In the Democratic Republic of the Congo, a groundbreaking Ebola treatment trial has enrolled its first patients, offering hope amid a devastating outbreak. The Partners trial, set up just six weeks after the World Health Organization declared the outbreak a public health emergency of international concern on 17 May, is testing two experimental drugs: remdesivir and MBP134. This rapid pace is unprecedented for clinical research in an outbreak setting, according to scientists.
Outbreak Toll and Community Strain
As of 9 July, the Bundibugyo strain of Ebola has caused 1,792 confirmed cases and 625 deaths. Unlike the Zaire strain, there is no approved vaccine or treatment for this virus. The outbreak remains in its expansion phase, according to the WHO. In Bunia, the capital of Ituri province, residents express frustration. Neema Haba, a mother of three and banana seller, said: "I hope these drug trials proceed quickly. Financially, we are being driven to the brink by this outbreak and nothing is going right."
The response relies on basic containment: identifying cases, isolating patients, and tracing contacts. However, only about 75% of known contacts are being tracked, hampered by low trust in authorities and a highly mobile population. Some frontline workers stopped work in protest over unpaid wages. Ovide Maliabo, a driver for a burial team in Rwampara, said: "At one point, we narrowly escaped being lynched. It's a shame that we aren't being financially supported." Bahati John, head of a burial team, added: "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." DRC officials say payments have been made, but it is unclear if activities have fully resumed.
Experimental Drugs and Trial Design
The Partners trial is testing remdesivir, an antiviral from Gilead Sciences, and MBP134, a monoclonal antibody from Mapp Biopharmaceutical. Both drugs have shown efficacy against the Bundibugyo virus in animal models, according to Prof Laurens Liesenborghs of the Institute of Tropical Medicine, Antwerp, who is working on the trial. Patients are randomly assigned to receive either drug, a combination, or standard supportive care. Remdesivir is given as a 10-day intravenous course, while MBP134 is a single infusion.
The goal is to determine if these drugs can reduce mortality. The Bundibugyo strain typically kills about one in three infected people. Researchers will compare death rates between groups. "Any improvement is good," said Liesenborghs. "But it needs to be statistically detected, so we need to see a substantial drop." In previous trials for the Zaire strain, monoclonal antibodies lowered death rates from 50% to 35%.
Rapid Setup and Inclusivity
Prof Amanda Rojek, international principal investigator for Partners from the University of Oxford, praised the speed: "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 that we’ve managed to achieve that in kind of six weeks." The trial design allows adding other potential treatments. A result will likely require 700 to 1,000 patients. WHO officials said enough remdesivir and MBP134 have been donated for 1,200 patients, with discussions ongoing for post-trial supplies.
Notably, the trial includes patients of all ages, including pregnant and breastfeeding women, who are often excluded from research. "We always think of risk-benefit," Liesenborghs said. "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."
Broader Context and Future Trials
Another trial is set to begin this week, testing obeldesivir to prevent disease in people who have been in contact with Bundibugyo cases. Africa CDC said that trial needs around $18 million, with $6 million committed so far. Prof Yap Boum, head of emergency response at Africa CDC, noted: "What limits an outbreak is our capacity to provide care, our surveillance capacity and our ability to isolate people. These trials will enable us to access treatment, and when we treat people, it also sends a message to the community."
