tanzania (across Lake Tanganyika) to the east, and Zambia and Angola to the south.
By Adedapo Adesanya
The National Health Insurance Authority (NHIA) says the number of Nigerians enrolled in health insurance has risen to more than 22 million.
The Director-General of NHIA, Mr Kelechi Ohiri, said this resulted from the implementation of the mandatory health insurance, which has gained momentum nationwide.
He said this on Wednesday at the Annual General Meeting of the Nigerian Association of Insurance and Pension Editors (NAIPE) in Lagos.
Mr Ohiri said enrolment had increased to 22.03 million, representing a 35 per cent year-on-year growth, attributing this to stronger collaboration with state social health insurance agencies, ministries, departments and agencies, organised labour, employers, the private sector, and the gradual implementation of the mandatory health insurance provisions of the NHIA Act.
He said that the country had moved beyond policy formulation to delivering measurable improvements in healthcare access, service quality and consumer protection in line with the federal government’s health sector reform agenda.
According to him, Nigeria already has the necessary policies and legislation to achieve Universal Health Coverage, positing that the key challenge was effective implementation.
“The decisive variable is now implementation- consistent, rigorous and accountable execution that converts political commitment into healthcare access for real Nigerians,” he said.
Mr Ohiri said that the transition from the former National Health Insurance Scheme to the NHIA had strengthened regulation, consumer protection, accountability and strategic purchasing, while providing the legal and operational framework for achieving Universal Health Coverage.
He added that improving the experience of enrollees remained central to the Authority’s reform agenda.
According to him, NHIA has strengthened its complaints management system, introduced faster resolution timelines, and intensified compliance monitoring of Health Maintenance Organisations (HMOs) and healthcare providers.
He further added that NHIA had sanctioned facilities that failed to meet the required standards, adding that his organisation had resolved 3,878 complaints, representing an 87 per cent resolution rate, while 95 per cent of the cases were concluded within prescribed timelines.
Mr Ohiri noted that more than N14.2 million had been refunded to enrollees, while non-compliant healthcare facilities had been sanctioned.
He said NHIA had also introduced service standards, including a one-hour treatment commencement target for enrollees requiring urgent care, to improve access to timely and quality healthcare services.
The NHIA boss further disclosed that capitation payments to healthcare providers had been increased by 93 per cent.
He said fee-for-service reimbursements rose by 378 per cent to enable providers to invest more in personnel, equipment and infrastructure.
According to him, 7,592 healthcare facilities have been assessed under the SafeCare quality framework as part of efforts to institutionalise continuous quality improvement across the country.
Mr Ohiri also highlighted interventions targeted at vulnerable groups, including support for more than 48,500 pregnant women, expanded maternal and newborn healthcare services, the Vulnerable Group Fund, and improved access to healthcare for pensioners and retirees.
He said Universal Health Coverage could only be achieved if every Nigerian, regardless of income or location, had access to quality healthcare services.
By Modupe Gbadeyanka
The new one-hour authorisation response time ultimatum policy introduced by the National Health Insurance Authority (NHIA) has received the full backing of SUNU Health Nigeria Limited.
This policy was introduced by the agency to ensure enrollees get prompt approval codes to access care.
Healthcare service providers have been urged to report any Health Maintenance Organisation (HMO) that violates this initiative through an email, with the HMO in copy and a timestamp attached as evidence of the request. They may proceed to offer services to enrollees thereafter.
Speaking at the company’s second-quarter Providers’ Forum for the Lagos-Ogun region in Lagos recently, the chief executive of SUNU Health, Dr Moyosore Olomola, expressed optimism that this policy would improve healthcare delivery in the country, especially for enrollees, who crave quality service.
At the event themed Improving Quality and Access to Care Through Stronger Provider Network, and held at the Nigerian Institute of Medical Research (NIMR) in Yaba, Lagos, Mr Olomola reaffirmed the HMO’s commitment to operating within legal and operational frameworks to guarantee adequate care for enrollees.
“Access to care and quality of care remain key priorities in our healthcare systems. We know quite well that deliberate collaboration, strategic partnerships, and a shared commitment to excellence are required to achieve these priorities.
“A strong provider network is doubtless the backbone of any effective healthcare system. It ensures that our mutual enrollees receive the right care, at the right time, in the right place, and at the right price,” Mr Olomola, represented at the programme by the organisation’s Chief Operating Officer (COO), Dr Faith Nwachi, stated.
He further assured that SUNU Health would strictly adhere to the one-hour authorisation limit, stressing that this aligns seamlessly with one of the organisation’s core values—promptness and its corporate slogan, Humanity is the centre of our initiatives.
In a bid to further improve access and quality of care, SUNU Health also demonstrated its new operational software and Mobile app, aptly named SUNU Legacy.
Also speaking at the event, the NHIA Lagos State Coordinator (Ikeja), Dr Bethuel-Kasimu Abraham, noted that the forum’s expected outcome is to significantly reduce delays in accessing medical care.
Other key expectations include ensuring continuity of care, improving patient outcomes, and strengthening accountability among HMOs.
Addressing specific pain points faced by enrollees, the NHIA Ogun State Coordinator, Mr Dare Adefeso, acknowledged that the agency had received complaints regarding out-of-stock drugs and the discrimination of enrollees by certain providers.
He affirmed that the NHIA is actively addressing these issues, stressing that moving forward, every facility must ensure enrollees are properly catered to regardless of their status, provided they have an active health insurance plan.
Corroborating the long-standing legacy of SUNU Health, the Ogun State Director of the National Orientation Agency (NOA), Mrs Aishat Tiamiyu, shared that her agency is responsible for public information dissemination and has been enrolled with SUNU Health for over 25 years.
Commending the HMO’s stellar service over two decades, she called for the immediate enrollment of new NOA staff into the scheme.
The Providers’ Forum remains one of the strategic channels employed by SUNU Health to consistently engage healthcare providers, understand their operational challenges, introduce new software updates, and solidify partnerships aimed at fostering premium healthcare delivery across Nigeria.
