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In the urgent struggle to stop the Ebola epidemic in the Democratic Republic of Congo, doctors are rolling out powerful vaccines and lifesaving antiviral drugs, but the year-old outbreak, mired in violence among warring militias, is now caught between expert groups feuding over the best strategy to stamp out the disease.
At the same time, there are disturbing suggestions that the virus may have spread to Tanzania and that the government there is withholding information about possible cases from the World Health Organization.
The outbreak in Congo continues unabated, with 3,157 cases and 2,108 deaths as of Sept. 19, when the W.H.O. reported that disease transmission had worsened, with 57 new cases that week, versus 40 the week before. The affected region includes the provinces of North Kivu and Ituri, in the northeastern part of the country, near the borders of Uganda, Rwanda and South Sudan.
Efforts to contain the disease in one hot spot, Lwemba, had to be suspended because of violence from Sept. 14 to Sept. 17, “a community response to the death of a local health worker” from Ebola, the W.H.O. reported, adding that the suspension “has a serious impact on the response activities on the ground.”
A dispute between two major players in the epidemic response — Doctors Without Borders and the W.H.O. — erupted on Monday, just as the W.H.O. announced that a new vaccine, the second to be deployed, would be introduced into the region.
On Monday, Doctors Without Borders accused the World Health Organization of “rationing Ebola vaccines and hampering efforts to make them quickly available to all who are at risk of infection.”
The W.H.O. quickly fired back, saying it was “not limiting access to vaccine but rather implementing a strategy recommended by an independent advisory body of experts and as agreed with the government of the D.R.C. and partners.”
The statement, from Dr.
Mike Ryan
, executive director of the W.H.O.’s health emergencies program, also said that the organization had deployed more experts to the region than any other group, and added, “Along with the D.R.C. government, no one wants to bring this epidemic to an end more than W.H.O.”
The approach so far has relied on a traditional strategy called ring vaccination that has been used successfully against other diseases. It involves vaccinating everyone who has had contact with an infected person, and all the contacts of those people, as well.
Officials from Doctors Without Borders say the strategy has not worked in Congo, in part because it has not been possible to track down every person who has come into contact with someone infected with Ebola, and because some contacts have refused to cooperate. The group has urged more widespread vaccination in regions where the disease is spreading, whether people are known contacts or not.
But it says that instead the W.H.O. has doled out limited amounts of vaccine. About 225,000 people have been vaccinated, but Doctors Without Borders says 450,000 to 600,000 should have received the vaccine by now.
The vaccine that has been used so far, made by Merck, takes effect after one dose.
On Monday, the W.H.O. announced that the health authorities in Congo had decided to allow use of a second vaccine, made by Johnson & Johnson. That vaccine requires two doses, about two months apart, and will be used only in areas that are at risk but where the need is not urgent because the disease is not being actively transmitted.
People at high risk, including contacts of cases, and their contacts, will still receive the Merck vaccine.
Congo’s previous minister of health,
Dr. Oly Ilunga
, vehemently opposed using any vaccine but the Merck one, saying people had come to trust it and would be unlikely to accept a new one. He resigned in July after Congo’s president took control of the Ebola response away from him. Dr. Ilunga was arrested on Sept. 14, accused of mismanaging some $4 million meant for the Ebola response, a claim that his lawyers deny.
Concerns about possible spread of the disease to Tanzania arose on Sept. 10, when the W.H.O. obtained “unofficial reports” of the death in Dar es Salaam, the largest city in Tanzania, of someone suspected to have had Ebola. Further unofficial reports said the person had tested positive for Ebola. Then the W.H.O. heard of two more possible cases.
The W.H.O. said it requested information from Tanzania, but received none, even though International Health Regulations, agreed on by all W.H.O. member countries, require that suspected cases of Ebola be reported.
The government later said that no Ebola cases had been confirmed and that two suspect cases tested negative at its national lab. But the government did not have its test results confirmed by a W.H.O. collaborating lab, despite recommendations that it do so.
On Sept. 19, W.H.O. heard more unofficial reports about a contact of the first person suspected of having Ebola falling ill.
Again, Tanzania said there were no Ebola cases there and that no patients suspected of having Ebola had been admitted to a hospital anywhere in the country.
The W.H.O. said it had not received the details it would need to verify the information or assess the risk.
“At this stage, W.H.O. is not aware of signs of a widespread transmission of any illness related to these cases,” the organization said.
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