"GLOBAL ISSUES, LEADERSHIP CHOICES":

Global health workers are starting to conclude that the Ebola outbreak in the northeastern corner of the Democratic Republic of the Congo that has infected hundreds of people since last August will last at least another six months and could become permanent, not because of mutations in the microbe but because of human factors:

"Despite having a tool kit at its disposal that is unrivaled—including a vaccine, new diagnostics, experimental treatments, and a strong body of knowledge regarding how to battle the hemorrhage-causing virus—the small army of international health responders and humanitarian workers in Congo is playing whack-a-mole against a microbe that keeps popping up unexpectedly and proving impossible to control. This is not because of any special attributes of the classic strain of Ebola—the same genetic strain that has been successfully tackled many times before—but because of humans and their behaviors in a quarter-century-old war zone. The sheer duration of the present epidemic means that the 4.5 million people in the currently affected North Kivu province of Congo are no longer the only ones in danger. The rest of the country and populations in the bordering nations of Uganda, Rwanda, South Sudan, and Burundi are now at risk, too. ... The problem: North Kivu is one of the most violent places on Earth, rife with distrust, rumors, conflicts, and multigenerational hatreds. Investigators can’t find the links in the disease chains because the people there do not trust anything, even the very idea that a virus called Ebola exists, and refuse to comply with investigations. On Jan. 11, for example, villagers in Marabo rose up in protest against the construction of an Ebola treatment center in their community after three high school students were diagnosed and placed in quarantine to stop a local chain of transmission. When international disease fighters tried to vaccinate all of the high school students, rumors spread that the vaccine was dangerous, students fled, and their three infected colleagues were helped to escape quarantine. Such events have been repeated throughout the area since the outbreak began. An Ebola disease that became endemic in Congo would pose many novel dangers. The disease can be transmitted sexually up to 18 months after an individual’s cure, and, like Zika and HIV, it can also pass from pregnant mothers to their fetuses. It can also spread within military units that refuse scrutiny from virus detectives and among groups involved in illegal war-related activities such as arms smuggling. Even immune survivors might be at risk in an endemic context, as a recent study found that Ebola survivors carry two types of immune responses—one that will protect them against future exposures to the virus and another that perversely enhances infection, worsening their odds of dying if re-exposed."
foreignpolicy.com/2019/01/15/ebola-has-gotten-so-bad-its-normal