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Public mistrust after Congo election raises Ebola epidemic anxiety

FILE PHOTO: A healthcare worker sprays a room during a funeral of a person who is suspected of dying of Ebola in Beni, North Kivu Province of Democratic Republic of Congo, December 9, 2018. REUTERS/Goran Tomasevic/File Photo

By By, Kate, Kelland,, Health and and

LONDON, Jan 14 (Reuters) – Global health teams battling the world’s second largest Ebola epidemic in Democratic Republic of Congo fear an election dispute may deepen public mistrust and allow the epidemic to run out of control.

Fostering confidence in health authorities is essential when fighting a disease that can spread furiously through communities where local services are scant and patients are often scared to come forward to government or international response teams.

“When you have political instability, public health always suffers,” said Jeremy Farrar, an infectious disease expert who recently visited east Congo with a World Health Organization leadership team.

Without public trust, he said, the Congo epidemic could kill many hundreds more people.

The Dec. 30 election was supposed to mark Congo’s first uncontested democratic transfer of power after 18 years of chaotic rule by President Joseph Kabila.

But accusations of fraud and calls for a recount are threatening more volatility and violence after opposition leader Felix Tshisekedi was declared the winner.

“The worst case scenario is that political instability remains, mistrust grows … and then there’s nothing to stop the epidemic getting embedded into a big urban center and taking off as it did in West Africa,” said Farrar.

“GAINS COULD BE LOST”

Already, 385 people have been killed in the outbreak of Ebola in east Congo that began six months ago and has infected at least 630 people, according to WHO data. The death rate in this epidemic – by far the biggest Congo has seen, and the world’s second largest in history – is more than 60 percent.

Ebola spreads through contact with bodily fluids. It causes hemorrhagic fever with severe vomiting, diarrhea and bleeding. The outbreak is concentrated in North Kivu and Ituri provinces.

There are some signs case numbers in the North Kivu city of Beni may be leveling off, but WHO experts are cautious.

They say the apparent lull might be due to people getting ill but failing to seek proper diagnosis and treatment.

The West Africa Ebola outbreak Farrar referred to lasted for two years from 2014. It infected 28,000 and killed more than 11,300 people in an epidemic that devastated Sierra Leone, Liberia and Guinea and spread in sporadic cases to several other African countries as well as the United States and Europe.

The WHO says the risk of the disease spreading remains “very high” at national and regional levels and is working urgently with Congo and its neighbors – Uganda, Rwanda and South Sudan – to do everything to avoid that happening again.

WHO spokesman Tarik Jasarevic said 25 million people have already been screened for Ebola at border checks with Congo’s neighbors. Vaccination campaigns have also begun for health workers in Uganda and South Sudan.

Jasarevic also said multiple threats to response teams’ ability to find, treat and prevent cases of Ebola infection make the Congo situation particularly worrisome: “Gains could be lost if we suffer a period of prolonged insecurity,” he said.

(Reporting by Kate Kelland; Editing by Andrew Cawthorne)

As Ebola threatens mega-cities, vaccine stockpile needs grow

FILE PHOTO: Healthcare workers carry the coffin of a baby believed to have died of Ebola, in Beni, North Kivu Province of Democratic Republic of Congo, December 15, 2018. REUTERS/Goran Tomasevic/File Photo

By Kate Kelland

LONDON, Dec 20 (Reuters) – Doubts are growing about whether the world’s emergency stockpile of 300,000 Ebola vaccine doses is enough to control future epidemics as the deadly disease moves out of rural forest areas and into urban mega-cities.

Outbreak response experts at the World Health Organization (WHO) and at the vaccines alliance GAVI are already talking to the leading Ebola vaccine manufacturer, Merck, to reassess just how much larger global stocks need to be.

“We’re actively engaged with the World Health Organization and with groups like GAVI, the U.S. government and others to try to understand what will be an appropriate sized stockpile in the future,” Merck’s head of vaccines clinical research, Beth-Ann Coller, said in a telephone interview.

Supply of the Merck shot, which is currently being used to fight a large and spreading outbreak of Ebola in the eastern Democratic Republic of Congo, is not a problem right now, according to the WHO’s deputy director-general of emergency preparedness and response, Peter Salama.

But the nature of Ebola outbreaks is changing, he told Reuters. As the virus finds its way out of rural villages into populous urban settings, plans for how to contain it in future must change too.

