Did Trump's foreign aid cuts fuel the Ebola outbreak?

The Ebola outbreak in the Democratic Republic of Congo is growing – and is likely larger than official numbers show. The deadly disease spreads through bodily fluids, on average killing half the people it infects. And while officially declared in May, the case numbers point to the virus circulating for months without being detected. To make matters worse, there’s not a vaccine for this specific species of ebolavirus – at least, not yet. NPR global health correspondent Jonathan Lambert https://www.npr.org/people/703751120/jonathan-lambert has been covering everything Ebola-related for the past month or so, and shares what he’s learned today. Interested in more health and science news? Email us your question at [email protected] mailto:[email protected]. Support public media with NPR+ and enjoy perks for over 25 podcasts like this one. It includes perks like bonus episodes, early access, archive access, curated playlists and sponsor-free listening. Learn more at plus.npr.org http://plus.npr.org/. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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• 0:00Speaker 00

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• 0:16Regina Barber?

  You're listening to Short Wave from NPR.

• 0:22Regina Barber?

  Hey, Short Wavers. Regina Barber here. And today I'm joined by NPR global health reporter Jonathan Lambert. Hey, John.

• 0:28Speaker 02

  Hey, Gina.

• 0:29Regina Barber?

  So you're here today to talk about the ongoing Ebola outbreak.

• 0:33Speaker 02

  Yeah, it's been just about the only thing I've covered over the past month and a half or so. The outbreak has gotten really big, really fast. It's already the third largest Ebola outbreak on record.

• 0:43Regina Barber?

  That's terrible. So where do the numbers stand right now?

• 0:47Speaker 02

  As of now, there are over 1,000 confirmed cases and over 250 confirmed deaths, but the toll is likely much higher.

• 0:55Regina Barber?

  Why is that?

• 0:57Speaker 02

  Well, many cases and deaths are probably going uncounted. The outbreak is centered in a region of the Democratic Republic of Congo that's really remote and battered by a lot of ongoing conflict.

• 1:07Regina Barber?

  Hmm, I see how that could make responding to the outbreak a lot harder.

• 1:11Speaker 02

  Yeah, and the virus got a head start. It was likely circulating for months before officials realized that it was. That's made it harder to rein in, which is really worrisome for a disease that, on average, kills about half the people it infects.

• 1:24Regina Barber?

  So do scientists have a sense of how bad it could get?

• 1:28Speaker 02

  Well, the CDC projects that in the absence of robust control measures, as many as 20,000 people could be sick by August. If it continues at that pace, it could rival the 2014 to 2016 Ebola outbreak in West Africa, which killed over 11,000 people. And there are concerns that it could spread more widely in the region.

• 1:48Regina Barber?

  So today on the show, how this became one of the largest Ebola outbreaks in history.

• 1:53Speaker 02

  And what has to happen to treat patients and get it under control.

• 1:57Regina Barber?

  You're listening to Short Wave, the science podcast from NPR.

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• 3:31Regina Barber?

  OK, so John, remind us of some of the basics of Ebola.

• 3:34Speaker 02

  Yeah, it's a disease caused by a virus, specifically the orthoebolavirus. The first known outbreak was in 1976 in the Democratic Republic of Congo. Since then, at least a couple dozen outbreaks have occurred, mostly from East to West Africa.

• 3:48Regina Barber?

  So what causes an outbreak to occur?

• 3:51Speaker 02

  Usually, it's a spillover event. That's when a virus that typically circulates in non-human animals jumps from an animal to a human. Scientists aren't sure how many animals harbor Ebola, but they do know that it circulates in some bats.

• 4:05Regina Barber?

  So how does this virus get from the bat to the human?

• 4:07Speaker 02

  It's not exactly clear. In many parts of East and West Africa, some people eat bat meat for food and could get exposed that way. Exposure to guano or bat poop could be another route.

• 4:18Regina Barber?

  Yeah, this reminds me of COVID, but this infection is much more serious, right?

• 4:22Speaker 02

  Right. Ebola is a very deadly disease, and its deadliness stems in part from a kind of sneakiness.

