Ebola Outbreak in the Democratic Republic of the Congo: Treatment Trials Underway

As medical teams battle the ongoing Ebola outbreak in the Democratic Republic of the Congo, no approved drugs currently exist to aid in their efforts. However, there is a glimmer of hope, as treatment trials have now begun enrolling patients, a significant step forward that comes just six weeks after the World Health Organization (WHO) classified the outbreak as a public health emergency.

In Bunia, the capital of Ituri province, the urgency is palpable among residents. “I hope these drug trials proceed quickly,” expressed Neema Haba, a local banana seller and mother of three. “Financially, this outbreak is pushing us to the edge, and everything seems to be going wrong. We’re struggling to support our children.”

As of July 9, there have been 1,792 confirmed cases and 625 deaths linked to the Bundibugyo strain of the virus, which is particularly concerning as there is no vaccine or approved treatment available. WHO officials have indicated that the outbreak is still “in the expansion phase.”

Efforts to combat the epidemic have relied heavily on basic strategies, such as identifying infections, isolating patients, and monitoring individuals they’ve come into contact with. Currently, around 75% of known contacts are being traced, but a lack of trust in authorities and the highly mobile population are complicating these efforts. Recently, some frontline workers staged a protest due to payment issues.

The bodies of Ebola victims pose significant risk and must be handled by trained professionals. Ovide Maliabo, a driver for one of the burial teams in Rwampara, mentioned that mistrust from the community often puts them in danger. “We even narrowly escaped being attacked once,” he said, lamenting the lack of financial support for their work.

Bahati John, the head of his team, shared the toll the situation has taken on them. “Honestly, since we started working in May, with all the harassment we’ve endured, we haven’t seen a single payment. We’re trying to support our families, but they’re suffering.”

Local officials have indicated that payments have been made, but it remains unclear if normal activities have fully resumed. The closure of the airport in Bunia is also hampering responses, particularly concerning the supply of needed resources.

The hope now lies with researchers working tirelessly to find effective treatments. The Partners treatment trial has kicked off, focusing on two drugs: remdesivir and MBP134. Participants will receive either drug, a combination, or standard care.

Remdesivir, developed by Gilead Sciences, is an antiviral medication, while MBP134 is a monoclonal antibody crafted by Mapp Biopharmaceutical, aimed at neutralizing the virus. Both drugs are administered intravenously, with MBP134 as a single infusion and remdesivir requiring a 10-day regimen.

“Both have shown promise in animal studies against the Bundibugyo virus,” stated Prof. Laurens Liesenborghs from the Institute of Tropical Medicine, Antwerp, who is involved in the trial. “Now we need to see if they can lower mortality rates in humans.”

Typically, Bundibugyo has a lower death rate than the Zaire strain, which has driven previous outbreaks, but it still has a one-in-three fatality rate among those infected.

Researchers are closely monitoring the differences in mortality rates between those on experimental drugs and those receiving standard care. “Any improvement is good,” Liesenborghs noted, but emphasized the need for significant statistical evidence of efficacy.

In earlier trials involving monoclonal antibodies for Zaire strain cases, death rates decreased from 50% to 35%. “Hopefully, we’ll see similar results,” he mentioned.

The design of the trial allows for the inclusion of other potential treatments as they become available. A successful outcome will require between 700 and 1,000 patients. “We’ve opened one site and hope to establish more swiftly, but it will take time depending on the outbreak’s progression,” he added.

The WHO confirmed that sufficient quantities of remdesivir and MBP134 have been donated for 1,200 patients. Discussions are ongoing to ensure adequate supplies remain post-trial, should the drugs be deemed safe and effective.

The trial is open to patients of all ages, including pregnant or breastfeeding women, groups that are often excluded from medical research. “We assess the risk-benefit ratio,” Liesenborghs remarked. “Here, the benefit could be huge, as we’re offering potentially life-saving treatment to individuals with a high risk of death.”

There’s evidence that Ebola can cause miscarriages, but animal studies have shown no sign of risk during pregnancies with the drugs being used.

“It’s fantastic that we’ve been able to start so quickly,” said Prof. Amanda Rojek from the University of Oxford, who is leading the trial. She highlighted the critical role of strong scientific leadership during previous outbreaks in the DRC.

Reflecting on past challenges, she compared the current response favorably to the lengthy timeline of earlier trials during the West African Ebola outbreak. “It’s impressive to see how quickly we managed to move forward this time,” she noted.

Funding for the Partners trial comes from organizations such as the WHO and the Wellcome Trust. Prof. Yap Boum from the Africa CDC warned that threats from the outbreak are not over. However, he expressed optimism that improving care capabilities and treatment access will help mitigate the situation. Another trial is also set to begin, which will explore whether a drug called obeldesivir can prevent individuals in contact with Bundibugyo cases from developing the disease.

The Africa CDC highlighted a need for around $18 million for this trial, with only $6 million currently secured.