The Ebola outbreak in the Democratic Republic of Congo is not only a public health emergency of international concern, but also a national security concern, members of the U.S. Department of Health and Human Services said on the one-year anniversary of the crisis.
As of Aug. 1, which marks one year since the first case, 1,813 deaths have been reported, and no evidence suggests that the outbreak is slowing down, Centers for Disease Control and Prevention's Henry Walke said during a media briefing.
Walke also confirmed a third case in Goma, a city in the DRC that borders Rwanda. The new case is a relative of the second case in Goma, reported on July 30, and the ongoing investigation is evaluating the other family members with high-risk of contact.
Risk of the virus traveling to the U.S. is low based on travel volume as the DRC has no direct flights to the U.S. and fewer than 16,000 travel between the countries annually, said Walke, the director of the Division of Preparedness and Emerging Infections and Incident Manager, 2018 CDC Ebola Response.
In addition, the spread of the outbreak via migration is highly unlikely, as the incubation period for Ebola is between two and 21 days; a migrant would take months to travel from the DRC to Mexico, Walke said.
Walke reiterated that trade and travel restrictions should not be imposed as a result of the outbreak.
Hampered efforts, despite the WHO's call for help
According to Walke, 15 to 20 CDC staffers are in the DRC responding to the outbreak, and the CDC plans to double that number in the next month, potentially deploying responders to other large urban areas to prepare for the potential spread. Staffers are also on the ground in the DRC's neighboring countries South Sudan, Uganda and Rwanda, with about two to five responders in each nation.
The World Health Organization has called for more resources to aid with the outbreak, but the CDC's deployment of personnel remains contingent on the U.S. Department of State and the DRC's diplomatic security's assessment of conflict areas and civil unrest. Ebola treatment centers and health workers have encountered attacks from militant groups and armed rebels.
Walke acknowledged that mistrust in the community has hampered vaccination and efforts to trace contact of infected individuals.
"We do know that the vaccine is generally accepted by the population, but it's important to sensitize the population to vaccination efforts," Walke said.
Various medical countermeasures are being supported by the Biomedical Advanced Research and Development Authority, including the two vaccine candidates by Merck & Co. Inc. and Johnson & Johnson and four experimental therapeutics, one of which is being developed by Regeneron Pharmaceuticals Inc.
But while BARDA is supporting both Merck and J&J's vaccines, director Rick Bright said the organization is deferring to the local health authorities to choose which vaccine is in use in their jurisdiction.
"I believe we all are in agreement that it's important to have more than one vaccine licensed for the long-term," Bright said.
Several hundred thousand doses of vaccines are being produced in the country or available for transfer, according to Bright. Among vaccinated healthcare workers who were infected with the Ebola virus, none died, Bright added.
Merck has submitted a licensing application for its vaccine candidate, which the U.S. Food and Drug Administration is currently evaluating, director of the Center for Biologics Evaluation and Research Peter Marks said.
Meanwhile, the clinical trial testing the four therapeutic interventions will be expanded from the previous 500 to 545 individuals to 725 people, at which point the trial will terminate.
"We fully believe we will get to that number certainly before we have control of the outbreak in the DRC," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "Hopefully by the end of this endeavor, we will be able to make some sort of determination about which one or more of these interventions are actually effective."