More than three months have passed since the start of the latest Ebola virus epidemic in the Democratic Republic of Congo. The outbreak has infected 55 people, leaving 28 dead (as of 24 June), and raising concerns that an outbreak concentrated in urban areas such as Mbandaka - a city of 1.2 million on the Congo river that has reported cases - could pose unprecedented challenges and risks.
With nine outbreaks since 1976 and five viral variants identified so far, over the years Ebola has caused intense distress among African populations, and severe concern among local health officials and in the international community.
But this time there's evidence that overall preparedness, containment measures, information and the launch of a new vaccine are making a meaningful difference in the management of the infection, says TWAS Fellow Vincent Titanji of Cameroon.
According to World Health Organization (WHO) reports, the spread of the infection seems to be restricted to a relatively small area, with more than 3,268 people vaccinated since 21 May (as of 23 June) and lower risk at global level.
Titanji, an expert in infectious diseases like malaria, river blindness and tuberculosis, is the former vice-chancellor and coordinator of the biotechnology unit at University of Buea in Cameroon. With a PhD (1987) in physiological chemistry and the docent title (1988), both from Uppsala University in Sweden, Titanji developed an early interest in molecular techniques that he has applied to diagnose tropical diseases and to devise new therapies and therapeutic approaches.
His contributions to the field of vaccine development are well known: choosing river blindness as a model disease, he has spotted new antigens for vaccine development. His investigations have further included other important diseases like malaria, tuberculosis and metabolic diseases.
With support from the International Science Programme (ISP), a Swedish initiative aimed at strengthening local research capacities of lower-income countries, Titanji in 1987 set up a Biotechnology Centre in Yaoundé, Cameroon's capital city, which he ran for a decade before moving to Buea, where he established another biotechnology unit.
Speaking with TWAS staff writer Cristina Serra about the recent EVB epidemics, Titanji offers his view and advice on how to best break the transmission chain in the case of Ebola by acting on multiple fronts.
Africa, and the Democratic Republic of Congo (DRC) in particular, is experiencing another Ebola outbreak. Are today's health systems, both in Africa and elsewhere, better prepared to these events than in the past?
In a way, we are all better prepared. There is more awareness than during past epidemics. What's more, there is now a usable Ebola vaccine that is part of the available tools we can use to control the infection. But the response still depends heavily both on international organizations, and on the health system of the affected countries. Democratic Republic of Congo, for example, is still not strong enough to cope with this by itself.
What role should international organizations have?
I think their role would be to provide technical expertise first, and then funds and logistics. If there is a need, that need should be met rapidly enough to allow the handling of unexpected situations as soon as they are detected. However, this time the international response has been very rapid. More than in the past. From all the indications we receive it seems that, now, Ebola is almost under control.
What are major lessons that we have learned regarding epidemics, not only for Ebola but for infectious diseases in general?
Methods for the control of epidemics have been improved, and are now well known to most epidemiologists. Isolation procedures are equally better. Whenever the source or the cause of the epidemics is known, it is easier to eliminate. However, the case of Ebola is special because it is very deadly and also very infectious: it can spread by simple contact with an infected person or the corpse of a victim of the disease. During Ebola epidemics in West Africa, robust protocols were developed for preventing the spread of the disease. Each time we learn something new.
Is an outbreak such as Ebola potentially more dangerous in a city than in the countryside?
Given the high population density of cities, yes, an outbreak might be more dangerous in an urban context that in the countryside. On the other hand, cities have generally better health facilities than rural areas, and are able to respond quickly. But the circulation of people between cities and the countryside suggests to keep the alert on, and not be complacent about the city. We need to work extensively to prevent epidemics, and be ready to stop their spread wherever they occur.
Why is it that Ebola bursts out in some years (the current outbreak is the 9th in 40 years), and then it suddenly disappears? And why so often in DRC?
That is a good question. We can only speculate on that. Perhaps the source has not been completely eliminated. In a case where there is a reservoir in the population, or maybe among animals, then if you treat or eliminate the disease in the population, the reservoir could remain untouched. And if the reservoir – or latent forms – are then activated by some means that we are not aware of yet, or we do not fully understand, there can be an eruption. But we have no evidence. More research needs to be done. Regarding the geographical area of the epidemics, most of them are in DRC but not all of them. Last time Ebola affected West Africa. What is important is to remain vigilant and prepared to act when outbreaks occur. Meanwhile efforts to deploy the new vaccine should be stepped up. But this will need funding.
It was a bit alarming that, during this new epidemics, some health officials have been infected as well.
In the last epidemics some officials died because, at the outbreak, the standard protocols –how to use protectve clothes, how to handle the people, how to trace those who are in contact with infected people – were probably not well set up and deployed. As time goes by, protocols get better refinement and become established.
What kind of interventions can we put in action to prevent the spreading of these deadly events?
The very first one is working on health education and health sensitization, because the public that is at-risk of exposure should be constantly informed about the potential epidemics that can erupt in a certain area. Second, local health systems should be strengthened: they should be on the alert all the time. But when the situation calls for it, we should wait for the international community to intervene.
This year we have a vaccine that seems to work. Do you think the population is aware of the importance of vaccination?
I think that the population is well informed and the response is good. However, in few cases there has been misinformation, so we should continue along that line, providing better information, better deployment to reaching out to many people.
Ebola is a peculiar virus – other viruses are not as dangerous. Shall we act in the same way for all of them?
I agree when you say that Ebola is an extreme case, but there are many other challenges that we should be aware of in devising general strategies for infectious diseases: better information, better deployment of preventative measures, and preparedness in case there is an outbreak. Viruses call for a continuous fight that has to be carried out, where education and prevention are powerful tools at the local levels. But then of course, if there is a massive epidemics, the international systems should also be ready to cope with it.