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 Kinshasa's 12 million people - twice as many as there are doses of
yellow fever vaccine anywhere in the world - are largely unprotected
against this sometimes deadly but easily preventable illness, which
has killed at least 353 in Democratic Republic of Congo and neighbor
Angola.
And though the mosquito-borne virus has yet to gain momentum in
Africa's third largest metropolis, officials in Congo's government
and the World Health Organisation (WHO) are racing to avoid a repeat
of the kind of urban epidemics that decimated Western cities like
New York and Philadelphia in centuries past.
With three weeks to go before they start a vaccination campaign for
11.6 million people against the hemorrhagic virus in three Congolese
provinces, and only 1.3 million doses of the vaccine on their way to
Congo, time is not on their side.
"The epidemic has become something that can exponentially reinforce
itself. It's not that easy to reverse," Doctors Without Borders (MSF)
head of operations Bart Janssens said.
"The risk is ... (significant) that this could become a big epidemic
... That's what we'd like to avoid at all costs."
There are currently just six million doses of vaccine in the world,
and the method of making more, using chicken eggs, takes about a
year. As an emergency measure, health officials have decided to
split the doses into fifths, enabling them to cover more people,
although only for a year rather than a lifetime.
"Kinshasa has millions of inhabitants. We cannot allow the epidemic
to spread there," Congo's health minister Felix Kabange told Reuters
by telephone.
"We realized that if we gave the full dose, the time needed to
manufacture all those vaccines would risk allowing the epidemic to
embrace the whole country."
SLOW BURN CRISIS
Yellow fever was once a big killer in the West, wiping out about a
tenth of the population of New York and Philadelphia in the 18th
century. Then, 80 years ago, a vaccine was created and the virus was
quickly eradicated in the rich world.
In Africa it mainly persists in remote rural areas, and not since
the 1970s has it threatened a major city.
The current outbreak, with 3,464 suspected cases so far, about a
third of them in Congo, began in Angola in December. Hitching a ride
on popular trade routes from the capital Luanda, it jumped the
border into Congo, then to its megacity capital.
A small but significant fraction of those who catch the disease die
from jaundice, bleeding and multiple organ failure.
In Kinshasa, a city whose tin-roofed shanty towns encircle the
skyscrapers of its business district, the fear is palpable.
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"Everyone is panicking at the news of yellow fever. I'm afraid of
catching it and dying," said street vendor Gallo Musambu, who has
little hope of being able afford the vaccine.
"I don't even want to touch people from Angola because that's where
it came from," he added, revealing that the government also has work
to do explaining how it is transmitted.
Unlike the Ebola virus, which has killed 11,300 people in West
Africa since 2013, yellow fever initially spreads slowly, as the
mosquitoes carrying it don't travel more than 100 meters from where
they are born, health officials said. That may give some breathing
space for the response.
The response in Angola was at first somewhat lumbering, the MSF's
Janssens said, but officials raised their game when it reached
Congo, mobilizing resources and implementing mass vaccinations.
Yet the bigger risk with a city, he said, is that the mosquitoes
themselves start passing the virus on to their own larvae, enabling
them to become a reservoir for the disease.
And, as with Ebola, a worry is that aeroplanes can carry the virus
to other more distant cities.
Asia has never had yellow fever, despite being home to the
mosquitoes that spread it. But this year 11 Chinese expatriates
working in Angola contracted it and brought it back to China.
Erin Staples, epidemiologist at the Centers for Disease Control and
Prevention (CDC), said there have been "a lot of phone calls in the
past two weeks between the WHO and countries in southeast Asia"
about how to prevent the disease spreading there. Many have started
active screening at airports, she said.
Even with dose fracturing and a faster mobilization, the campaign in
Congo is expected to continue well into next year, said Eugene
Kabambi, WHO spokesman for Congo.
Health officials worry that is a dangerously long window.
(Additional reporting by Amedee Mwarabu Kiboko in Kinshasa; Editing
by Gareth Jones)
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