Congo Draws Up a New Battle Plan Against Ebola Amid Power Struggle

By | July 26, 2019

Faced with an Ebola outbreak that sprawls over a vast swath of Congo, public health officials are conceding that their battle against the virus is failing and have proposed a comprehensive new strategy for ending the epidemic.

The plan envisions no longer treating the epidemic simply as a health emergency, and reframing it as a regional humanitarian crisis. That may include more troops or police to quell the murders and arson that have made medical work difficult, and food aid to win over skeptical locals. And the country will deploy a second vaccine to form a protective “curtain” of immunity around outbreak areas.

The outbreak, which began almost exactly a year ago and was declared a global health emergency this month, is now the second-biggest in history, with more than 2,600 cases and more than 1,750 dead. The outbreak has persisted in part because of a fierce but hidden power struggle for control of the response inside Congo, according to documents obtained by The New York Times and interviews with Ebola experts.

The country’s health minister, Dr. Oly Ilunga, resigned on Monday after a public dispute with donors at a World Health Organization meeting over whether to roll out the second vaccine, which he opposed. The effort to contain the outbreak will no longer be overseen by the country’s health ministry but by an expert committee reporting directly to Congo’s new president, Felix Tshisekedi.

Ebola Cases by Week

Reported cases in the Democratic Republic of Congo, as of July 21.

120

Confirmed cases

Probable cases

100

80

60

40

20

May

2018

July

Sept.

Nov.

Jan.

2019

March

May

July

2019

120

Confirmed cases

Probable cases

100

80

60

40

20

July

2018

Sept.

Nov.

Jan.

2019

March

May

July

2019

By The New York Times | Source: World Health Organization

Dr. Ilunga was the target of a scathing internal government report produced in April, just as new cases began soaring above 100 per week. The report was written by a commission convened by Congo’s new president, some of whose members are now overseeing the response.

The report said “arrogant” national health officials took “an aggressive and ostentatious attitude” when they visited the outbreak area, renting deluxe hotel rooms and expensive cars and “brandishing large dollar bills” while local health workers went unpaid.

A spokeswoman for Dr. Ilunga called the report “weak.” She said he had resigned not because of it, but because the president had split the authority to oversee the response to the outbreak between his office and an independent commission, which she claimed was a violation of the Congolese Constitution.

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CreditJohn Wessels/Agence France-Presse — Getty Images
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CreditJerome Delay/Associated Press

Dr. Ilunga’s departure pleased some donors and agencies supporting the fight against Ebola. The United States is by far the biggest donor. Tibor P. Nagy, the State Department’s top official for African affairs, told a Senate subcommittee on Wednesday that Dr. Ilunga’s resignation “may be an improvement to the situation.”

The country is seeking $ 288 million to implement its new Ebola strategy, and is likely to get it. The World Bank recently offered $ 300 million, and the United States increased its previous giving by $ 38 million this week.

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The new plan may include a campaign to win the hearts of the area’s traumatized population by vaccinating against other diseases, offering hot meals and bulk food, deworming schoolchildren, and even creating thousands of jobs.

International assistance efforts will no longer be directed solely by the W.H.O. and its director-general, Tedros Adhanom Ghebreyesus, but by David Gressly, a former head of U.N. peacekeeping troops in Congo who was recently given charge of the entire U.N. response.

SUDAN

CHAD

BENIN

NIGERIA

ETHIOPIA

TOGO

SOUTH

SUDAN

Ebola R.

200 miles

UGANDA

Current

outbreak

KENYA

GABON

DEM. REP.

OF CONGO

CONGO

REP.

TANZANIA

MALAWI

ANGOLA

Forested areas

ZAMBIA

Areas at risk of

Ebola outbreaks

SUDAN

CHAD

SOUTH

SUDAN

Ebola R.

UGANDA

Current

outbreak

DEM. REP.