“What I’m concerned about is the medium- to long-term stockpile. The figure of 300,000 was very much based on previous Ebola outbreaks where you never really had huge numbers of cases because they were in isolated, rural, populations. But now, we increasingly see Ebola in mega-cities and towns.”

“We need to view it now as an urban disease as well as a rural one – and therefore one requiring a different order of magnitude of preparations, including vaccines,” he said.

Merck’s experimental Ebola vaccine, known as rVSV-ZEBOV, is the furthest ahead in development. Another potential vaccine being developed by Johnson & Johnson could also eventually become part of the stockpile, global health officials say.

Congo’s two Ebola outbreaks this year illustrate the shifting nature of the threat.

The first was relatively contained, infecting up to 54 people and killing 33 of them in an area of DRC’s Equateur Province that is remote and sparsely populated.

Several of the eight outbreaks before this one in Congo – including one in 2014 and another in 2017 both also in Equateur – were also quickly contained and limited in size.

But this year’s second outbreak in Congo – and the country’s tenth since the virus was first identified there in 1976 – is concentrated not in rural villages but in urban areas of the North Kivu and Ituri provinces.

It has already infected more than 450 people, killed more than 270, and last month spread to Butembo, a densely populated city of about one million.

This kind of prospect means global health emergency responders must “review our assumptions around Ebola”, Salama said. “If it were to take off in Butembo, or Goma, or, even worse, Kinshasa, we’d be talking about a totally different issue in terms of … vaccine supplies required.”

Seth Berkley, chief executive of the GAVI vaccines alliance which has an agreement with Merck to ensure a current stockpile of 300,000 rVSV-ZEBOV doses, told Reuters that around 40,000 doses had been used so far in the Congo outbreak.

The emergency response is based on “ring vaccination” which aims to control an outbreak by identifying and offering the vaccine to contacts of anyone likely to be infected. This method uses relatively small numbers of vaccine doses and forms a human buffer of immunity to try to prevent spread of the disease.

For now, in Congo, Berkley said, there is no immediate need to boost the stockpile. But looking towards future inevitable outbreaks, the numbers would likely need to change.

“The challenge we would have – and this has been under discussion – is if we started to do community-based vaccination in urban and semi-urban areas. That’s when the numbers would start to get quite big quite quickly,” he told Reuters.

Merck’s shot has proven safe and effective in trials in West Africa but has yet to be approved for a license by U.S. and European regulators, so is being used in the Congo outbreak under special emergency rules for experimental products.

When it gets approval, which Coller hopes would be in 2019, it will be made at a newly built manufacturing plant in Germany.

Coller said Merck is not yet clear how many doses a year, or a month, the German facility could churn out once it is in production, but she stressed the company would “work collaboratively with the public health agencies to do our best to support their needs”.

(Reporting by Kate Kelland; Editing by Giles Elgood)

Deadly political calculations: Why India isn’t fixing its toxic smog problem

A boy rides a bullock cart as smoke billows from paddy waste stubble as it burns in a field near Jewar, in the northern state of Uttar Pradesh, India November 6, 2018. REUTERS/Altaf Hussain

By Neha Dasgupta and Mayank Bhardwaj

NEW DELHI (Reuters) – As pollution levels surged to “severe” and “hazardous” levels in New Delhi, India this week, there was little sign that residents of India’s teeming capital were doing much to protect themselves.

The smog, which is expected to worsen in the next few days, exposed people to as much as 24 times the recommended limits for dangerous particles on Monday. But unlike in many Chinese cities, where face masks are a common sight when smog levels spike, it is still rare to see locals taking measures to reduce their exposure.

Toddlers stand at school bus stops in crisply ironed uniforms, while security guards, street sweepers, and rickshaw drivers spend many hours outside breathing in filthy air – all without any attempt at protection.

Ask middle-class residents whether they have air purifiers in their homes and the answer is invariably no.

This is despite the extensive coverage of the capital’s pollution crisis by local media, including numerous warnings from doctors about massive health hazards, especially for children, the sick and the elderly.

The apparent lack of concern about the toxic air – whether through ignorance, apathy or the blinding impact of poverty -gives federal and local politicians the cover they need for failing to vigorously address the problem, said pollution activists, social scientists, and political experts.

Neither the governing party at federal level nor the main opposition are in power in the capital, giving them little incentive to cooperate with the city authorities.

