Key points

• Ambulance attack highlights dangers facing responders
• Motorbike riders are key to tracking infections
• Surveillance and treatment capacity reinforced

“Almost on a daily basis we face some kind of reaction from the communities,” said Dr Thierno Baldé, WHO Incident Manager for the Bundibugyo virus disease in the DRC. “These are difficult situations. People are having their relatives who are sick, who are dying.”

Speaking via video from the outbreak’s epicentre in Bunia, the medic told reporters in Geneva that on Monday, one of the ambulances used in the response was attacked. It was not an isolated incident.

According to local authorities on Monday, the Ebola Bundibugyo outbreak has killed 2,325 people, surpassing the 2,299 deaths recorded in the DRC’s 2018-2020 outbreak, previously the most lethal. The fatality rate has risen to 46 per cent, according to Government data. 

Dr Baldé said that the milestone of 5,000 confirmed cases has been crossed and confirmed that cases have been identified in a sixth province, Bas-Uele. 

Working day and night

“The situation is quite difficult, but people are working here days and nights trying to control this outbreak,” Dr Baldé insisted. 

“We are really recentering all of the operational approach, all of our activities, around the engagement of the communities,” the WHO official said.

Describing the multi-pronged scale-up underway, he said that one of the key targets of the response is the association of motorbike riders, involved in the transport of patients and dead bodies. 

Hand-washing stations and disinfectant have been made available, but the new objective is to recruit them as surveillance and response officers, Dr Baldé said.

The WHO medic explained that the bikers are one of the most affected categories in the population because of their transport duties. Some have lost multiple family members to the virus. 

Because the motorbike riders are a key link in the chain of disease surveillance, they need to “be able to tell us wherever they transport a sick person”, contact the surveillance team and enable the suspected case to be tested, Dr Baldé explained. 

This grassroots engagement is taking place “in a very dignified manner”, Dr Baldé said, “by convincing them, explaining to them…this is for the good of themselves, the good of their family”.

Treatment capacity push

In other response measures, WHO plans to deploy 100 additional expert epidemiologists in health zones. They will be supported by more than 500 community health workers who can pursue contact tracing and identify infected individuals and convince them to seek treatment.

Some 400 beds have been added in facilities in various localities over the past two weeks.

Dr Baldé insisted that an extra push is needed to ensure safe and dignified burials “by engaging those local people who are doing that in the villages and equipping them with chlorine and gloves “to be able to handle these bodies in a very safe manner”.

The WHO official highlighted the localities of Lita and Nizi as examples of progress today, whereas “we were overwhelmed by the number of community deaths about six weeks ago, seven weeks ago”. 

“Today, we are reporting only few cases, few deaths, and those deaths are being safely and dignifiedly, buried at the right time…We have seen a kind of stabilization of the situation where we are capable of intervening as quick as possible,” he concluded. 

The outbreak of Ebola Bundibugyo virus disease, for which there is no vaccine and no approved treatment, was declared by DRC authorities on 15 May.

Experts meet

On Tuesday, the International Health Regulations Emergency Committee met for the second time on the epidemic, which has already been declared a public health emergency of international concern. The panel was expected to advise on the current risk level in its recommendations to countries. 

In his remarks to the panel, WHO Director-General noted that clinical trials are advancing for vaccines and therapeutics specifically to treat Bundibugyo virus.

For the first time, two vaccines designed specifically against Bundibugyo virus have entered human trials; a separate vaccine has shown cross-protection in animal studies and it is being proposed for phase III trial. This is the third of four phases of clinical trials and often precedes approval for a new treatment.

“The response still needs faster data sharing, enhanced surveillance, sustained financing, access and security, and stronger cross-border coordination,” Tedros insisted.

Equally, “we must also remember that Ebola is only one threat the people of DRC face, including maternal mortality, diarrheal disease, pneumonia, malaria, cholera and more”, the WHO chief stressed. “Even as we fight to end this epidemic, we cannot allow the response to disrupt access to other essential health services.”

According to WHO’s attacks on healthcare tracker, there have been 18 incidents – including six where people have died – since 1 January, including 14 on facilities, two on medical transport and 26 on health personnel and patients. 

According to local authorities, the disease has killed 2,325 people, surpassing the 2,299 deaths recorded in the DRC’s 2018-2020 outbreak, which was previously the country’s deadliest.