• 4:29Regina Barber?

  Like, how? How is it sneaky?

• 4:32Speaker 02

  So when the virus first infects a person, it goes straight for key immune cells. Typically, these cells help spur the production of antibodies, which allow the immune system to target a pathogen. But by attacking these cells first, Ebola viruses delay this response, and that gives the virus a huge head start.

• 4:49Regina Barber?

  This is terrifying.

• 4:50Speaker 02

  Yeah, so the virus first goes to the lymph nodes, then to the spleen, the liver, and kidneys, replicating and damaging these tissues as it goes. I spoke to virologist John Connor at Boston University about this. Here's how he put it.

• 5:03Speaker 04

  The cleaning and garbage disposal units of the body are backing up. And that backs up into the blood system. It has a lot of negative consequences. And these cascading problems can be very damaging. And that's often, that's why you get to death.

• 5:19Speaker 02

  One major cause of death is just loss of all these fluids through vomiting and diarrhea. Patients can lose up to 10 liters a day.

• 5:28Regina Barber?

  That is so much. That's like over two and a half gallons.

• 5:32Speaker 02

  Yeah, and it's through contact with those bodily fluids or handling infected dead bodies that the virus spreads. So, you know, we compared it to COVID earlier. It's not spread through droplets in the air like that. So Ebola isn't as contagious.

• 5:46Regina Barber?

  Yeah, but it still sounds like an awful disease.

• 5:49Speaker 02

  It is, and that's why health officials are really usually on the lookout for it. And over the last decade or so, countries like DRC that experience a lot of Ebola outbreaks have really beefed up their surveillance systems. For instance, they've built up lab infrastructure so they can test samples that might be from Ebola patients. US Foreign Aid really helped build up those systems. And in recent years, it's helped outbreaks get declared relatively early on.

• 6:13Regina Barber?

  OK, so usually they're caught pretty early, but you're saying that didn't happen for this current situation?

• 6:19Speaker 02

  No, so when the outbreak was declared on May 15th, that initial death toll had already reached 65. I track outbreaks like these pretty closely. And when I saw that announcement, I had this like moment of panic that I'd somehow missed early reports because the numbers just seemed too big for a new outbreak.

• 6:36Regina Barber?

  Oh, wow.

• 6:37Speaker 02

  Now, health officials suspect the outbreak wasn't new then, and it likely started months ago, perhaps as early as February.

• 6:44Regina Barber?

  So why was there a delay in declaring it?

• 6:47Speaker 02

  A few reasons. Like I said, it's a tough region to work in because it's remote and there's conflict. And the species of Ebola that's spreading is a rarer one. It's called boondaboujo, and there have been only two other outbreaks of it, in 2007 and 2012. Genetically, it's like 30% different than the more common species. Unfortunately, that means that the tests that DRC typically uses can't detect it. So cases that seemed like Ebola kept turning up negative.

• 7:14Regina Barber?

  Ooh, so how did they eventually tell it was Ebola?

• 7:17Speaker 02

  Health officials shipped samples to a bigger lab in Kinshasa, DRC's capital, where they did more sophisticated tests. But even that process was delayed. Early samples weren't shipped properly, and there were delays in those shipments.

• 7:29Regina Barber?

  Wow.

• 7:30Speaker 02

  Yeah, and these outbreak surveillance activities are the kind of thing that used to be heavily supported by US foreign aid, including by USAID.

• 7:38Regina Barber?

  And after the Trump administration's massive aid cuts last year, I'm sure it was affected.

• 7:43Speaker 02

  Yeah, a lot of it is gone. The State Department has said that it's false to claim that those cuts impacted the Ebola response, but I've spoken with a lot of global health experts who think it contributed. One of them was Anna Bodepo Mbayamba. She worked on the Ebola response in DRC for USAID.

• 7:59Speaker 05

  When you dismantle those programs, you no longer have your frontline eyes and ears on the ground that can alert you. And so it's very easy for an outbreak to spread very quickly.

• 8:11Regina Barber?

  And the outbreak is clearly spreading quickly now. So how are health officials responding?

