The Ebola outbreak in Congo and Uganda has claimed more than 200 lives in its first month, with 894 confirmed cases so far and cases up 38% since last week, Africa’s Centres for Disease Control and Prevention said. The numbers point straight at the hierarchy of neglect: a fast-moving outbreak in eastern Congo, a border crossing into Uganda, and a response that is still lagging behind the pace of the disease.
Who Pays for Delay
Dr. Wessam Mankoula, a medical epidemiologist at Africa CDC, said the current outbreak is the worst known outbreak at this stage and is three times worse than a previous outbreak in Uganda in 2000, which had 281 cases at the same point. The outbreak was confirmed on May 15, weeks after it was suspected to have begun, and the latest number of cases is believed to be higher because of that delay. In other words, the disease had room to spread before the official machinery caught up.
The outbreak is now in 32 health zones across eastern Congo. It is caused by the rare Bundibugyo virus, which has no approved vaccines or treatments and was not tested for in the early days. The more common Zaire virus, for which there is a vaccine, was responsible for most of Congo’s past 16 outbreaks of the disease. So the people in the path of this outbreak are dealing with a virus that the existing medical system was not prepared to confront, while the familiar version of Ebola is the one that already had a vaccine in the pipeline.
So far 74 patients have recovered from the disease across eastern Congo and Uganda, and experimental treatments like monoclonal antibodies are being developed for Bundibugyo. But the outbreak remains concentrated in Congo’s eastern province of Ituri, which accounts for more than 90% of the cases. Cases have also been recorded in the North Kivu and South Kivu provinces and have spread across the border to Uganda, where 19 confirmed cases have been reported and two people have died.
What the Ground Looks Like
Contact tracing remains an issue because of the area’s remoteness and ongoing insecurity in Ituri province, Mankoula said. He said that for those 800 confirmed cases, there should be between 17,000 and 35,000 contacts on the contact list, but currently only around 4,000 contacts have been tracked and are being evaluated, less than 15%. Mankoula said, “We are still far from controlling the situation of this outbreak.”
Nearly a million people have been displaced by years of conflict in Ituri, according to the U.N. humanitarian office, making contact tracing difficult as people flee attacks or move frequently in the vast province with dense forests, poor roads and remote villages that can take days to reach. The outbreak is not unfolding in a neat public-health chart; it is moving through a landscape already broken by conflict, displacement and isolation.
Tracing is also difficult among the thousands of miners who regularly move among remote sites in the mineral-rich region. The people most exposed are also the people least likely to be easily reached by the apparatus that is supposed to contain the outbreak.
Money Promised, Bodies Missing
Of the more than $900 million pledged to fight the outbreak, only $90 million has been released, Mankoula said. Africa CDC estimates it needs 540 personnel to fight the outbreak and so far only 84 have been deployed. The gap between what has been promised and what has actually arrived is doing its own damage.
Mankoula said, “We’re keeping our fingers crossed those new pledges will be fast tracked, and we’ll be following up with different member states and different partners about their commitment to turn those pledges into actual money released to their affected countries or partners.” That is the language of dependence: waiting on member states and partners to convert pledges into cash while the outbreak keeps moving.
The outbreak was confirmed on May 15, weeks after it was suspected to have begun, and the delay is part of the story. So are the 32 health zones affected, the 19 confirmed cases in Uganda, the two deaths there, the more than 200 lives lost overall, and the fact that only around 4,000 contacts have been tracked when the number needed is far higher. The disease is spreading through a region shaped by conflict, displacement, and under-resourced response, while the money and personnel remain stuck in the pipeline.