In the midst of the Covid-19 pandemic, a new health front is opening up: Ebola reappeared in early February on the continent.
Within days of each other, cases of virus infection reappeared in the Democratic Republic of Congo and Guinea, where health authorities declared the country "in an epidemic situation".
With this new outbreak, West Africa is seeing the specter of the 2013-2016 epidemic resurfacing, which left 11,300 dead (out of 28,600 cases recorded), the heaviest toll recorded for this virus originating in Central Africa which causes fever, headache, vomiting and diarrhea.
However, the situation is quite different today.
The authorities reacted quickly by decreeing a series of restrictive measures in the affected areas and by calling on the WHO for reinforcement.
John Johnson has been involved in numerous Ebola response campaigns.
Vaccination and epidemic response referent for MSF, he answers questions from France 24 on this new resurgence of the disease.
France 24: How do we explain the return of the Ebola virus to Africa?
John Johnson:
Some diseases, like measles or smallpox, only exist in the human body.
On the other hand, Ebola is present in a vector, a reservoir, probably the bat.
It can happen that this animal transmits the disease either directly or through another infected animal.
Ebola cannot therefore be eradicated because it exists in nature.
So it's predictable to have this new outbreak of cases.
This remains worrying, but it is not unexpected.
Moreover, this kind of outbreak can be quickly quelled.
Ebola is very fatal, but not very contagious.
Its reproduction rate is only 1.5, because it requires close contact with an infected person, especially with their bodily fluids.
Often, it is the caregivers who find themselves infected.
In Guinea, the current epidemic is believed to be linked to a funeral in the Gouécké region, in south-eastern Guinea. Why can funerals represent a special risk?
We had already pointed out this phenomenon during the epidemic which spread between 2013 and 2016 in West Africa.
Culturally, it is very important to attend the funeral of a member of the community and to come into contact with his body.
However, the body is much more contagious than a person who has just caught the disease because the viral load has had time to develop.
However, we are better prepared than five years ago.
There is now know-how, knowledge around this disease and prevention messages.
Another element to prevent funerals from becoming places of contamination: “dignified and secure” burials.
When there is a suspicious death, the body is placed in an airtight bag and the burial is carried out by a specialized team.
How is the authorities' response organized?
In the DRC, this is the twelfth Ebola epidemic.
So the authorities know the disease very well and know how to mount a response.
It was in the Congo that Professor Jean-Jacques Muyembe discovered Ebola in 1976 and today, he is part of the team responsible for organizing the response.
So the DRC has a lot of experience in stopping transmission: case surveillance, contact tracing over the past 21 days, vaccination that we didn't have five years ago.
Another novelty, today we have drugs: monoclonal antibodies that reduce mortality in patients with Ebola, especially if they are administered early.
Guinea is also well prepared.
There has been a lot of skills transfer between Guineans and Congolese and they have the experience of 2015. They will have to adapt their approach by trying to decentralize the care of patients with the establishment of local centers and by integrating their response monoclonal antibodies and vaccines that will prevent contamination of caregivers.
A humanitarian flight is expected to arrive in Guinea next weekend with
11,000 doses of vaccine.
Do we have enough doses
?
There are two vaccines: that of Johnson and Johnson, a two-dose vaccine that requires patient monitoring, and that of Merck with a binding cold chain comparable to that of Pfizer's vaccine against Covid.
In both cases, there are challenges to overcome.
Logistically, this will pose difficulties in reaching the populations of south-eastern Guinea, but we have seen in Kivu [region located in the east of the DRC in the grip of armed conflicts] that this was possible.
The situation is not comfortable, but we have enough doses to start the campaign before a possible ramp-up to produce more doses.
Africa is also facing the Covid-19 pandemic. Can this complicate the response to Ebola?
Yes of course, for example last year there was the biggest measles epidemic in Chad, the Central African Republic and the DRC.
However, very little was said about it, because everyone was focused on the Covid-19.
Traditionally, Ebola epidemics also have the effect of "breaking" the health system.
Everything is turned upside down to organize the response to the epidemic.
Patients avoid self-care for fear of illness.
It is the same with the Covid which reduces the number of routine vaccinations.
This situation can therefore create other problems and weaken already fragile health systems.
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