A clinical trial of a potential post-exposure prophylaxis medicine is underway in Ituri province in the Democratic Republic of the Congo as the Ebola outbreak continues to spread. The trial, led by the DRC's National Institute for Biomedical Research with an international consortium of research and outbreak-response partners, has enrolled over 25 patients to test whether an oral medicine given for 10 days to confirmed high risk contacts could prevent disease.
Who Gets Managed, Who Gets Protected
The people at the center of this response are not the institutions directing it from above. They’re the confirmed high risk contacts in Ituri province, the ones being enrolled while the outbreak keeps moving. The trial is part of a wider response as deaths and cases rise in what the World Health Organization called the largest ever outbreak on record in the DRC. That’s the scale of the emergency, and the scale of the apparatus now moving around it.
The WHO said on Tuesday that results may be months away, but efforts are advancing toward enhanced treatment and the world's first vaccine for the Bundibugyo species of Ebola. It said there are still no proven safe and efficacious treatment, preventive or vaccination options for the Bundibugyo species of the Ebola virus. So the people facing exposure are asked to wait on trials, protocols, and future promises while the outbreak keeps exacting its toll.
The WHO said 3,748 cases, including 1,657 deaths and 708 recoveries, had been recorded as of 1 August. Those numbers sit at the center of the crisis. They also sit under layers of institutional management, with agencies and research partners trying to build a response fast enough to outrun the spread.
The Machinery of Response
Vasee Moorthy, acting lead of WHO's R&D Blueprint, said protocols had been written before the current outbreak was declared in the DRC in mid-May, which allowed trials to start more quickly than in previous Ebola outbreaks. He said it would likely still be several months before more definite conclusions could be drawn from the ongoing trials. The system moves faster when its paperwork is already in place. The people on the ground still wait.
Dr. Moorthy said a new 100-bed treatment centre was inaugurated in Bunia, capital of Ituri. He also said that since the outbreak was declared, three testing sites have opened in Ituri province and a fourth is set to open later this week so patients can enrol in trials and be monitored in safe conditions to see if the medicines are effective. "We are trying to ramp up the enrolment," he said. "Because they're a clinical trial, we have to have safe, monitoring of the people that are enrolled in the trial. And that does take time to have more and more teams and more sites enrolling."
That quote says a lot in plain language. Safe monitoring takes time. More teams take time. More sites take time. Meanwhile, the outbreak doesn’t pause for the schedule of the institutions trying to contain it.
What the Agencies Are Doing
The WHO said new data has also emerged in animal studies on the licensed vaccine Ervebo, which targets a different Ebola strain. The UN health agency's technical advisory group convened last Friday and is expected to publish recommendations later this week. The process keeps moving through committees and recommendations, while the outbreak keeps moving through communities.
The UN refugee agency, UNHCR, is supporting screening, infection prevention, risk communication and provision of essential hygiene items. At the DRC-Uganda border, a mobile lab supported by WHO and the World Food Programme delivers Ebola test results in around one hour, cutting delays and bringing diagnostics closer to more than 94,000 people. UNICEF operates nurseries for youngsters of Ebola-affected families. The MONUSCO peacekeeping mission in the DRC protects civilians, conducts information campaigns for local communities and has increased presence around medical facilities to support WHO teams and partners. UN aid coordination office OCHA is releasing up to $60 million to support response and preparedness efforts in the DRC and neighboring countries through the UN's Global Emergency Fund, CERF.
Those are the institutions now spread across the response: refugee agency, food agency, children’s agency, peacekeeping mission, aid office, research bodies, outbreak-response partners. A whole administrative stack. Each one has a role. Each one claims necessity. The people in Ituri still live with the outbreak.
The WHO said trials for the first ever Bundibugyo species-specific candidate vaccine began in the UK on 24 July, with a second starting in Canada this week. A vaccine trial in the United Kingdom entered phase one on 24 July, and another was due to begin in Canada in coming days. Both trials are being conducted on ferrets and monkeys, after which results will be analysed by WHO before a decision on whether to move to the subsequent phase. That’s the long road of biomedical gatekeeping: animals first, analysis later, another decision after that.
The outbreak was declared in the DRC in mid-May, and the WHO said the current response has moved faster than in previous Ebola outbreaks because protocols were already written. Even so, the agency said it will likely still be several months before more definite conclusions can be drawn from the ongoing trials. The people most exposed are left inside that delay, while the institutions call it progress.