The outbreak, declared by national authorities on 15 May, became the country’s largest in terms of total confirmed cases in late July. There are currently 4,945 confirmed cases, the latest data shows.

A total of 730 patients remain in isolation or in the hospital and 1,040 people have recovered from the disease, and the fatality rate has risen to 46 per cent, according to Government data.

The current outbreak remains eclipsed only by West Africa’s 2014-2016 Ebola outbreak, which saw 28,616 cases and 11,310 deaths, according to WHO, but the Bundibugyo outbreak is taking lives at a much faster rate.

Vaccine trials are underway in the UK and Canada as the Bundibugyo strain has no approved treatment.

Inadequate health infrastructure, ongoing conflict at the epicentre of the outbreak and distrust of medical authorities have all hindered efforts to help as WHO warns the outbreak is “outpacing the response.”

Neighbours on high alert

The UN and its global health partners are working to prevent the spread of Ebola to neighboring countries such as South Sudan and the Central African Republic.

In early June, WHO and the Africa Centres for Disease Control and Prevention launched a response plan to improve emergency coordination, disease surveillance, laboratory testing, infection prevention and control, clinical care, community engagement, research, logistics, and support for essential health services across the continent.

The UN’s humanitarian aid office, OCHA, has allocated $54.5 million to accelerate the response in the DRC, help prepare neighboring countries for the disease’s possible spread and work with local communities to build trust in the public health response.

In the Central African Republic, the UN’s peacekeeping mission, MINUSCA, is working with multiple UN agencies to assist local authorities with technical assistance, surveillance and preparedness measures, communication and community awareness activities, as well as capacity building, UN Spokesperson Stéphane Dujarric told reporters on Monday.

“Our peacekeeping colleagues in the country have been providing technical and logistical assistance, including the transportation of health experts throughout the CAR and the delivery of essential equipment and supplies,” Mr. Dujarric said.

‘Major scale-up’ underway

WHO spokesperson Tarik Jašarević told UN News the agency has initiated a “major scale-up in every aspect of the response” to Ebola. 

On Friday, WHO convened a meeting in Bangui between representatives from the Central African Republic, DRC, Republic of the Congo, South Sudan and Uganda. 

The countries agreed to strengthen cooperation in disease surveillance and pandemic preparedness.

WHO said last week that it hopes to reverse the fast-moving spread of Ebola within three months by bringing transmission under control.

The agency said support is still needed “for all areas of the response.”

“Responders need safe access to communities, and the resources to end this outbreak and save lives,” WHO said.

Twenty-seven former rebels are being deployed as community mobilisers in the Tchomia locality of Ituri Province to promote behaviours that prevent the spread of the deadly virus.

A deadly outbreak 

The Ebola outbreak is on track to become the deadliest epidemic in the history of the DRC.

The latest information states that the current outbreak has already killed 2,000 lives across the country. 

Caused by the Bundibugyo species, for which there is not yet an approved vaccine, the outbreak is spreading quickly. 

Conflict, poor roads and the lack of access to healthcare are making it difficult to contain. It has recently reached a sixth province in the DR Congo, and it is threatening to spread to neighbouring South Sudan, according to media reports. 

Rebel combatants turned community mobilisers 

Eastern DRC has suffered years of instability as rebel groups have continued to fight government forces, driving millions of people from their homes.

The UN peacekeeping mission, MONUSCO, has supported the demobilisation of former rebels.

After receiving training on prevention measures and detection of suspect cases, the rebels-turned community mobilisers were sent to heavily frequented areas across Tchomia including the central market, the town centre, and the animal feed production site. 

They emphasised the importance of regular handwashing, shared information on how to identify symptoms and stressed the need to promptly report suspect cases to health authorities. 

“The idea here is to make these former combatants and community members active participants in the fight against Ebola,” said Florent Nzama, the coordinator of a local NGO network. 

For MONUSCO the project serves a dual purpose: Responding to a public health emergency and contributing to stabilisation efforts by strengthening community cohesion. 

“This action illustrates their involvement in community life after demobilization,” explained a MONUSCO representative.

In its latest update, published Thursday, WHO said hidden chains of transmission are being fuelled by patients who reach advanced stages of the disease without ever receiving care. 