• 8:17Speaker 02

  On a few fronts. They've significantly ramped up testing. So now there are more labs that can test samples in the Northeast where this outbreak is, and they added testing machines that can detect boondaboujo, this rarer species of Ebola. So that's good. But WHO officials told me that they need to do a lot more testing to keep up.

• 8:38Regina Barber?

  And as they do that testing, once somebody's results comes up positive, what happens?

• 8:43Speaker 02

  Well, from a public health perspective, the hope is that they isolate to limit further spread. Now, you can't make an infected person do that, but you can hope that they do. Meanwhile, health officials work to figure out their contacts and hopefully get them to quarantine in case they're infected, too. There isn't an approved vaccine for this species of Ebola, so this kind of basic bread and butter response is the main tool that officials have to curb the spread.

• 9:07Regina Barber?

  What about treating the disease? Like, are there any approved treatments for Ebola?

• 9:11Speaker 02

  Unfortunately, not for this kind of Ebola. Now, that doesn't mean patients can't be treated at all. Providing what's called basic supportive care, like replacing lost fluids, treating pain, treating other co-infections, can help people recover. And at least 100 people already have.

• 9:26Regina Barber?

  That's good.

• 9:27Speaker 02

  Yeah. But this kind of care isn't available everywhere. And health officials are scrambling to set up treatment centers in more remote areas, but those are still out of reach for many. And the conditions in some of those centers are really rough for both providers and patients.

• 9:42Speaker 06

  I'm here in Wampara Ebola Treatment Center.

• 9:45Speaker 02

  This is journalist Emmett Livingstone, who is reporting on Ebola for NPR in the DRC. He visited a clinic earlier this month.

• 9:52Speaker 06

  All of us are in full protective gear, which includes a bib, two layers of clothing, several layers of gloves, goggles, a mask. It's difficult to describe the level of discomfort wearing one of these suits. It's very hot in a turi. The sun is bright. It's very difficult to breathe inside the suit. And on top of that, the goggles fog up, so it's also difficult to see.

• 10:16Speaker 02

  Working under these conditions makes it hard for doctors to treat patients, and it's obviously a difficult situation for those patients.

• 10:22Speaker 06

  The Ebola patients themselves, some of them appear to be in a great deal of pain. We heard some people crying out. The doctors said that at a certain stage of the Ebola virus disease, the whole body aches, and it's extremely painful.

• 10:37Regina Barber?

  This all sounds so heartbreaking.

• 10:39Speaker 02

  Yeah, it is not good. I've spoken to a number of clinicians who've worked in Ebola wards in the past, and they've described some really harrowing experiences. But they also maintained that Ebola isn't a death sentence. And with access to high-quality care, people can get better. It's just really hard to access that kind of care in the places where Ebola typically spreads.

• 11:01Regina Barber?

  So we're now a month into the official outbreak. What are you watching for now?

• 11:08Speaker 02

  A few things. One is just how big the outbreak continues to get and where it goes. Right now, it's still mostly in DRC with a handful of cases in Uganda, but that could change. I'm also closely watching if contact tracing becomes more robust. Right now, only a little over half of contacts are being identified by officials. Experts are telling me that that's way too low, and that percentage ticking up will be a sign that the outbreak is starting to get under control.

• 11:35Regina Barber?

  So what about new treatments? Like, could those come anytime soon?

• 11:39Speaker 02

  There are efforts underway to quickly stand up clinical trials to test possible treatments and vaccines. Those take time, probably at the earliest a month or two. But the sooner they start, the sooner clinicians and health officials could have more powerful tools to treat patients and rein this outbreak in.

• 11:58Regina Barber?

  John, thank you so much for bringing us this reporting.

• 12:01Speaker 02

  Of course, Gina.

• 12:03Regina Barber?

  This episode was produced by Hannah Chin and edited by Rebecca Ramirez.

• 12:07Speaker 02

  Tyler Jones checked the facts. Jimmy Keeley was the audio engineer. I'm Jonathan Lambert.

• 12:11Regina Barber?

  And I'm Regina Barber. Thank you for listening to Short Wave, the science podcast from NPR.

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