Democratic Republic of Congo (DRC) Health Minister Oly Ilunga resigned from his post Monday after being removed as the head of the nation’s Ebola outbreak response, a move that followed Ilunga rejecting pressure to introduce a second Ebola vaccine into the population.
DRC has currently deployed a vaccine by the German company Merck that has been proven to have 97 percent effectiveness. Other DRC officials and international groups helping the country fight the outbreak have lobbied for DRC to purchase a second vaccine by Johnson & Johnson and deploy it simultaneously. All current Ebola vaccines are experimental, developed in the aftermath of the 2014-2016 west African Ebola outbreak that proved to be the deadliest in recorded history.
Ilunga repeatedly insisted on increasing supplies of the Merck vaccine given its proven effectiveness. He argued that asking local Congolese communities to take a second vaccine would rekindle widespread distrust of Western medical practices throughout the country, which continues but has abated enough for officials to distribute the first vaccine.
Many Congolese, and Africans generally, trust only in traditional herbalist healers and witch doctors. Conspiracy theories abound in DRC, Uganda, and Rwanda – the two countries with borders closest to the center of the current outbreak – that Western scientists invented Ebola to keep African populations low. Some believe the vaccines are lethal doses of Ebola and doctors are deliberately infecting and killing people.
This distrust has triggered violence against health workers in North Kivu province, the center of the outbreak. North Kivu and neighboring Ituri provinces are facing ongoing warfare among a host of rival militias seeking to control the region’s natural resources, forcing a growing wave of civilian refugees into Uganda. These militias have also turned against health workers coming to treat Ebola patients. The most prominent victim so far has been World Health Organization (WHO) epidemiologist Dr. Richard Valery Mouzoko Kiboung, killed in April during the siege of a hospital in Butembo, one of North Kivu’s biggest population centers.
That month, Congolese President Felix Tshisekedi addressed the nation to assure them that Ebola was “not an imaginary disease” and urge them to cooperate with health officials.
After weeks of openly criticizing the lack of sensitivity towards the local populations of those in the federal government and international aid groups, Tshisekedi fired Ilunga as head of the Ebola response team on Saturday, replacing him with Jean-Jacques Muyembe Tamfum, director of the National Institute for Biomedical Research in Kinshasa, the Congolese capital. The Congolese government is organizing under Muyembe a special task force to deal with Ebola.
Tshisekedi did not remove Ilunga, but stripped him of the power to respond to the Ebola crisis, which is the primary job of the Ministry of Health currently. Ilunga was reported on in DRC when Tshisekedi announced the formation of the new Ebola response team.
“As a result of your decision to place the response to the Ebola outbreak under your direct supervision … I hereby submit my resignation as health minister,” Ilunga wrote in a letter he posted on Twitter on Monday. “As in any war, because that is what this is, there cannot be several centers of decision-making for risk of creating confusion.”
Ilunga used his letter to condemn advocates of the Johnson & Johnson vaccine.
“[It is] fanciful to think that the new vaccine proposed by actors who have shown an obvious lack of ethics by voluntarily hiding important information from medical authorities, could have a significant impact on the control of the current outbreak,” the former minister’s letter read.
Johnson & Johnson insists their vaccine can be used in tandem with Merck’s and that tests have not indicated it poses any significant concerns regarding side effects or general safety.
Ilunga served as health minister for two years. He made his resistance to deploying two vaccines simultaneously known, insisting that confusing the local population with multiple vaccines – and, in the Johnson & Johnson model case, a vaccine that requires two doses – would significantly hurt efforts to gain enough public trust to treat Ebola patients, contain suspected patients, and convince all citizens to engage in Ebola prevention efforts.
“There’s a whole debate raging around vaccinations. And we need to close down this debate,” Ilunga told the WHO last week. “We have an effective weapon. … Let’s focus on that.”
Speaking to the health news publication STAT, Ilunga described the advocates for the second vaccine as having “no respect for ethics,” implying corrupt motivations behind the push for the vaccine.
“We are in the presence of a very, very dangerous situation. We have people who don’t want to discuss [their plans] with the government. People who have no respect for ethics. And they are ready to introduce a new vaccine and to create new communications problems and trust problems with the community,” he told the outlet. “So I just made the decision to say no. We are not going to start a discussion again.”
Rather than demand residents of North Kivu take two vaccines with little explanation, Ilunga had proposed clinical trials of the second vaccine outside of the outbreak area.
On Friday, the Congolese newspaper Actualité quoted Ilunga arguing that the federal government had not invested properly in health infrastructure, international aid organizations were not sufficiently transparent, and that, without this investment, he could not properly end the outbreak.
“If we really want to solve this epidemic and have a lasting impact, we need to strengthen the health system by working with the actors in this system and with the community,” he said during a visit to suspected Ebola patients in Beni, another affected city.
“While the government continues to openly share with partners and donors how it uses the funds received, we hope there will be greater transparency and accountability of humanitarian actors in their use of funds for to respond to this Ebola outbreak,” he added, according to the newspaper.
The WHO declared the central African Ebola outbreak a “public health emergency of international concern” last week, urging the global community to invest more heavily in fighting the disease.
“It is time for the world to take notice and redouble our efforts. We need to work together in solidarity with the DRC to end this outbreak and build a better health system,” WHO Director-General Dr. Tedros Adhanom Ghebreyesus said in a press statement. “Extraordinary work has been done for almost a year under the most difficult circumstances. We all owe it to these responders — coming from not just WHO but also government, partners and communities — to shoulder more of the burden.”
According to the latest estimates from the WHO, as of Sunday, the current Ebola outbreak has resulted in 2,592 cases of Ebola and 1,743 deaths.