Over 2000 people have died so far in the Ebola Bundibugyo outbreak in the Democratic Republic of Congo (DRC), and the only way to break the chains of transmission is via scaled-up local surveillance, according to the World Health Organization (WHO).

“Most concerningly, we see a high proportion of deaths in communities instead of treatment units, outside of known contact lists,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday.

“That tells us there are chains of transmission we don’t know about, and until we know about and break every chain of transmission, we will not stop the outbreak,” he said.

“Surveillance is our priority operational challenge. With partners, we’re mapping and pooling resources to strengthen community-based surveillance to bring every suspected case into care and reach the 95% contact tracing target needed to interrupt transmission.”

About 90% of the 4,449 official cases and 80% of deaths are in the province of Ituri, with sustained transmission in the towns of Bunia, Rwampara, Nizi and Litha, said Tedros.

Most infections happen when people have late-stage disease and are not in treatment, or when their bodies are handled after they have died.

“Early clinical care and safe and dignified burials are therefore critical for interrupting transmission, and both depend on the trust of affected communities, which means community engagement and community ownership are essential,” Tedros stressed.

‘Hope is not a strategy’

Partners have set the ambitious goal of ensuring 3,000 beds are available for Ebola patients as soon as possible – but it has taken three months to set up 1,500 beds.

Dr Abdi Rahman Mahamud, WHO director for Health Emergency Alert and Response Operations, said that the moderate scenario for the outbreak was for it to peak within six months.

“But this is a highly dynamic outbreak, and unless, as the DG said, we have the community on our side, we’ll be struggling. The last previous outbreak, which happened in a security-compromised situation, lasted about two years=,” said Mahamud.

“We don’t want to repeat that. Under the leadership of the government, we are doing everything possible to reduce that, and hopefully in the next six months.”

He added: “But hope is not a strategy. We have to have the community on our side, increase the surveillance, and increase our safe and scalable care.”

Under-funded

Yet the response is only around 50% funded, with $264 million of the $518 million pledged having been disbursed, 

WHO DRC representative Dr Anne Ancia said that the DRC Government’s latest estimate to address the outbreak was $940 million.

She added that most of the money raised so far had gone to partners rather than the DRC government. The DRC government, which has invested $50 million, aims to cover health workers’ salaries with domestic funds eventually, but it was not yet possible given the massive need for additional posts.

Tedros said that 21,000 health workers have been tained so far but that the response needs three health workers per patient.

Earlier this week, Wellcome Trust gave a $3 million grant to the WHO to expand community intelligence about the outbreak. This will provide authorities with more insight into how people perceive risk, seek care, respond to public health measures and experience the broader social and economic impacts of the outbreak.

“Every outbreak is shaped not only by the pathogen, but also by how people understand risk, access care and respond to public health measures,” said Dr Chikwe Ihekweazu, executive director of WHO’s Health Emergencies Programme. 

“This investment is about making social analytics part of how outbreak intelligence works in practice. By integrating community-generated evidence throughout the response, we can build a more complete picture of the outbreak and make faster, more effective decisions that ultimately save lives.”

Meanwhile, the speed of the outbreak was more likely the result of the difficult conditions, including armed conflict, rather than viral mutation, WHO Chief Scientist Dr Sylvie Briand told the briefing.

“Currently, we have not seen any mutation in this virus, and probably the course of the outbreak is currently much more explained by the context in which the virus is circulating, which is an area of conflict with a lot of population mobility,” said Briand.

On Monday, researchers reported in Nature that the current outbreak was likely to stem from a new zoonotic spillover from animals to humans, as it was different from the 2007 and 2012 Bundibugyo outbreaks. They deduced this by examining samples from 22 infected people.