And while Delhi may have a population of more than 20 million, its importance at voting time – a national election is due by May next year – is insignificant in comparison with states such as neighboring Uttar Pradesh, which has 220 million.

“The tragedy is that there is no political will at all either on the part of the federal government or the state government of Delhi and, as a result, we can see both blaming each other for the crisis that we are in,” said Yogendra Yadav, a political polling expert. “Whatever little government action you get to see is because of the pressure that environmental activists and the Supreme Court get to exert.”

COCKTAIL OF FUMES

India’s problems with smog extend far beyond Delhi – the nation of 1.3 billion has 14 out of the 15 most polluted cities in the world, according to the World Health Organisation.

But in the capital, at least, this was the year the problem was supposed to be addressed.

After a cocktail of toxic fumes enveloped the area in October and November last year, the Delhi city government declared it a public health emergency and its Chief Minister Arvind Kejriwal described the Indian capital as a “gas chamber”. Officials of the federal government said Prime Minister Narendra Modi’s office had asked them to ensure that it did not happen again.

But steps taken so far have failed to make much difference, and now there is finger-pointing between Modi’s administration, the Delhi city government, and the governments of states around the capital.

As this year’s crisis has worsened, environment ministers from Punjab and Haryana – whose farmers’ stubble-burning is a major contributor to the haze – failed to turn up for a meeting called by the federal environment ministry last week, sending their civil servants instead.

The farmers have been torching their fields as they get ready for new plantings, despite being offered government subsidies on machinery that would allow them to mulch the material into the ground without lighting fires.

Farmers say the subsidies were not enough to cover the price of the machinery, the cost of running it, and the additional labor needed, especially given higher fuel prices.

India had planned to reduce crop burning by up to 70 percent this year but only a 30 percent drop has been visible so far, according to a government statement last Thursday.

Blaming that as the main reason behind New Delhi’s poisonous air, a spokesman for the city government said: “We can’t take steps in isolation in Delhi; we can’t build a wall.”

The federal government, meanwhile, has attacked the city for doing little to control pollution from dust, vehicles, and industries.

Certainly, there has been little done to reduce the number of heavily polluting vehicles on the roads in and around Delhi despite threats that have been made but not followed through, including one from the Supreme Court-appointed Environmental Pollution Control Authority (EPCA) to ban all private vehicles from the city.

And while the nation’s top court has issued a ruling trying to restrict the use of fireworks on the night of the Hindu festival Diwali, which is on Wednesday, few expect it to be enforced. For one thing, the court’s edict that only “green”, less-polluting firecrackers can be let off between the hours of 8 p.m. and 10 p.m. is likely to be ignored because there are no “green” fireworks for sale in the city.

People pass by an installation of an artificial model of lungs to illustrate the effect of air pollution outside a hospital in New Delhi, India, November 5, 2018. Picture taken November 5, 2018. REUTERS/Anushree Fadnavis

WAKE-UP CALL?

Most officials expect to wake up to even worse pollution on Nov. 8, as smoke from the festivities mixes with the smog from other sources to create a deadly cocktail. Light seasonal winds and a lack of rain at this time of year means pollution can linger for weeks, as it did last year.

But Modi’s ruling Hindu nationalist Bharatiya Janata Party (BJP) is more concerned about the impact of weak farm incomes, high fuel prices, and whether job creation has been adequate as issues at the polls.

“A holistic approach in the current climate is difficult to envisage as political divisiveness means that politicians are not looking for enduring solutions,” said Pavan K Varma, an official from a regional party in the state of Bihar and former diplomat who lives in Delhi.

Neither is it in the BJP’s interests, or in the interest of the main opposition Congress party, to help Kejriwal’s New Delhi government. In 2015, Kejriwal’s anti-establishment Aam Aadmi (Common Man) Party, campaigning on an anti-corruption platform, crushed the BJP and Congress to take control of the city.

For Delhi’s doctors it is a nightmare.

This year, the number of patients with severe lung problems has already gone up by up by 25 percent and is expected to increase further after Diwali, said Doctor Desh Deepak, a chest physician at government-run Ram Manohar Lohia Hospital.

“It’s tragic that children are suffering and we’ll destroy a whole generation if we don’t take cognizance of the fact that pollution needs to be tackled on a war footing,” said Dr Neeraj Jain, head of chest medicine at Sir Ganga Ram Hospital in Delhi.

