We are the breadwinners of our families, and our families are suffering.
In the Ituri region of the Democratic Republic of the Congo, where a strain of Ebola with no approved treatment has claimed more than six hundred lives, researchers have opened a clinical trial of two experimental drugs at a speed the scientific community has never before achieved. The trial, launched just six weeks after the WHO declared a global health emergency, reflects both the hard-won institutional knowledge of a country that has weathered Ebola before and the urgent arithmetic of an outbreak still in its expansion phase. Yet the science unfolds against a backdrop of unpaid burial workers, community violence, and families pushed to the edge — a reminder that the distance between a promising drug and a saved life is measured not only in data, but in trust.
- The Bundibugyo strain of Ebola has no vaccine and no approved cure, and with 625 dead among nearly 1,800 confirmed cases, every week without a proven treatment is a week the virus holds the advantage.
- The Partners trial broke records by enrolling its first patients just six weeks after the WHO emergency declaration — a feat made possible by the DRC's deep experience hosting major outbreak research.
- Two experimental drugs, remdesivir and the monoclonal antibody MBP134, are being tested head-to-head and in combination against standard care, with researchers hoping to replicate the mortality reductions seen in earlier Zaire strain trials.
- Burial teams trained to safely handle the most contagious bodies have walked off the job over unpaid wages, and workers describe being attacked by the very communities they are trying to protect.
- The trial needs between 700 and 1,000 enrolled patients to produce statistically meaningful results, but community mistrust, a mobile population, and a closed airport are all working against the clock.
- A second trial testing a preventive drug for exposed contacts is waiting on twelve million dollars in funding still uncommitted — a gap that could determine whether the outbreak is contained or continues to spread.
In the Ituri region of the DRC, researchers have begun enrolling patients into a clinical trial testing two experimental drugs against the Bundibugyo strain of Ebola — a virus that has killed 625 of 1,792 confirmed cases and for which no approved treatment exists. The trial opened just six weeks after the WHO declared a global health emergency on May 17, a pace scientists describe as unprecedented. In Bunia, the provincial capital, the outbreak has already pushed families to the edge. Neema Haba, a mother of three who sells bananas, captured the mood plainly: financially, she said, nothing is going right.
The trial, called Partners, will test remdesivir — an antiviral from Gilead Sciences — and MBP134, a monoclonal antibody engineered to recognize and neutralize the virus. Patients are randomly assigned to one drug, both together, or supportive care alone. Bundibugyo kills roughly one in three infected people, and researchers hope to see mortality reductions comparable to those achieved in earlier monoclonal antibody trials against the Zaire strain, where death rates fell from fifty percent to thirty-five percent. Between 700 and 1,000 patients must be enrolled to detect a meaningful difference in survival. Enough donated supply exists to treat 1,200 patients. Notably, the trial includes pregnant and breastfeeding women — groups typically excluded from research — because the potential benefit of a life-saving treatment outweighs the risks suggested by animal studies.
The trial's rapid launch has been credited to the DRC's National Biomedical Research Institute, which has led major trials during previous outbreaks. Prof. Amanda Rojek of Oxford, the international principal investigator, contrasted the six-week timeline with the more than a year it took to begin trials during the West Africa epidemic. The trial is sponsored by the WHO and funded by the Wellcome Trust and UK government bodies.
On the ground, however, the response is under strain. Contact tracing has reached about three-quarters of known contacts, but a mobile population and deep mistrust of authorities complicate the work. More urgently, burial teams — whose work is essential to stopping transmission — have halted operations over unpaid wages. Ovide Maliabo, a driver in the mining town of Rwampara, described narrowly escaping a lynching. Bahati John, his team leader, said he had lost a tooth in an attack and had not received a single payment since work began in May. DRC officials say payments have been made, though whether work has fully resumed is unclear; the closure of Bunia's airport has hampered the delivery of cash to pay workers at all.
A second trial, testing whether the drug obeldesivir can prevent infection in people exposed to Bundibugyo cases, is set to begin this week but requires eighteen million dollars — with only six million committed. Prof. Yap Boum of the Africa CDC framed the stakes simply: treating people sends a message to communities, and community trust is itself a tool for ending outbreaks.
In the Ituri region of the Democratic Republic of the Congo, where an Ebola outbreak is spreading with no approved treatment in sight, researchers have begun enrolling the first patients into a clinical trial testing two experimental drugs. The speed at which this trial opened is itself remarkable—just six weeks elapsed between the World Health Organization's declaration of a public health emergency on May 17 and the moment the first patients were enrolled. Scientists involved in the work say this pace is unprecedented for this kind of research.
By July 9, the Bundibugyo strain of Ebola had claimed 625 lives among 1,792 confirmed cases. Unlike the Zaire strain responsible for most previous outbreaks, Bundibugyo has no vaccine and no approved drug to combat it. The virus still spreads, the WHO notes, in what it calls an expansion phase. In Bunia, the provincial capital, the outbreak has created cascading hardship. Neema Haba, a mother of three who sells bananas, spoke of financial ruin. "I hope these drug trials proceed quickly," she said. "Financially, we are being driven to the brink by this outbreak and nothing is going right. We are struggling to provide for our children."