Deaths are still occurring outside health facilities and known transmission chains, while several treatment centres are now overwhelmed.

“Transmission is occurring faster than case detection and isolation, while contact tracing capacities are increasingly strained,” WHO said.

Spilling outward

The outbreak remains heavily concentrated in Ituri province, which accounts for roughly 90 per cent of cases and 80 per cent of deaths. The Bunia–Rwampara–Mongbwalu–Nizi corridor remains the main axis of spread, but transmission is also continuing in neighbouring North Kivu, and cases are rising in Haut-Uélé. 

In all, 53 of 140 health zones across five affected provinces have now reported cases.

Congolese authorities reported 4,449 confirmed cases and 2,061 deaths as of Tuesday – a fatality rate of 46 per cent. 

Only 886 patients have recovered. Those numbers put the outbreak on track to potentially become the deadliest Ebola epidemic ever recorded, surpassing the 2014 to 2016 West Africa outbreak, which killed more than 11,000 people among over 28,000 cases.

Contact tracing up, but patchy

One indicator is improving: the contact-tracing rate has passed 85 per cent nationally for the first time. 

But the average masks sharp regional gaps – in Haut-Uélé, the rate is only around 58 per cent, which WHO attributed partly to incomplete reporting.

Gaps also persist in alert reporting and in following up confirmed cases, meaning patients can slip through surveillance and sustain chains of transmission that authorities never detect. 

Insecurity and community mistrust are compounding the problem, with some incidents delaying safe burial teams.

WHO said community trust is now central to the response, and urged greater reliance on local leaders and trusted community networks to find cases and contacts, encourage early care-seeking, and ensure safe burials.

Overwhelmed, under strain

Even when patients are found, capacity to treat them is running short. Several treatment and transit centres in Ituri are now “saturated”, WHO said. North Kivu lacks sufficient options to refer patients to specialized facilities, and none of the six affected health zones in Haut-Uélé yet has a treatment centre meeting required standards.

Response teams themselves are under pressure. WHO said delays in paying some response personnel had been reported in several affected zones, warning this “could affect staff motivation and the continuity of response activities, including community engagement and operations at entry and checkpoints.”

The challenge is now twofold: finding the transmission chains still evading surveillance, while urgently expanding capacity to treat those who are found. Until case detection and isolation outpace transmission, better tracing alone will not be enough to turn the epidemic around.

The current Ebola outbreak caused by the Bundibugyo species, was declared by DRC health officials on 15 May and declared a public health emergency of international concern by the World Health Organization (WHO) two days later.

With more than 4,000 confirmed cases, it is both the second-largest and the fastest-growing on record. Only West Africa’s 2014 to 2016 outbreak, which saw more than 11,000 deaths, was larger.

Just three months into this Ebola emergency, the death toll is already close to the total number of people killed in the 2018 to 2020 epidemic, which saw fewer overall cases.

Mutation fears arise

Alarmed by the virus’s rapid spread, local health officials have recently raised concerns that the virus could be mutating.

In response, the director of the Africa Centres for Disease Control and Prevention met WHO Director-General Tedros Adhanom Ghebreyesus recently to investigate the threat of the virus mutating.

There are no approved vaccines or treatments for the Bundibugyo strain.

Vaccine trials have been authorised in Canada and the UK, though results are likely several months away. Treatment trials are underway in the DRC’s Ituri province – the epicentre of the outbreak.

Julian Harneis, the UN’s senior Ebola coordinator in the DRC, said aid workers, organizations, governments, donors and local communities “must do more, and do it today, to save lives and stop Ebola.”

Violence, geography imperil response

The Ebola Bundibugyo virus is proving hard to control in eastern DRC because of ongoing violence by non-State armed groups in the remote and mineral-rich region and a lack of accessible healthcare for vulnerable populations.

In addition, at least a dozen facilities treating Ebola have been attacked, largely due to fear, misinformation and deep community mistrust of outside authorities.

WHO reported that between 60 to 70 per cent of Ebola deaths occur in communities, and that many patients can’t been seen by a doctor until it is too late.

Further complicating the response is the ongoing conflict in eastern DRC between the Congolese military and Rwanda-backed M23 militia.

According to the UN’s humanitarian aid office (OCHA), at least 13 civilians were killed, several more were abducted and homes were burned in a Friday attack on the village of Banana École in Ituri, causing more than 28,000 people to flee.

