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A Year On, HHS Agencies Detail Their Ebola Response in DRC

— Assisting efforts through responders on the ground in Africa, research back at home

Ƶ MedicalToday

One year after the start of the most recent Ebola outbreak in the Democratic Republic of the Congo (DRC), U.S. health agencies reaffirmed their commitment to help stop the outbreak through response teams, research efforts, and medical countermeasures.

The CDC activated its Emergency Operations Center on June 13, and has deployed over 200 experts to not only the DRC and Goma, a large city on the border with Rwanda, but to the World Health Organization (WHO) headquarters in Geneva, Switzerland, as well. That's in addition to work the CDC is performing at its Atlanta headquarters, the agency said .

Most recent reports indicate there are now 2,713 cases of Ebola during this outbreak, including 148 healthcare workers, and 1,813 deaths. In addition, there have now been three cases of Ebola reported in Goma, a city of 2 million directly adjacent to Rwanda.

Earlier media reports said that Rwanda had closed its border -- which the World Health Organization (WHO) explicitly said not to do when declaring the Ebola outbreak an international health emergency in mid-July. However, Reuters quoted Rwandan officials later on Thursday as insisting the border was always open, but had caused backups.

Henry Walke, MD, director of the Division of Preparedness and Emerging Infections and incident manager for the 2018 CDC Ebola response, said the CDC has 15 people on the ground in Goma and elsewhere in the DRC.

"We plan on doubling our responders in the next month and maintaining our presence in Goma, Kinshasa [capital of the DRC] and other large urban areas," he said. "We are anxious to get on the ground in outbreak areas, but ... the security situation changes on a regular basis."

While security remains a challenge in the DRC, one thing Walke was unequivocal about was the threat of Ebola transmission to the U.S., which he stated remains "low," based on travel volume.

"Fewer than 16,000 people a year travel from the U.S. to the DRC, and there are no direct flights," Walke said, adding that the best way to keep Americans safe at home is to control the outbreak overseas.

The War at Home

In addition to the CDC, other agencies under the Department of Health and Human Services, such as the National Institute of Allergy and Infectious Diseases (NIAID) and the Biomedical Advanced Research and Development Authority (BARDA), are working to conduct clinical trials for new therapeutics and collaborating with industry to help with the development and deployment of vaccines and new diagnostics.

NIAID Director Anthony Fauci, MD, discussed an ongoing clinical trial of four Ebola therapeutic agents, including ZMapp, the cocktail of antibodies tested in West Africa that had a signal "suggestive of being effective," though it did . The other three agents are remdesivir, a nucleoside analog; MAb114, which was developed at the NIAID; and REGN-EB3, an investigational agent from Regeneron.

Fauci said that the trial started with 500-545 individuals, but they plan to increase that number to 725. Currently, they are at 631 people in the trial.

"We will get to [725] before we have control of the outbreak," he noted. "Hopefully, at the end of this endeavor, we will be able to make some sort of determination about which one or more of these interventions is effective."

Rick Bright, PhD, director of BARDA, said that Ebola is not only a public health concern, but has been "identified by the Department of Homeland Security as a national security threat." As such, the agency is working with industry to develop medical countermeasures, including the two Ebola vaccine candidates (rVSV-ZEBOV vaccine from Merck and Janssen's Ad26.ZEBOV/MVA-BN vaccine).

Notably, he said that over 180,000 individuals have been vaccinated during the current outbreak. Though he said there is an "agreement" that there should be more than one licensed Ebola vaccine available for long-term use, U.S. agencies have been "deferring to local health authorities for which vaccines are available for use."

Bright said they are also supporting a rapid point-of-care diagnostic for Ebola by OraSure Technologies.

"This allows physicians and health workers to be able to test those who have died to see if they were exposed to Ebola to ensure a proper and respectful burial," he said.

Peter Marks, MD, PhD, director of the Center for Biologics Evaluation and Research at the FDA, said that the agency has been involved with the development of investigational medical products that are "critical in the fight against Ebola," such as investigational vaccines and therapeutic drugs.

He also said that the sponsor of the Merck Ebola vaccine has started the application process to get the vaccine reviewed by the FDA.

When asked if the outbreak was slowing down, Walke said that it "continues at the same pace" and shows "no evidence of slowing," adding that the agency was "supportive" of the WHO declaration of a PHEIC (Public Health Emergency of International Concern).

Though not on the call, CDC Director Robert Redfield, MD, released a statement saying that the "CDC remains prepared for the prolonged journey ahead and remains committed to working with our U.S. government and international partners to support the response and end this outbreak."