G20+ countries pledged an additional $700 million this week to counter the Ebola outbreak in the Democratic Republic of Congo (DRC), Dr Jean Kaseya, Director-General of Africa Centres for Disease Control and Prevention, told a media briefing on Thursday.

The new pledges were made at the G20+ Foreign Ministers’ meeting convened by the United States on Wednesday on the sidelines of the UN General Assembly in New York.

The additional pledges mean that over $2.9 billion has been raised for the outbreak, which is growing at five times the rate of the previous biggest Ebola outbreak.

Describing the new money as “huge”, Kaseya thanked the US government, which is the biggest funder of the response, followed by the European Union.

“But pledges alone will not stop Ebola,” Kaseya added. “We must be able to trace every single dollar—from commitment to disbursement, from implementing partner to expenditure, and ultimately to the services delivered to affected communities. Transparency builds trust, accelerates delivery and saves lives.”

To date, the United States government has provided $887 million to combat the Ebola outbreak, and it pledged an additional $267 million at Wednesday’s meeting.

The new money will go towards “new Ebola treatment units, additional safe and dignified burial teams, mass procurements of personal protective equipment, expanded surveillance, critical health commodities, and contact tracing through trusted implementers,” the US State Department said.

Kaseya also recognised contributions from 27 African countries to address the outbreak, with confirmed cases reaching 7,820 and 3,779 deaths. Health workers account for 239 cases and approximately 50 deaths.

Nord-Kivu surge

The outbreak is “cooling in Ituri [province] while it accelerates in Nord-Kivu”, said Dr Wessam Mankoula,  Africa CDC’s head of emergencies.

In the past three weeks, new cases in Ituri – the epicentre of the outbreak – have dropped by 25% and deaths decreased by 31%. However, new cases in Nord-Kivu have increased by 56% and deaths by 19%, Mankoula told the media briefing.

The case fatality rate in Nord-Kivu is 60.5% in comparison to the national average of 48.3%.  Ongoing conflict in the province is hampering the efforts of health and humanitarian teams, people are also seeking treatment very late, and there is a shortage of health workers in the province.

However, Ituri remains by far the worst affected province, with 5,966 cases and 2 737 deaths in comparison to 1 438 cases and 872 deaths in Nord Kivu, according to the DRC’s health ministry on Monday.

High mortality in children under five

Meanwhile, the overall death rate is highest among children under the age of five, with a case fatality rate of 62%. People over the age of 65 had the next highest CFR (43%).

Dr Daniel Youkee, the World Health Organization’s (WHO) Ebola case management team lead, explained that “young children have a lower physiological reserve and not fully developed immune systems”. 

“They require constant attention and special care. They need specific expertise, equipment and medications which are sometimes not readily available,” said Youkee.

“Standardised supply kits need to incorporate paediatric sized equipment and medication with paediatric dosage and presentation. Staff need to be trained on paediatric guidelines, including response to hypoglycaemia and ionic shock in children.”

The speed of the current outbreak is of great concern, growing from eight confirmed cases in three health zones on 15 May to the current size, affecting 63 health zones across seven provinces.