News reports indicate the attacks were likely carried out by militants affiliated with the local ISIL terrorist group.

“We, along with our partners, continue to support the response, but our work is hindered by insecurity,” UN Deputy Spokesperson Farhan Haq said on Tuesday.

Responding to the outbreak

Briefing journalists in New York the previous day, he said OCHA was working with partners to prepare neighbouring Rwanda for the possible spread of Ebola.

Although Rwanda has not confirmed any Ebola Bundibugyo cases, the country remains at risk due to frequent border crossings.

WHO has helped train Rwandan healthcare workers on prevention and surveillance. The UN is also working with local authorities to improve screening, traveller monitoring, personnel deployment, provision of protective equipment and community engagement.

The UN and its partners also run mobile Ebola testing labs, operate nurseries for children in Ebola-affected families, protect medical facilities, upgrade hygiene infrastructure and distribute infection prevention equipment.

“We reiterate our call on all parties to the conflict to protect civilians and facilitate safe and sustained humanitarian access to communities impacted by both violence and the outbreak,” Mr. Haq said.

The current Ebola outbreak caused by the Bundibugyo species, was declared by DRC health officials on 15 May and declared a public health emergency of international concern by the World Health Organization (WHO) two days later.

With more than 4,000 confirmed cases, it is both the second-largest and the fastest-growing on record. Only West Africa’s 2014 to 2016 outbreak, which saw more than 11,000 deaths, was larger.

Just three months into this Ebola emergency, the death toll is already close to the total number of people killed in the 2018 to 2020 epidemic, which saw fewer overall cases.

Mutation fears arise

Alarmed by the virus’s rapid spread, local health officials have recently raised concerns that the virus could be mutating.

In response, the director of the Africa Centres for Disease Control and Prevention met WHO Director-General Tedros Adhanom Ghebreyesus recently to investigate the threat of the virus mutating.

There are no approved vaccines or treatments for the Bundibugyo strain.

Vaccine trials have been authorised in Canada and the UK, though results are likely several months away. Treatment trials are underway in the DRC’s Ituri province – the epicentre of the outbreak.

Julian Harneis, the UN’s senior Ebola coordinator in the DRC, said aid workers, organizations, governments, donors and local communities “must do more, and do it today, to save lives and stop Ebola.”

Violence, geography imperil response

The Ebola Bundibugyo virus is proving hard to control in eastern DRC because of ongoing violence by non-State armed groups in the remote and mineral-rich region and a lack of accessible healthcare for vulnerable populations.

In addition, at least a dozen facilities treating Ebola have been attacked, largely due to fear, misinformation and deep community mistrust of outside authorities.

WHO reported that between 60 to 70 per cent of Ebola deaths occur in communities, and that many patients can’t been seen by a doctor until it is too late.

Further complicating the response is the ongoing conflict in eastern DRC between the Congolese military and Rwanda-backed M23 militia.

According to the UN’s humanitarian aid office (OCHA), at least 13 civilians were killed, several more were abducted and homes were burned in a Friday attack on the village of Banana École in Ituri, causing more than 28,000 people to flee.

News reports indicate the attacks were likely carried out by militants affiliated with the local ISIL terrorist group.

“We, along with our partners, continue to support the response, but our work is hindered by insecurity,” UN Deputy Spokesperson Farhan Haq said on Tuesday.

Responding to the outbreak

Briefing journalists in New York the previous day, he said OCHA was working with partners to prepare neighbouring Rwanda for the possible spread of Ebola.

Although Rwanda has not confirmed any Ebola Bundibugyo cases, the country remains at risk due to frequent border crossings.

WHO has helped train Rwandan healthcare workers on prevention and surveillance. The UN is also working with local authorities to improve screening, traveller monitoring, personnel deployment, provision of protective equipment and community engagement.

The UN and its partners also run mobile Ebola testing labs, operate nurseries for children in Ebola-affected families, protect medical facilities, upgrade hygiene infrastructure and distribute infection prevention equipment.

“We reiterate our call on all parties to the conflict to protect civilians and facilitate safe and sustained humanitarian access to communities impacted by both violence and the outbreak,” Mr. Haq said.