A woman waits to receive treatment for respiratory issues at Ram Manohar Lohia hospital in New Delhi, India, November 5, 2018. REUTERS/Anushree Fadnavis

Dipankar Gupta, a leading sociologist who has written books on Indian society, said only heavy state intervention was likely to solve the problem. He pointed to an improvement in the pollution levels in Beijing last year because of strict government measures to curb polluting industries near the Chinese capital.

But that state crackdown still seems a long way from happening in India. The EPCA has announced a variety of steps between Nov. 1-10 as part of an emergency package, including the use of water sprinklers and a complete ban on construction.

But most environmental experts say it is far too little, too late, and is not addressing the biggest pollution sources.

Modi has not publicly addressed the health crisis that has engulfed the capital.

The grim prognosis means that foreign organizations, including embassies in Delhi, are finding it difficult to get top talent to come to the city.

“Staff with young children are increasingly choosing not to come which wasn’t the case a few years ago,” a Western diplomat told Reuters on condition of anonymity.

Most of the city’s residents are poor, however, and more worried about making enough money to buy food than pollution.

“The daily grind … leaves no room to think about the haze and smog,” said Vimla Devi, who works as a maid in the suburbs of Delhi.

(Additional reporting by David Stanway in BEIJING; Edited by Martin Howell and Alex Richardson)

U.S. judge affirms Monsanto weed-killer verdict, slashes damages

Monsanto's Roundup weedkiller atomizers are displayed for sale at a garden shop near Brussels, Belgium November 27, 2017. REUTERS/Yves Herman

By Tina Bellon

(Reuters) – A U.S. judge on Monday affirmed a verdict against Bayer AG unit Monsanto that found its glyphosate-based weed-killers responsible for a man’s terminal cancer, sending the German company’s shares down 8 percent.

In a ruling by San Francisco’s Superior Court of California, Judge Suzanne Bolanos said she would slash the punitive damages award to $39 million from $250 million if lawyers for school groundskeeper Dewayne Johnson agreed.

Bayer said in a statement the decision to reduce the damages was a step in the right direction, but it would still file an appeal with the California Court of Appeal because the verdict was not supported by the evidence presented at the trial.

“According to an earlier hearing, the judge toyed with the idea of dropping the damages altogether,” brokerage alpha said in a note to clients. “Now, however, the judge made a U-turn and confirmed the jury’s previous verdict.”

Monsanto, which denies the allegations, had asked the judge to throw out the entire original $289 million verdict or order a new trial on the punitive damages portion.

A jury on Aug. 10 found the company’s glyphosate-based weed-killers, including RoundUp and Ranger Pro, had caused Johnson’s cancer and that the company failed to warn consumers about the risks.

The verdict wiped 10 percent off the value of the company and marked the first such decision against Monsanto, which faces more than 8,000 similar lawsuits in the United States.

Plaintiff Dewayne Johnson leaves the courtroom following a post-trial hearing at the Superior Court in San Francisco, California, U.S., October 10, 2018. REUTERS/Jim Christie

The German company, which bought Monsanto this year for $63 billion, says decades of scientific studies and real-world use have shown glyphosate to be safe for human use.

Lawyers for Johnson in a statement on Monday said they were still reviewing whether to accept the reduced award or retry the punitive damages portion.

“The evidence presented to this jury was, quite frankly, overwhelming,” the lawyers said.

The amount of punitive damages is limited by law, and Bolanos said California’s constitution did not permit a higher award. If Johnson accepts the reduced damages, the final verdict would order Monsanto to pay a total of $78 million, split equally between compensatory and punitive damages.

Bolanos’ Monday decision is a turnaround from a previous tentative ruling she issued on Oct. 10.

In that preliminary order, Bolanos said she was considering ordering a new trial on punitive damages, saying Johnson had failed to meet his burden of producing clear and convincing evidence of malice or oppression by Monsanto, a requirement for allowing a jury to award punitive damages.

But following that tentative ruling, at least five of the jurors who delivered the Aug. 10 verdict sent letters to the judge, urging her to uphold their decision. Bolanos did not directly refer to the jurors’ letters in her Monday ruling but said the jury was entitled to its findings.

In September 2017, the U.S. Environmental Protection Agency concluded a decades-long assessment of glyphosate risks and found that the chemical was not a likely carcinogen to humans.

