"This is not a happy anniversary," said Yap Boum, the regional representative for Epicentre Africa, the research arm of Médecins sans Frontières (Doctors Without Borders).
On Aug. 1 of 2018, the World Health Organization confirmed four Ebola cases in the conflict-torn east Democratic Republic of Congo. Since then, the outbreak has slowly and steadily worsened. There have now been roughly 2,700 cases and more than 1,800 deaths from the disease, making this the second-largest Ebola outbreak after the 2014-2016 West Africa crisis, which claimed more than 11,000 lives.
And health officials worry that the Congo outbreak is still far from over.
The challenges of containing it have been immense. The virus is spreading in a deeply impoverished part of the country that has been ravaged by various militias since the final days of the Mobutu Sese Seko dictatorship in the mid-1990s.
"It's happening in a conflict zone," said Boum, who's based in Cameroon but has been traveling back and forth to Congo to work on this health crisis. "One of the pillars of Ebola response is community engagement. So if you cannot reach the community then your response is affected."
According to Matshidiso Moeti, the World Health Organization's Africa director, there have been 198 attacks on Ebola clinics and response teams over the past year, killing seven Ebola workers and injuring at least 58.
"This violence is a reminder that this outbreak is one with unprecedented challenges," Moeti said.
Adding to the difficulties, Congo's health minister resigned last week in a power struggle with the president. And this week a second Ebola case was confirmed in the bustling city of Goma on the border with Rwanda, raising fears of regional spread. That patient died a day after being diagnosed.
Amid all this, the World Health Organization is begging for more money from international donors.
In a call with reporters on Tuesday, Michael Ryan, head of WHO's Health Emergencies Programme, said that WHO has budgeted $350 million for its response for the rest of 2019.
"We received well short of $50 million to cover that," he said. WHO is still talking with donors and hopes more contributions will come in soon. He didn't elaborate on why the shortfall is so large but told the press, "You can characterize that donor response as you will."
One encouraging sign is the slowing pace of new cases over the past few months. But from a historical perspective, the number is still incredibly high.
In the first seven months of the outbreak, health officials saw roughly 30 new cases each week.
Then, in March, the number started to rapidly increase. In one week in April, there were 126 new cases.
Now the tally has dropped to about 80 new Ebola admissions each week. In any other context, that figure would be considered high. Some outbreaks don't even get to 80 cases in total.
But there have been some successes. This is the first time that a vaccine has been widely used to combat the spread of the virus.
More than 170,000 people have received that vaccine from Merck. There's talk of deploying a second vaccine from Johnson & Johnson.
And even though there's still no licensed drug to treat Ebola itself, there's a difference between this outbreak and past outbreaks. Several experimental treatments are now available to patients in Congo.
Officials with WHO say that despite the challenges, they're making progress. Without the vaccine and the deployment of new therapies, the situation would be even worse, they say.
They also point out proudly that when a family, several of whom were sick with Ebola, crossed into Uganda, they were identified quickly. The virus didn't spread to anyone else in Uganda.
But many public health officials remain anxious.
"I don't mean to be overly alarmist, but I'm very concerned about the situation," said Dr. Daniel Bausch, who has worked on Ebola research for more than two decades. Bausch now directs the United Kingdom's Public Health Rapid Support Team, which has deployed experts to Congo since the early days of this outbreak.
"I think there's still a risk of this being like the West Africa outbreak," Bausch said. "Given the limited amount of vaccine that's available and the really concerning epi curves [rise in cases] we've seen over the last few weeks, I think we should be prepared for a long outbreak that will still go on for many months or years."
DAVID GREENE, HOST:
Today marks one year since an Ebola outbreak began in the Democratic Republic of Congo, and that outbreak is still spreading.
On August 1 of last year, the World Health Organization confirmed four Ebola cases in the conflict-torn east of the country. And since then, the outbreak has grown steadily worse. There have now been 2,700 cases and more than 1,800 deaths from the disease, making this the second-largest Ebola outbreak ever.
NPR's Jason Beaubien has been following this story and joins me. Hi there, Jason.
JASON BEAUBIEN, BYLINE: Hey. Good morning.
GREENE: So we're talking about 1,800 deaths here. I mean, that sounds tragic. Help us understand exactly what's happening.
BEAUBIEN: I mean, the situation is really pretty bad. You know, the number of new cases is down from a peak that we were getting in April, where we had about 120, 126 cases a week back then. Now we're down to about 80 new cases every week. But obviously, you know, that's a huge number of Ebola cases just per week.
And one of the greatest fears here has been that this outbreak would reach the city of Goma. It's a major transportation, commercial hub - about 2 million people. It's on Lake Kivu, and it's right up against the Rwandan border.
And this week, we heard that there's a second case that has turned up in Goma. This man had gotten sick, and he was being cared for by family members at home before dying yesterday at a clinic. And now there's confirmation of a third case in Goma, and we are seeing reports that this is a daughter of the man who just died.
So obviously, there's a lot of concern that this outbreak may be getting a foothold in Goma and could be spreading elsewhere in the city.
GREENE: Weren't we talking about the world being better prepared to deal with Ebola? I mean, why has this outbreak gotten so bad?
BEAUBIEN: Yeah. After the West Africa outbreak, there was this sense that, you know, we're in much better shape. We know more about it. We've got new treatment options. We've got a vaccine that's out there.
But in this one, it really has been this perfect storm. The area that this occurred in is incredibly poor, that had poor health care infrastructure beforehand. It's incredibly volatile; there's these militias that have basically been running that part of the Democratic Republic of Congo for decades. They're vying for control of minerals. And, you know, they have really undermined any governmental institutions that would be there.
And then all these health care workers show up to try to contain the Ebola treatment unit - that Ebola, you know, outbreak, and some of them were attacked, even killed. The World Health Organization yesterday was saying they've documented 198 attacks on Ebola clinics and workers over the last year. So obviously, that's an incredibly high number for attacks on a health response, you know, even in a declared war zone.
GREENE: Well, I mean, yeah, it is a war zone, but why attack - specifically attack clinics that you know are treating a disease?
BEAUBIEN: Because there's just these incredibly high levels of distrust of outsiders. This is an area that's 1,500 miles away from Kinshasa. Some people think that this is a hoax of some kind. And then when the presidential elections were occurring last year, they basically canceled the balloting only in the areas where the Ebola was spreading, further leading to more people feeling like this is some sort of political scandal. You know, there's been some jealousy about jobs going to some people and not others. There's just a lot of issues that have made this a really difficult social situation.
GREENE: As difficult as it is - I mean, you mentioned there were lessons from the West Africa outbreak - are we seeing those lessons play out in any way here?
BEAUBIEN: Absolutely, we are. There's new treatments that are being tested, that are being used. People are getting access to them. And probably the biggest issue is that there's now a vaccine, and it has been widely used. About 200,000 people have gotten this vaccine that - people say it's very effective. And people say this has kept this from being an explosive outbreak like we had in West Africa.
GREENE: NPR's Jason Beaubien. Jason, thanks for your reporting.
BEAUBIEN: You're welcome. Transcript provided by NPR, Copyright NPR.