“The Bundibugyo virus continues to outpace us,” said Dr. Mohamed Janabi, WHO Regional Director for Africa, speaking from Bunia, the epicentre of the outbreak in eastern DRC – referring to a particularly lethal Ebola strain for which there is still no approved vaccine. 

“The Bundibugyo virus continues to outpace us,” Dr. Mohamed Janabi, WHO Regional Director for Africa, said at a press conference, referring to the particularly lethal species of Ebola for which no approved vaccine currently exists.  

Three months into the outbreak, the UN health agency intends – along with Congolese authorities and their partners – to “urgently intensify” the response because behind the heavy human toll lies a problem that has become central: too many patients are receiving treatment too late.  

Understanding the numbers 

Dr. Janabi recently spent three days in Bunia, capital of Ituri province – his fifth visit since the epidemic was declared there on 15 May. 

Alongside Dr. Steve Ahuka, one of the Congolese leaders of the response, he visited several treatment centres and met community members to understand why the death toll remains so high. 

Discussions with representatives of the local transport association highlighted shortcomings in the patient transport system. According to WHO, half of the deaths observed among transported individuals are linked to the conditions of their care. 

“We asked ourselves why people are dying in Bunia? But talking to these leaders, we understood two things,” said Dr. Janabi.  

“Village centres outside of Bunia, they don’t have these services. As a result, everyone comes to Bunia. Unfortunately, they come late.”  

Distances and deaths 

The concentration of healthcare capacity in the city thus transforms distance into a factor in mortality.  

As patients lack suitable facilities near their homes, they must travel long distances before receiving care, and sometimes when their health is already severely compromised. 

The journey itself can also fuel the epidemic. Patients taken to Bunia are not always sent directly to an Ebola treatment centre. Some are first taken home. When they die, their bodies may be taken back to their villages, thus multiplying contacts and the risk of further infections. 

WHO wants to break this chain by bringing healthcare facilities closer to communities, better informing the public and transport providers, and promptly referring suspected cases to appropriate centres.  

“Three months after the start of the epidemic, if we are seeing only 30 per cent, can we sit down and review our approach?” asked the agency’s head for Africa. 

Aru shows the way 

The town of Aru, also in Ituri province, provides an example of what this shift in strategy could achieve. No new cases have been recorded there for two weeks, representing a real “success story”.  

Dr. Janabi said that after a case was detected, teams identified 159 contacts, including 121 people who were considered suspected cases. However, response was not limited to monitoring these individuals and was extended to surrounding communities, from which many patients originate. 

Moreover, healthcare facilities are being established – and awareness campaigns conducted – so that residents no longer have to travel to Bunia for treatment. The objective is twofold: to treat patients earlier and to prevent the provincial capital from becoming a hub for both patients and increased risk of transmission. 

Centred on community 

“We have to protect Bunia now,” said Dr. Janabi, adding that WHO will meet with the Congolese health authorities “and see how we can build centres now outside Bunia so that we can content those people where they are.” 

WHO also plans to add 400 beds dedicated to Ebola patients and another 100 for various health services, but the UN agency also insists on the need to broaden the response beyond the healthcare system alone. 

For example, vendors in markets could install handwashing stations themselves, he said, stressing that the fight against Ebola must be a collective effort. 

“I don’t expect the central Government to do everything. I don’t expect our agencies to do everything. But if we raise awareness among market vendors, they can themselves donate a bucket or two for handwashing,” he said. 

After three months of the epidemic, WHO is therefore counting on a change of scale but above all, of method: less concentration of the response in Bunia and earlier intervention closer to transmission hotspots.  

Dr.  Janabi believes that this approach could produce results in the next two or three months. 

The top WHO official said he was leaving Bunia “very optimistic”, but the figures demonstrate the current urgency because if the majority of Ebola deaths continue to occur in communities rather than in healthcare facilities, the virus will maintain its advantage. 

Children and women continue to bear a disproportionate share of the outbreak in Ituri, the most affected province, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

The health crisis is unfolding in a province where nearly one million people have been displaced by conflict, with women and children accounting for around 80 per cent. 

Young lives lost

The outbreak emerged in mid-May and since then, more than 300 children have succumbed to the virus, the UN Children’s Fund (UNICEF) said.

Moreover, children make up nearly a quarter of confirmed cases, but almost a third of all deaths, the agency added.