However, in 2015, the cancer unit of the World Health Organisation classified glyphosate as “probably carcinogenic to humans.”

Johnson’s case, filed in 2016, was fast-tracked for trial due to the severity of his non-Hodgkin’s lymphoma, a cancer of the lymph system, that he alleged was caused by years of glyphosate exposure.

(Additional reporting by Ismail Shakil in Bengaluru and Arno Schuetze in Frankfurt; editing by Robert Birsel)

WHO extremely concerned about Ebola ‘perfect storm’ in Congo

FILE PHOTO: A medical worker wears a protective suit as he prepares to administer Ebola patient care at The Alliance for International Medical Action (ALIMA) treatment center in Beni, North Kivu province of the Democratic Republic of Congo September 6, 2018. REUTERS/Fiston Mahamba/File Photo

By Tom Miles

GENEVA (Reuters) – The World Health Organization (WHO) said on Tuesday an Ebola outbreak in northeastern Democratic Republic of Congo could worsen rapidly because of attacks by armed groups, community resistance and the geographic spread of the disease.

At least 100 people have died in the outbreak, out of 150 cases in North Kivu and Ituri provinces.

“We are now extremely concerned that several factors may be coming together over the next weeks and months to create a potential perfect storm,” the WHO’s head of emergency response, Peter Salama, told a news conference in Geneva.

The response is at a critical juncture and, although the weekly number of new cases has fallen from about 40 to about 10 in the past few weeks and more than 11,700 people have been vaccinated, major obstacles remain ahead, Salama said.

Attacks by armed opposition groups have increased in severity and frequency, especially those attributed to the Alliance of Democratic Forces, most dramatically an attack that killed 21 in the city of Beni, where WHO’s operation is based.

The city has declared a “ville morte”, a period of mourning until at least Friday, obliging WHO to suspend its operations.

Overnight on Monday, unidentified assailants entered the town of Oïcha, about 20 km (12 miles) north of Beni, burned houses, killed one man and kidnapped 14 children and one woman, according to two local officials. Oicha has two confirmed cases of the virus and one probable case.

On Monday 80 percent of Ebola contacts — people at risk of developing the disease and so requiring monitoring — and three suspected cases in and around Beni could not be reached for disease monitoring.

EXPLOITATION

Pockets of “reluctance, refusal, and resistance” to accept Ebola vaccination were generating many of the new cases, Salama said.

“We also see a very concerning trend. That resistance, driven by quite natural fear of this terrifying disease, is starting to be exploited by local politicians, and we’re very concerned in the run-up to elections, projected for December, that exploitation… will gather momentum and make it very difficult to root out the last cases of Ebola.”

Some people were fleeing into the forest to escape Ebola follow-up treatment and checks, sometimes moving hundreds of kilometers, he said.

There was one such case to the south of Beni, and another to the north, close to the riverbanks of Lake Albert. Both were inaccessible for security reasons.

Neighboring Uganda was now facing an “imminent threat”, and social media posts were conflating Ebola with criticism of the DRC government and the United Nations and “a range of conspiracy theories”, which could put health workers at risk.

“We will not yet consider the need to evacuate but we are developing a range of contingency plans to see where our staff are best located,” he said.

“If WHO and its partners had to leave North Kivu … we would have grave concerns that this outbreak would not be able to be well controlled in the coming weeks or months.”

(Reporting by Tom Miles; Additional reporting by Fiston Mahamba in Goma,; Editing by Andrew Heavens, William Maclean)

Alcohol abuse kills 3 million a year, most of them men: WHO

FILE PHOTO: Beer cans are displayed in a store in Ciudad Juarez, Mexico, July 31, 2018. REUTERS/Jose Luis Gonzalez/File Photo

By Kate Kelland

(Reuters) – More than 3 million people died in 2016 due to drinking too much alcohol, meaning one in 20 deaths worldwide was linked to harmful drinking, the World Health Organization (WHO) said on Friday.

More than three quarters of these deaths were among men, the U.N. health agency said. And despite evidence of the health risks it carries, global consumption of alcohol is predicted to rise in the next 10 years.

“It’s time to step up action to prevent this serious threat to the development of healthy societies,” the WHO’s director-general, Tedros Adhanom Ghebreyesus, said in a report. “Far too many people, their families and communities suffer the consequences of the harmful use of alcohol.”

