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Beni, Congo – Until his last breath, Salomon Nduhi Kambale insisted he had been poisoned by someone and that was the reason he was vomiting blood. The 30-year-old man wouldn’t give community health teams his phone number, and when they found it, he hung up on them.

Health workers were desperate to persuade him to get vaccinated for Ebola after a friend fell ill with the lethal and highly contagious disease.

But within days, Nduhi was dead. His widow and their four young children were given his positive Ebola test result and a chilling warning from a team of health workers: “If you don’t accept vaccination, you can prepare to die.”

Deep distrust – along with political instability and deadly violence – has severely undermined efforts by public health authorities in Congo to curb the outbreak by tracing and vaccinating those who may have come into contact with infected people.

Health experts agree the experimental Ebola vaccine has saved multitudes in Congo. But after nearly a year and some 171,000 doses given, the epidemic shows few signs of waning. The virus has killed more than 1,700 people and has now arrived in the region’s largest city, Goma. The World Health Organization last week declared the outbreak a global health emergency.

During the 2014-16 Ebola epidemic in West Africa, which left more than 11,300 people dead, health workers could only dream of a vaccine with a 97.5 percent effectiveness rate that could improve the odds of survival even in those already infected.

“We have it now and it’s not the miracle we wanted it to be,” said Dr. Joanne Liu, president of Doctors Without Borders. “The fact that we’ve used so much vaccine, and the epidemic hasn’t stopped, that shows us that contact tracing is not great.”

WHO says as many as 90 percent of those eligible for vaccination have accepted it, but that figure only includes those who gave contact tracers enough information to be included on a list. The success rate excludes those who distrusted health workers and fled, or those who couldn’t be found in the first place.

Health workers have been using what is known as a ring vaccination strategy: The vaccine is first given to those who were in close contact with a sick person. Then a second so-called ring is created by giving the vaccine to those who were in contact with those people.

Because of the difficulties in making that strategy work, some people didn’t get vaccinated until they had already been infected with the virus, and they developed Ebola anyway. That increased doubts about the vaccine in communities where the public health campaigns led by outsiders already were viewed with suspicion and hostility.

“The rumors were if you got vaccinated you would die,” said Liboke Kakule Muhingi, a 43-year-old farmer in Mangina, where the epidemic began last August.

His mother was among the first to die. Then, one by one, six of his sisters who had cared for their ailing mother were killed by Ebola. Kakule accepted the vaccine and made sure his wife and eight children got it, too.

“If I hadn’t, we’d all be dead,” he said.

In some cases, health teams have been unable to reach certain areas because of violence or rebel activity. Earlier this month, the head of the Congolese health ministry’s response efforts in Beni was at one point unable to return from a field visit while the military battled ADF rebels, who are linked to the Islamic State.

More often, though, contact lists have fallen apart simply because people have deliberately evaded health workers or did not understand they shouldn’t travel after being exposed.

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