By Monica Kayombo/Zambia, Lusaka,
THE world is losing the fight against the fast-growing Bundibugyo Ebola outbreak, with more than 2,640 people already dead and over 5,500 confirmed infections recorded as the crisis enters its 100th day, the Independent Panel for Pandemic Preparedness and Response has warned.
The Panel is calling for an immediate and massive scale-up of testing, treatment centres, community engagement, safe and dignified burials and essential health services, warning that failure to act urgently could see the outbreak continue to expand and potentially become the deadliest Ebola outbreak in history.
“We must urgently secure enough testing, build enough treatment centres to save as many people as possible, and ensure safe and dignified burials for every person who has died,” said Dr Joanne Liu, a member of the Independent Panel.
“We need enough trained people to help engage with every community at risk and continued essential health services for all. If we don’t achieve this, this crisis will continue to expand.”
The warning was contained in a statement issued on August 24 to mark 100 days since emergency declarations were made over the outbreak.
The Panel described Bundibugyo as the fastest-growing Ebola outbreak ever recorded and the second largest in history, warning that, at its current pace, it could surpass the 2014–2016 Ebola outbreak in West Africa.
The situation could also be considerably worse than the confirmed figures suggest.
Africa Centres for Disease Control and Prevention (Africa CDC) estimates that the true scale of the outbreak could be three times higher than reported, while sequencing data from the World Health Organisation (WHO) indicates that the virus has been circulating since mid-February.
The Panel said most reported deaths were occurring in communities rather than Ebola treatment centres, highlighting major weaknesses in the ability to detect cases, provide timely treatment and prevent further transmission.
The response is being further complicated by insecurity, unmet humanitarian needs, inadequate basic health services, non-payment of health workers and low community trust.
Reports from the field have also indicated continued attacks on health workers and significant gaps in community reporting.
“One hundred days ago the world was warned of the Ebola Bundibugyo emergency. One hundred days later it is the fastest-growing Ebola outbreak ever recorded,” said Right Honourable Helen Clark, Co-Chair of the Independent Panel.
She said bringing the emergency to an end would require a dramatic increase in both the scale and speed of the response, with the necessary resources and tools reaching people working on the front lines.
The Panel is calling for ceasefires in affected areas to enable people to be reached, diagnosed and treated, saying continued insecurity is directly undermining efforts to reverse the outbreak.
It also wants a major expansion of testing and treatment capacity, alongside safe and dignified burials and continued delivery of essential health services.
A key part of the proposed response is greater community involvement.
WHO, Africa CDC and the Government of the Democratic Republic of the Congo (DRC) are shifting towards a community-based approach, but the Panel says this will require thousands of additional support workers to be trained, paid and mobilised.
Community trust, engagement and ownership, it says, will be critical to controlling the outbreak.
However, the Panel has raised serious concerns about whether enough money is reaching the frontline quickly enough to support the expanded response.
Although more emergency funding has been disbursed during the past two months, responders in the DRC report that the money is still not arriving quickly enough where it is most needed.
The Panel also cited continued reports of unpaid health workers and insufficient funding for community organisations.
As of August 23, the WHO-Africa CDC financing tracker showed US1.3billioninpledgesbutonlyUS333.3 million in disbursements against a continental response plan estimated to cost US$518 million through the end of November.
The Panel also pointed to a discrepancy between the joint tracker and figures reported by Africa CDC.
While the WHO-Africa CDC tracker recorded US333.3millionindisbursements,AfricaCDCreportedonAugust20thatapproximatelyUS758 million had been released.
The Panel said it remained unclear why the figures differed.
It further warned that the overall financing picture remained difficult to assess because money was arriving through multiple channels, much of it earmarked, while published figures on commitments and disbursements did not always align.
Some of the largest gaps are in areas directly linked to controlling transmission and saving lives.
Risk communication and community engagement require US46.6millionbuthadreceivedonlyUS24.2 million.
The Infection Prevention and Control, Water, Sanitation and Hygiene, and Safe and Dignified Burials pillar had received US23.3millionagainstanestimatedrequirementofUS49.1 million.