FILE PHOTO: Suspects arrested over the production and sale of illegal alcohol which claimed the lives of more than 80 people this week in Jakarta and nearby West Java province, are seen during a police a press conference in Jakarta, Indonesia April 11, 2018. REUTERS/Willy Kurniawan/File Photo

In its “Global status report on alcohol and health 2018”, the WHO said that globally, an estimated 237 million men and 46 million women are problem drinkers or alcohol abusers. The highest prevalence is in Europe and the Americas, and alcohol-use disorders are more common in wealthier countries.

Of all deaths attributable to alcohol, 28 percent were due to injuries, such as traffic accidents, self-harm and interpersonal violence. Another 21 percent were due to digestive disorders, and 19 percent due to cardiovascular diseases such as heart attacks and strokes.

An estimated 2.3 billion people worldwide drink alcohol, with average daily consumption of people at 33 grams of pure alcohol a day. This is roughly equivalent to two 150 ml glasses of wine, a large (750 ml) bottle of beer or two 40 ml shots of spirits.

Europe has the highest per person alcohol consumption in the world, even though it has dropped by around 10 percent since 2010. Current trends point to a global rise in per capita consumption in the next 10 years, the report said, particularly in Southeast Asia, the Western Pacific and the Americas.

“All countries can do much more to reduce the health and social costs of the harmful use of alcohol,” said Vladimir Poznyak, of the WHO’s substance abuse unit. He said proven, cost-effective steps included raising alcohol taxes, restricting advertising and limiting easy access to alcohol.

Worldwide, 45 percent of total alcohol consumed is in the form of spirits. Beer is the second most popular, accounting for 34 percent of consumption, followed by wine at 12 percent.

The report found that almost all countries have alcohol excise taxes, but fewer than half of them use other pricing strategies such as banning below-cost sales or bulk buy discounts.

(Reporting by Kate Kelland, Editing by Alison Williams)

Congo starts vaccinating health workers against Ebola

A Congolese health worker checks the temperature of a woman before the launch of vaccination campaign against the deadly Ebola virus near Mangina village, near the town of Beni, in North Kivu province of the Democratic Republic of Congo, August 8, 2018. REUTERS/Samuel Mambo

By Fiston Mahamba

MANGINA, Congo (Reuters) – Congolese officials and the World Health Organization began vaccinating health workers against the deadly Ebola virus on Wednesday, to try to halt an outbreak in Congo’s volatile east.

A Reuters witness on a visit to Mangina, the village in eastern Democratic Republic of Congo where the epidemic was declared, saw health workers in protective suits administering the injections.

So far 43 people are believed to have been infected in North Kivu and Ituri provinces, including 36 who have died, the health ministry said on Tuesday.

“We are putting all our energy and all our expertise to quickly control this epidemic,” Health Minister Oly Ilunga told journalists at the start of the vaccination campaign.

“All the measures of prevention are in place. The vaccination is the last phase. It will enable us to break the chain of transmission of this epidemic.”

More than 900 contacts of those infected have been identified for monitoring, although security is an issue in the area where militia groups operate, WHO said.

The disease, which causes fever, vomiting, and diarrhea, is spread through direct contact with body fluids.

“Around 40 health workers are expected to be vaccinated today; by end of the week, once all the necessary steps are in place, vaccination of community contacts and their contacts will commence,” WHO spokesman Tarik Jasarevic said.

WHO has said that analysis of genetic sequencing showed it was a separate outbreak from the one 2,500 km (1,500 miles) away in the northwest that ended less than two weeks ago after killing 33 people — but the same Zaire strain.

This is Congo’s 10th Ebola outbreak since the virus was first identified near northern Congo’s Ebola river.

“There is a huge fear among the local population,” Kaswera Mathumo, a medical worker at a clinic in Mangina, where the vaccinations were taking place, said.

The experimental vaccine being used, which is manufactured by Merck, proved successful during its first wide-scale usage against the previous outbreak in Equateur Province.

More than 3,000 doses remain in stock in the capital Kinshasa, allowing authorities to deploy them quickly to affected areas.

But they face security challenges in eastern Congo, a region bubbling with conflicts over land and ethnicity stoked by decades of on-off war.

Local authorities announced on Tuesday that 14 bodies had been discovered in the town of Tubameme, about 40 km (25 miles) northeast of the epicenter of the outbreak in the town of Mangina, suspected to have been killed by a militia group.