OF CONGO

ANGOLA

Forested areas

ZAMBIA

Areas at risk of

Ebola outbreaks

200 miles

By The New York Times | Sources: World Health Organization; David M. Pigott et al., eLife Sciences

The strategy also envisions greater efforts to win the support of local officials, chiefs and religious leaders in the isolated eastern provinces, to negotiate a truce with armed groups, and to persuade people to accept vaccines and go to treatment centers.

Some 500,000 doses of a new Johnson & Johnson vaccine against Ebola will be introduced, and it will be used differently from the current vaccine, made by Merck. While Merck’s single-dose vaccine is used to “ring-vaccinate” everyone around each known case, the new vaccine — which requires two doses given two months apart — will be deployed in areas farther away.

The idea is to encircle the outbreak with immunized people, especially among health workers. While the Merck vaccine has been given to Ugandan health workers on the Congo border, for example, the second vaccine will be deployed in Mbabara, a regional capital 60 miles away with a big hospital that ill patients might travel to.

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CreditAmpe Rogerio/EPA, via Shutterstock
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CreditOlivia Acland/Reuters

At its core, the political struggle within Congo pitted Dr. Ilunga, 59, who had been a minister since 2016, against Dr. Jean-Jacques Muyembe, director-general of the country’s National Institute for Biomedical Research.

It also was a struggle between President Tshisekedi and his predecessor, Joseph Kabila, 48. After 18 contentious years in office, Mr. Kabila stepped down last year and is now a senator for life. In December, Mr. Tshisekedi won a disputed election, beating Mr. Kabila’s chosen successor. But since then, he has only slowly replaced Mr. Kabila’s cabinet ministers.

Dr. Ilunga, who visited the outbreak area several times, is respected by some Ebola experts. The head of one international agency, speaking on condition of anonymity to avoid involvement in another country’s dispute, called him “principled and data-driven.”

Dr. Muyembe, 77, is an internationally respected authority on Ebola who has helped fight every outbreak since the virus was discovered in 1976, when the country was named Zaire.

The report by the commission led by Dr. Muyembe accused Dr. Ilunga of “weak governance, weak leadership and a hyper-centralized response” that failed to coordinate with other ministries, including the police and army.

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CreditMatthieu Alexandre/Agence France-Presse — Getty Images
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CreditSalym Fayad/EPA, via Shutterstock

In addition to accusing Dr. Ilunga and his staff of “arrogance” and “ostentation,” the report also cataloged serious medical failures.

People with fevers who entered screening centers to see if they had Ebola did not get test results for three to five days, by which time they might be infected or infect others. Private clinics and traditional healers held patients in order to make money, possibly spreading infections.

There was little done to protect areas where the virus had not yet appeared or to coordinate with neighboring countries, the report said. And while the commission’s field visits had gone “generally well,” its work was hampered because Dr. Ilunga had refused repeated requests to meet with members and his office had been uncooperative with information requests.

Jessica Ilunga, a spokeswoman for the former health minister, derided the report and said it “had no data” — such as the names of health workers who claimed they had gone unpaid.

She denied that national officials had spent too much money and scoffed at the idea that outbreak cities like Butembo even had luxury hotels. National officials had needed running water and internet connections, she said.

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CreditJerome Delay/Associated Press
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CreditJerome Delay/Associated Press

The commission, she said, had never consulted the ministry, even though the minister asked it to explain what it would investigate. In addition, she said, since he took office in January, Mr. Tshisekedi had refused to see Dr. Ilunga.

The battle against Ebola was weakened by the struggle between the current president and the former one, said Dr. Peter Piot, director-general of the London School of Hygiene and Tropical Medicine.

But Dr. Piot, who is a discoverer of the Ebola virus and serves on W.H.O. advisory committees, confirmed the existence of personal antagonism between the two doctors.

After an expert committee had endorsed the Johnson & Johnson vaccine, he and Dr. Muyembe went to Dr. Ilunga’s office to discuss it. Dr. Ilunga — “appearing quite autocratic,” Dr. Piot said — saw him but refused to admit Dr. Muyembe.

“I thought, ‘Oh, God. I didn’t realize how bad the dynamics were.’”

NYT > Health