The deadliest and longest Ebola outbreak in the history of the Democratic Republic of the Congo has finally ended, the Health Minister Longondo Eteni jubilantly announced on Thursday. The outbreak, concentrated in Ituri and North Kivu provinces in the northeastern DRC, infected 3470 people, and caused 2287 deaths. 

The end of the nearly two-year long fight, was celebrated by the World Health Organization, and welcomed by other organizations such as the Wellcome Trust.

But officials are cautiously optimistic, and emphasize that vigilance must be maintained in order to support survivors and prevent potential resurgences.

“This is the time for celebration, but we must resist the temptation to be self-satisfied. Viruses don’t take a break. Ultimately, the best defense against any outbreak is to invest in a stronger health system that provides the foundation for universal health coverage,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a press release.

Some 1170 survivors will need support to manage the potential long term effects of infection, which include memory loss and kidney failure. And ongoing outbreaks of measles, COVID-19, and another cluster of Ebola cases in Western DRC present new challenges.

The announcement of the outbreak’s end was made 42 days after the last Ebola patient was discharged from a treatment center in Beni, North Kivu. No new cases have been reported in the 42 days since the patient’s release, well beyond the virus’ three-week incubation period.

The success of the Ebola response was largely due to the advent of new tools against the virus – two working vaccines and two effective Ebola treatments.

More than 303,000 people received Merck’s rVSV-ZEBOV-GP Ebola vaccine over the course of the outbreak, through a partnership between Merck and Gavi, the Vaccine Alliance. After the Merck vaccine received regulatory approval from WHO in November 2019, Gavi made moves to establish a stockpile of the vaccine in preparation for future outbreaks.

Epidemic Response Teams Face Challenges In Conflict-Ridden Zones

But in conflict-affected zones, affected communities’ participation was key to finding and treating patients, and vaccinating contacts. Survivors often returned to their communities to serve as health educators after beating the virus.

In Ituri and North Kivu province, insecurity and community distrust have presented significant challenges to quashing the outbreak, which has simmered in the background of the coronavirus pandemic since January. 

Earlier this year in April, a new cluster of Ebola cases emerged just days before WHO was poised to declare the Eastern DRC outbreak over. One patient escaped from a treatment center and has still not been accounted for, according to the New Humanitarian. 

An attack on an Ebola treatment centre in late November 2019 left at least four dead and six injured, and one Congolese journalist involved raising awareness about the Ebola response was killed earlier that month. A WHO epidemiologist was killed in April 2019, highlighting the dangers and difficulties of working in insecure regions.

Still, the significant Ebola response has helped build up infrastructure to respond to other pandemic threats, such as a contact tracing workforce. 

“The DRC is now better, smarter and faster at responding to Ebola and this is an enduring legacy which is supporting the response to COVID-19 and other outbreaks,” said Matishidiso Moeti, WHO Regional Director for Africa in a press release.

But the same challenges have resurfaced and amplified in the wake of the coronavirus pandemic, which has swept the globe, unlike Ebola’s confinement to poor countries. And also unlike Ebola, there are no vaccines or treatments for COVID-19. 

And COVID-19 is hitting the country in the context of another Ebola flare-up in more peaceful Équator province in western DRC and an ongoing measles epidemic that has killed more than 6000 people, mostly young children. So far, some 24 people in Équator province have been infected by Ebola and 13 have died since 1 June.

“With the worrying increase in cases linked to an Ebola outbreak in Mbandaka in western DRC, along with cases of COVID-19 rising in the region, it is vital we continue to support the DRC and other countries all around the world with fragile health systems,” said Josie Golding, epidemics lead at the Wellcome Trust.

“It is only through science and collaboration that we will be able to end the COVID-19 pandemic. We must continue to unite an international effort, to ensure that all advances, including vaccines and treatments, are equally available to all, with no country left behind.”

Image Credits: WHO.