(Additional reporting by Tom Miles in Geneva; Writing by Tim Cocks and Stephanie Nebehay; Editing by Richard Balmforth)

Congo Ebola outbreak poses high regional risk, says WHO

An ambulance from the Medecins Sans Frontieres (MSF) drives through a street in the town of Beni in North Kivu province of the Democratic Republic of Congo, August 2, 2018. REUTERS/Samuel Mambo

By Tom Miles and Fiston Mahamba

GENEVA/GOMA, Democratic Republic of Congo (Reuters) – An Ebola outbreak in eastern Democratic Republic of Congo is likely spread over tens of kilometers and poses a high regional risk given its proximity to borders, a World Health Organization (WHO) official said on Thursday.

Four people have tested positive for Ebola in and around Mangina, a town of about 60,000 people in North Kivu province, 100 km (62 miles) from the Ugandan border, the health ministry said. Another 20 people died from unidentified haemorrhagic fevers in the area, mostly in the second half of July.

Just last week, a previous outbreak on the other side of the Central African country was declared over after killing 33 people.

“It would appear that the risk, as we can surmise for DRC, is high. For the region it’s high given the proximity to borders, particularly Uganda,” said WHO’s emergency response chief Peter Salama.

“We are talking about tens of kilometers but I stress that this is very preliminary information at this stage.”

Ebola is believed to be transported long distances by bats and can find its way into bushmeat sold at local markets and eaten. Once present in humans, it causes haemorrhagic fever, vomiting, and diarrhea and is spread through direct contact with body fluids. Over 11,300 people died of an epidemic in West Africa from 2013 to 2016.

This is the vast, forested central African country’s 10th outbreak since 1976 when the virus was discovered near Congo’s Ebola river in the north. That is more than twice as many epidemics as any other country.

The response to Congo’s previous outbreak was considered a success despite the 33 deaths, as the use of a vaccine made by Merck helped contain the virus.

The kind of Ebola in the latest outbreak has been confirmed as the Zaire strain that the Merck vaccine protects against, Congo’s health ministry said late on Thursday. This should allow health officials to again use what has become the greatest weapon against Ebola epidemics to date.

Still, this outbreak poses new challenges. Eastern Congo is a tinderbox of conflicts over land and ethnicity stoked by decades of on-off war and this could hamper efforts to contain the virus.

About 1,000 civilians have been killed by armed groups and government soldiers around Beni since 2014, and the wider region of North Kivu holds over 1 million displaced people.

“FAST AS POSSIBLE”

Officials in Mangina rushed on Thursday to educate people about the risks of spreading the virus in a town that one local nurse told Reuters had no ambulance service.

Agents were deployed to warn people about the need for strict hygiene and the local radio station passed on messages about how to act, a local journalist said by phone.

“There is a great panic among the local population following the appearance of the Ebola epidemic,” said a nurse by phone, who asked not to be named.

The hospital where she works has already seen three people die recently of haemorrhagic fever. The hospital was awaiting help from the Red Cross to bury the bodies properly, she said.

Meanwhile, Uganda has set up screening at the land border it shares with Congo and at its Entebbe international airport.

“Ebola is highly infectious so we have put in place measures,” Uganda’s Junior Health Minister Sarah Achieng Opendi told Reuters.

An international delegation including officials from the United Nations, the World Bank and the WHO is in Beni, 30 km from Mangina.

(Reporting by Tom Miles in Geneva and Fiston Mahamba in Goma, Additional reporting by Elias Biryabarema in Kampala, Writing by Edward McAllister and Tim Cocks, editing by William Maclean and Rosalba O’Brien)

WHO says Ebola team arrives in Congo

FILE PHOTO: Medecins Sans Frontieres (MSF) workers talk to a worker at an isolation facility, prepared to receive suspected Ebola cases, at the Mbandaka General Hospital, in Mbandaka, Democratic Republic of Congo May 20, 2018. REUTERS/Kenny Katombe

By Tom Miles and Fiston Mahamba

GENEVA/GOMA (Reuters) – An international delegation has arrived in the town of Beni in Democratic Republic of Congo, 30 km (18 miles) from where an Ebola outbreak was declared, the World Health Organization and Congolese officials said on Thursday.

Officials from the United Nations, the World Bank, the WHO and Democratic Republic of Congo’s Ministry of Health, including Health Minister Oly Ilunga, will support a team already on the ground.