Earlier this week, the UN reported that the outbreak is also severely disrupting essential healthcare.

“In the hardest-hit areas, use of health services has dropped by more than 40 percent in recent months, as fear of infection keeps people away,” UN Deputy Spokesperson Farhan Haq told journalists in New York.

Pregnant women in peril

This fear, combined with overstretched health services, is preventing many pregnant women from seeking care.

 The warning by the UN’s sexual and reproductive health agency, UNFPA, comes as maternal deaths in Ituri have nearly doubled since the outbreak began.

Roughly six women die each week from childbirth-related complications, while Ebola infection during pregnancy remains associated with almost universal fetal loss. 

 Humanitarians stressed that restoring community confidence is key. In this regard, some 13,000 community workers have been deployed by the Congolese health ministry and partners, including the Africa Centres for Disease Control (Africa CDC), UNICEF and sister UN agency the World Health Organization (WHO).

 The community workers have reached more than 2.4 million people with information on Ebola prevention and early detection. They have also carried out over 500,000 household visits to counter misinformation, in addition to encouraging people to seek care early.

New vaccine trial 

Meanwhile, an expert panel convened by (WHO) has recommended that a single licensed Ebola vaccine be evaluated in a randomised clinical trial for Bundibugyo virus disease.

The WHO Technical Advisory Group on candidate vaccine prioritisation for Bundibugyo virus disease recommended Ervebo in a new report issued on Friday.

This follows new preliminary data from animal studies suggesting that the vaccine may offer some cross-protection against the species, particularly against causing fatalities.

Ervebo is the only licensed vaccine against the main form of Ebola virus disease, also known as Ebola Zaire.

WHO convened advisory groups after the Bundibugyo species outbreak in the DRC was declared a Public Health Emergency of International Concern on 16 May. 

The experts held two meetings to review the vaccine and “treatment landscape” for the species and issued an initial set of recommendations. 

At that time, they recommended that Ervebo should not be used outside carefully designed research settings so that its performance against Bundibugyo virus disease could be assessed.

Possible cross-protection

The advisory group met for a third time on 31 July to review new data on Ervebo. 

They examined preliminary data from animal studies showing that the vaccine offered some level of cross-protection against Bundibugyo virus disease in animals, particularly against death from the disease.

They assessed the vaccine’s safety, efficacy, availability and feasibility of implementation, agreeing that there were no safety concerns for its use, where contacts of confirmed cases are vaccinated.

More evidence needed

The advisory group recommended Ervebo to be prioritised for inclusion in a randomised clinical trial, in the absence of specific vaccines against Bundibugyo. Its efficacy against the species still needs to be proven.

The experts emphasised that a vaccine developed specifically for Bundibugyo virus would remain the preferred option.

Key points

• 3,748 cases, including 1,657 deaths and 708 recoveries, as of 1 August, according to WHO
• While Ebola vaccines exist, 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
• Clinical trials of medicine and treatment options are rolling out in Ituri province, the restive epicentre of the current outbreak 
• A new 100-bed treatment centre was inaugurated in Bunia, capital of Ituri

Searching for solutions

Compared to previous Ebola outbreaks, trials started more quickly this time as protocols had been written before the current one was declared in DRC in mid-May, said Vasee Moorthy, acting lead of WHO’s R&D Blueprint, a global platform for research and development collaboration to respond to epidemics and pandemics.

Despite ongoing efforts, there are still no proven safe and efficacious treatment, preventive or vaccination options for the Bundibugyo species of the Ebola virus, Dr. Moorthy told reporters in Geneva.

However, it would likely still be several months before more definite conclusions could be drawn from the ongoing trials, he said.

Vaccine trials

A vaccine trial in the United Kingdom entered phase one on 24 July, with another to begin in Canada in coming days, Dr. Moorthy said.

Both trials are being conducted on ferrets and monkeys, after which results would be analysed by WHO before deciding on whether to move to the subsequent phase.

New data has also emerged in animal studies on the licensed vaccine Ervebo, targeting a different Ebola strain, according to WHO.

The UN health agency’s technical advisory group convened last Friday and is expected to publish recommendations later this week.

New clinical trials

A clinical trial of a potential post-exposure prophylaxis – or preventative – medicine is underway in Ituri province.