The trial, called Partners, will test remdesivir—an antiviral developed by Gilead Sciences—alongside MBP134, a monoclonal antibody created by Mapp Biopharmaceutical. The antibody contains two engineered immune proteins designed to recognize and neutralize the virus. Patients will be randomly assigned to receive one drug, both drugs together, or standard supportive care alone. Remdesivir requires ten days of intravenous infusion; MBP134 is given as a single infusion. Both drugs have shown efficacy against Bundibugyo in animal models, but human testing is essential. "Basically, what we want to see is if they indeed can lower mortality," said Prof. Laurens Liesenborghs of the Institute of Tropical Medicine in Antwerp, who is overseeing the trial in Ituri.
Bundibugyo typically kills about one in three infected people—a lower fatality rate than Zaire Ebola, but still devastating. In previous trials using monoclonal antibodies against the Zaire strain, death rates fell from fifty percent to thirty-five percent. Liesenborghs said researchers hope to see improvements of similar magnitude. The trial's structure allows new treatments to be added if they become available. Enrolling between seven hundred and one thousand patients will likely be necessary to detect a statistically meaningful difference in survival rates. The WHO has confirmed that enough remdesivir and MBP134 have been donated—by Gilead and the U.S. government respectively—to treat twelve hundred patients.
The trial's design is notably inclusive. Patients of any age can enroll, including pregnant and breastfeeding women, who are typically excluded from medical research. Ebola causes miscarriages, but animal studies show no sign of harm to pregnancies from either drug. "We always think of risk-benefit," Liesenborghs explained. "Here the benefit is potentially very high because you offer a potentially life-saving treatment to someone who has a very high chance of dying."
Yet the trial's success depends on conditions on the ground that remain fragile. Contact tracing efforts have reached about seventy-five percent of known contacts, but low trust in authorities and a highly mobile population complicate the work. More troubling still, frontline workers—including burial teams trained to safely handle the highly contagious bodies of Ebola victims—have stopped work this week over unpaid wages. Ovide Maliabo, a driver for one burial team in Rwampara, a mining town in Ituri, described the danger and the indignity. "At one point, we narrowly escaped being lynched," he said. "It's a shame that we aren't being financially supported." Bahati John, head of the team, said he had lost a tooth in an attack by local residents. "Honestly, since we started working on 15 May, with all the insults we've had to put up with, we haven't seen a single penny," he said. "We are the breadwinners of our families, and our families are suffering." DRC officials said payments had been made, though it remains unclear whether work has fully resumed. The closure of Bunia's airport has further complicated the response, impeding the supply of currency needed to pay workers.
Prof. Amanda Rojek, international principal investigator for Partners at the University of Oxford, called the trial's rapid launch "fantastic." She credited strong scientific leadership in the DRC, which has hosted major trials during previous Ebola outbreaks and other disease emergencies. "If we look back at west Africa, where it took us over a year to start clinical trials, we're very proud of the team led by INRB [the DRC's National Biomedical Research Institute] that we've managed to achieve that in kind of six weeks since the outbreak was first announced." The trial is sponsored by the WHO and funded by the Wellcome Trust, the UK Foreign, Commonwealth and Development Office, and UK Research and Innovation.
Prof. Yap Boum, head of emergency response at the Africa CDC, acknowledged the danger remains. But he emphasized that treatment access itself carries weight beyond survival statistics. "What limits an outbreak is our capacity to provide care, our surveillance capacity and our ability to isolate people," he said. "These trials will enable us to access treatment, and when we treat people, it also sends a message to the community." A second trial is set to begin this week, testing whether a drug called obeldesivir can prevent infection in people exposed to Bundibugyo cases. That trial requires eighteen million dollars to proceed, with six million committed so far.
Citações Notáveis
I hope these drug trials proceed quickly. Financially, we are being driven to the brink by this outbreak and nothing is going right.— Neema Haba, banana seller and mother of three in Bunia
Honestly, since we started working on 15 May, with all the insults we've had to put up with, we haven't seen a single penny. We are the breadwinners of our families, and our families are suffering.— Bahati John, head of burial team in Rwampara
A Conversa do Hearth Outra perspectiva sobre a história
Why does it matter that they opened this trial in six weeks instead of, say, six months?
Because in an outbreak, every week counts. During the 2014-16 West African Ebola crisis, it took over a year to start clinical trials. By then, thousands had already died. Six weeks means you're testing treatments while the outbreak is still spreading, not after it's peaked. You have a chance to actually save lives in real time, not just learn lessons for next time.
But the trial needs 700 to 1,000 patients to work. How do you enroll that many people when communities don't trust the authorities?
That's the real problem. Contact tracing is only reaching 75 percent of known contacts. People are afraid, they're suspicious of outsiders, and frankly, they've seen burial teams get attacked. You can have the best drugs in the world, but if people won't come forward or cooperate, the trial stalls.
The workers haven't been paid. How does that affect the outbreak response?
It's catastrophic. These aren't abstract roles—burial teams handle bodies that are extremely contagious. If they stop working, bodies aren't safely buried, and the virus spreads further. And the workers themselves are desperate. One man lost a tooth being attacked. They're risking their lives for their families' survival, and they're getting nothing.
So the trial could fail not because the drugs don't work, but because the social conditions fall apart?
Exactly. The drugs showed promise in animals. But a clinical trial is only as good as the system around it. You need trust, you need workers, you need supplies, you need people willing to enroll. All of that is fragile right now.
What would success actually look like?
If remdesivir or MBP134 reduces the death rate from one in three down to something closer to one in five or one in six, that's substantial. In previous monoclonal antibody trials against Zaire Ebola, they cut mortality from 50 percent to 35 percent. If they see something like that here, it changes the calculus. Suddenly, people have a reason to seek treatment instead of hide.