Congo declared the new outbreak on Wednesday, just days after another outbreak that had killed 33 people in the northwest was declared over.

Twenty people have died from haemorrhagic fevers in and around Mangina, a densely populated town in North Kivu province about 30 km (18 miles) southwest of the city of Beni and 100 km from the Ugandan border.

The ministry has not made public when the deaths occurred. Another six who are still living are showing signs of fever, of which four tested positive.

“The Government-Partner delegation is holding its first meeting to organize the response,” North Kivu governor Julien Paluku tweeted. “Already a … team from Kinshasa is installing a laboratory and a single coordination center.”

But eastern Congo is a tinderbox of conflicts over land and ethnicity stoked by decades of on-off war and this could hamper efforts to contain the virus.

About 1,000 civilians have been killed by armed groups and government soldiers around Beni since 2014, and the wider region of North Kivu holds over 1 million displaced people.

(Writing by Tim Cocks; editing by Matthew Mpoke Bigg)

First Ebola vaccines given as WHO seeks to beat Congo outbreak

FILE PHOTO: A Congolese child washes her hands as a preventive measure against Ebola at the Church of Christ in Mbandaka, Democratic Republic of Congo May 20, 2018. REUTERS/Kenny Katombe/File Photo

By Kate Kelland

LONDON, (Reuters) – A vaccination campaign aimed at beating an outbreak of Ebola in Congo began on Monday in the port city of Mbandaka, where four cases of the deadly disease have been confirmed.

Use of the VSV-EBOV shot – an experimental vaccine developed by Merck – marks a “paradigm shift” in how to fight Ebola, said the World Health Organization’s head of emergency response, and means regions with Ebola outbreaks can in future expect more than just containment of an outbreak with basic public health measures such as isolation and hygiene.

The shot is designed for use in so-called ring vaccination plans. When a new Ebola case is diagnosed, all people who might have been in recent contact with the patient are traced and vaccinated to keep the disease from spreading.

“It’s the first time in the midst of an outbreak … that we’re using this as a way to stem transmission,” WHO’s Peter Salama said in a telephone interview. “It’s an important moment that changes the way we’ve seen Ebola for 40 years.”

The same strategy was used to test Merck’s vaccine in Guinea in late 2015, towards the end of an Ebola outbreak in West Africa from 2013 to 2016. The trial results showed it was safe and gave very high levels of protection against Ebola.

Around 30 Guinean health workers who were directly involved in that 2015 vaccine trial have travelled to Congo and will help with the immunizations there, Salama said.

Ebola causes hemorrhagic fever, vomiting and diarrhea and spreads through contact with the bodily fluids of an infected person. More than 11,300 people died in the West Africa epidemic.

This latest outbreak has killed 25 people since early April, according to the WHO. It is Congo’s ninth since the disease made its first known appearance near the country’s Ebola river in the 1970s.

Cases in Mbandaka, a port city on the Congo river, have raised concern that the virus could spread downstream to the capital, Kinshasa, which has a population of 10 million.

Salama, who visited Congo after the Ebola outbreak was first reported on May 8, said up to 1,000 people – first in Mbandaka and then in Bikoro and other affected areas -could be vaccinated within the next week.

Some 7,300 doses are already in Congo, and hundreds of thousands more are available in a stockpile built up by Merck.

“If we need any more we can ship it within days,” he said. “We’re fine for vaccine supply; that’s not an issue. The issue is going to be making sure we find every contact, track them down and get them vaccinated if they agree.”

Congolese health ministry data show four cases of Ebola confirmed in Mbandaka’s Wangata neighborhood and two suspected cases. One patient has died. For every case, up to 150 contacts will be offered the vaccine.

Salama said he was particularly concerned about the “unknowns” of the outbreak – namely the potential numbers of cases in the village of Ikobo, where no roads go and even helicopters have trouble landing.

“I’m actually very worried about Ikobo because we have four new suspected cases there and it’s very, very remote. We’ve tried to land helicopters there several times, but we need the community to clear the airstrip, and they haven’t fully cleared it yet,” Salama said.

“And when you haven’t got people on the ground, it’s very hard to assess the extent of the outbreak. I’m worried there are many more cases than we’ve been able to identify so far.”

(Reporting by Kate Kelland; Editing by Larry King)

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