Led by the DRC’s National Institute for Biomedical Research with an international consortium of research and outbreak-response partners, the trial has enrolled over 25 patients to evaluate whether an oral medicine given for 10 days to confirmed high risk contacts could prevent onset of disease. 

Since the outbreak was declared, three testing sites have opened in Ituri province and a fourth is set to open later this week where patients can enrol in trials and be monitored in safe conditions to see if the medicines are effective, Dr. Moorthy said.

“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.”

Watch the full press conference here.

What’s the UN doing?

Here is a look at some ongoing Ebola response initiatives:

• 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 (WFP) delivers Ebola test results in around one hour, cutting delays and bringing lifesaving diagnostics closer to more than 94,000 people
• The UN Children’s Fund (UNICEF) operates nurseries for youngsters of Ebola-affected families
• The MONUSCO peacekeeping mission in DRC protects civilians, conducts information campaigns for local communities and has increased presence around medical facilities to support WHO teams and partners (check out our interview with the current force commander here or right below)

• UN aid coordination office OCHA is releasing up to $60 million to support response and preparedness efforts in DRC and neighboring countries through the UN’s Global Emergency Fund, CERF

Learn more about the UN’s Ebola outbreak response here.

Why it matters

• As of 30 July, reports indicate a total of 3,605 confirmed cases, including 1,587 deaths, since the outbreak was first declared in mid-May, according to latest updates from WHO
• The highest number of reported cases (567) and deaths (296) were recorded in the most recent week’s data
• Over the last two months, the outbreak has expanded to five additional provinces and is now affecting 49 health zones
• The outbreak remains active in 33 of them, with confirmed cases still being reported
• Ituri remains the most impacted province, accounting for 88 per cent of all confirmed cases and 82.6 per cent of reported deaths nationwide
• Health partners will open DRC’s largest treatment centre this week, complementing an Ebola transit centre, according to the UN aid coordination agency, OCHA
• WHO warned a substantial scaling up of response activities is needed

“Ebola is moving fast, hitting people already facing conflict and hunger,” said Carl Skau, acting chief of the World Food Programme (WFP) following a weekend visit to eastern DRC. “Communities are key to ending it, but need support.”

WHO said the current outbreak is now the largest recorded Ebola virus disease outbreak in the country, surpassing the 2018 to 2020 outbreak which resulted in 3,317 confirmed cases.

During the most recent complete reporting week, the highest weekly number of reported cases (567) and deaths (296) to date were recorded, underscoring the exceptional pace of transmission.

Inside the red zone

The hardest hit areas are in a “red zone”, where lifesaving work is underway. UN agencies and partners, including the United States and the International Medical Corps (IMC), have helped to set up an Ebola transit centre at the Kigonze displacement camp on the outskirts of Bunia, the capital of Ituri.

The facility will make it easier to identify suspected cases more quickly and refer confirmed Ebola patients to treatment centres, an OCHA spokesperson said.

This week, health partners will also inaugurate the biggest treatment centre of the country, with a 100-bed capacity, OCHA announced.

Need for rapid action

However, a substantial scaling up of response activities is needed to get ahead of the outbreak, which has seen increasing number of cases, expanding geographic spread and high mortality, WHO warned.

“The convergence of insecurity, population displacement and mobility and cross-border movements complicate response operations and increase the risk of further geographical spread,” the UN agency said, noting that around 270,000 people who have fled violence now live in displacement sites across Ituri province, where conditions are ideal for the disease to spread.

Meanwhile, aid teams are finding that the disease appears to be causing still births and premature deliveries, underscoring the need to provide additional care for patients who are pregnant.

Expanding efforts

As needs have climbed, so has the response.

When the outbreak was announced late last year, UN agencies partnered with Congolese health authorities to open an innovative Ebola treatment centre in December that could accommodate 25 patients.

Since then, tonnes of supplies have been shipped and the number of treatment beds has expanded across affected areas, including Nizi, a priority area for the Ebola response, hosting more than 80,000 internally displaced people across 22 sites and facing high population movement linked to mining activities.

This week, WHO delivered 30 additional beds and 38 mattresses to health authorities in Nizi, located near Mongbwalu in Ituri province, bringing the Ebola Treatment Centre’s capacity to 80 beds.

Learn more about the UN Ebola response here.