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Ebola Veteran Promises an End to Congo's Epidemic (Science Magazine)

August 6, 2019

From the article:

Later this month, virologist Jean-Jacques Muyembe-Tamfum from the Democratic Republic of the Congo (DRC) will receive a prestigious award from Japanese Emperor Naruhito 'for his research to confront Ebola and other deadly viruses and efforts to train legions of disease-fighters.' The recognition, which comes with close to $1 million, is overdue, says David Heymann, an epidemiologist at the London School of Hygiene & Tropical Medicine (LSHTM). In 1976, at age 34, Muyembe was the first virologist ever to see an Ebola patient, and he has helped fight all nine of the outbreaks to strike his country since. Muyembe 'has never gotten the credit that he really deserves,' Heymann says.

But Muyembe, now 77 and head of the National Institute for Biomedical Research in Kinshasa, may be too busy to travel to Tokyo for his award. On 22 July, DRC President Félix Tshisekedi tapped him to head the government’s response to the latest outbreak, in the DRC’s northeast, after Minister of Health Oly Ilunga Kalenga suddenly resigned. Muyembe may be facing the most difficult fight of his life.

Now 1 year old, the epidemic has sickened more than 2700 people, at least 1800 fatally. That makes it the second biggest after the West African epidemic of 2013–16, which had more than 28,000 cases. Over the past 4 weeks, four people have fallen sick in Goma, a city of 2 million on the Rwandan border, heightening fears of further spread. A new, highly effective vaccine, produced by Merck & Co., has been given to more than 180,000 contacts of Ebola cases, but it has only slowed, not halted, the epidemic, which was declared a Public Health Emergency of International Concern by the World Health Organization (WHO) on 17 July...

The distrust has led people to flee, hide, refuse the vaccine, and even attack health care workers, seven of whom have so far been killed. As a result, response workers are missing many chains of transmission. 'I think there’s basically a battle going on between the vaccine and the mistrust,” says Jeremy Konyndyk, a senior policy fellow at the Center for Global Development in Washington, D.C., who visited the region in April and wrote a report about the response effort for WHO. (One version is public; a more candid one written for WHO Director-General Tedros Adhanom Ghebreyesus is not.) “The mistrust means they can’t ever quite stamp it out. The vaccine means it can’t ever quite explode,' Konyndyk says.

Muyembe says he hopes to win back trust by relying more on locals and less on people from Kinshasa or abroad to staff the response. 'We want to use the medical students and so on who speak the local language to go in the community for surveillance and even for vaccination,' he says.

Gaining trust may also mean scaling back security precautions—a risky strategy. Early on, the government decided to use armed guards to enforce public health measures, hoping to contain the virus quickly, Konyndyk says. Some suspected Ebola cases—which could include anyone with a fever and diarrhea—were forced to undergo treatment, and guards accompanied health workers. 'In some places, armed escorts were unavoidable at first,' Konyndyk says, 'but then that also set the tone for the rest of the response.'

Muyembe’s April report detailed many other problems that he will now have a chance to fix. It accused the health ministry of 'weak governance and a leadership deficit,' and criticized 'exorbitant expenses' for things like 'luxury hotels' and 'large rental cars...'"

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