Case Management and Clinical Care was the least funded pillar, with only US753,200disbursedagainstanestimatedrequirementofUS66.5 million.
The United States has announced more than US$512 million for the response and says it is the largest donor, but the Panel said the funding is not tracked on the WHO-Africa CDC platform and cannot be reconciled with published figures.
It said it was also unclear how much donor funding represented new money, how much had been reprogrammed and how much was directly available for the response in the DRC.
Despite the challenges, the Panel acknowledged significant scientific progress.
More than 1,200 people who contracted the virus have recovered, while vaccine and therapeutic trials have commenced and work is continuing to develop and validate new diagnostic tools.
Four vaccine candidates are being supported by the Coalition for Epidemic Preparedness Innovations, with two already in first-in-human trials.
The University of Oxford’s ChAdOx1 BDBV vaccine began trials on July 13, while Moderna’s mRNA-1469 vaccine dosed its first participant in Canada on August 3.
Two other candidates from IAVI and Public Health Vaccines remain in preclinical development.
The licensed Zaire ebolavirus vaccine, Ervebo, is also being introduced into the response following a recommendation by WHO’s technical advisory group that it be included in a Phase 3 study because of evidence of possible cross-protection.
The DRC is expected to receive 70,000 Ervebo doses, including 50,000 for compassionate use among frontline health workers and 20,000 for a Phase 3 trial examining its impact against Bundibugyo virus.
Two therapeutic trials are also underway.
The Partners trial is testing the monoclonal antibody MBP134 and antiviral remdesivir among confirmed patients, while the EBO-PEP trial is testing the oral antiviral obeldesivir as post-exposure prophylaxis among contacts of confirmed cases.
Progress has also been made in diagnostics, with the first Bundibugyo-specific diagnostic receiving WHO Emergency Use Listing on July 2.
However, the Panel said the response still lacked a rapid, true point-of-care diagnostic that could be used directly in communities, describing this as evidence of longstanding underinvestment in diagnostic systems.
The Panel is equally concerned about whether successful medical countermeasures will actually reach the people who need them.
Although some financing and commitments have already been secured, questions remain over the affordability and availability of successful vaccines, diagnostics and therapeutics for countries most affected by the outbreak.
Professor Michel Kazatchkine, a member of the Independent Panel, said the world had become capable of developing vaccines and treatments at extraordinary speed but had not yet solved the problem of getting them to people.
“We have learned to develop vaccines and treatments at extraordinary speed. We have not learned to guarantee they reach the people who need them,” he said.
The Panel is therefore calling for a clear roadmap showing who is responsible for moving each candidate vaccine, treatment and diagnostic from clinical trials to delivery, who will finance each stage and where the remaining gaps lie.
It also wants pharmaceutical companies and intellectual property owners to publicly state the volumes, prices and timelines for the products they commit to provide.
The Panel says financing for the purchase and delivery of successful products, particularly diagnostics and therapeutics, must also be identified now rather than waiting until trial results are announced.
With the outbreak entering its next 100 days, the Independent Panel has set out a series of immediate measures it believes are necessary to turn the tide.
These include ceasefires in conflict-affected areas and an end to attacks on health and Ebola care workers; large-scale testing and treatment; safe and dignified burials; continued essential health services; and the training and payment of thousands of additional support workers.
It is also demanding immediate financing commitments to the updated WHO-Africa CDC response plan, with minimal conditions attached, as well as transparent tracking of funds to establish what has actually reached frontline responders and community organisations.
The Panel says the international community must also establish clear responsibility for getting vaccines, treatments and diagnostic tools from trials to patients.
It warned that the next 100 days will be critical in determining whether the outbreak can be brought under control.
The response, it said, must involve the DRC and neighbouring countries, community organisations, international non-governmental organisations, the United Nations, WHO, Africa CDC, the African Union, international donors and the medical countermeasures industry.
Beyond containing the current emergency, the Panel said the response must establish lasting systems capable of preventing future outbreaks and enabling rapid action when they occur.
For now, however, the central message is that the window for action is narrowing and that without a rapid expansion of resources, frontline services and community engagement, the Bundibugyo Ebola crisis risks becoming significantly deadlier.
