Via JAMA: Ebola and War in the Democratic Republic of Congo: Avoiding Failure and Thinking Ahead. This article was published online last October, but its recommendations are still timely:
An expert consultation—with public health, humanitarian, security, anthropology, and human rights expertise—made the following recommendations to deepen US and global engagement, while recognizing key security details are not public.
First, through the UNSC, the United States and allies should mobilize high-level political attention and resources for the Ebola response. Many lives are at risk if the epidemic is not rapidly contained. The Security Council should engage all parties, including the DRC and African Union, to achieve mitigation of armed attacks by the ADF and other militia; improved security for health workers; a comprehensive aid package to communities; stronger preparedness in neighboring states; and a contingency plan to sustain the response if security worsens. US ambassadors in the region should use all diplomatic tools available to ensure the viability of the response.
Second, the US, along with allies and the UN, should develop a plan to deploy public health personnel to North Kivu. It is in US national interests to control outbreaks before they escalate into a crisis. The cost of addressing this epidemic now is far less than if mass mobilization were required due to international spread of the virus. The WHO and DRC have requested support from experienced personnel supported by US agencies. CDC and USAID experts could, for example, be embedded in the WHO or other UN agencies. The plan should include US security and diplomatic resources, coordinating with the UN, to assess and improve health worker security. Lessons can be drawn from humanitarian operations in unstable settings, including northern Nigeria and South Sudan.
Third, US engagement should be closely coordinated with the WHO and the national government. The WHO is the lead health agency for containing potential PHEICs. When deploying US and other countries’ resources in a conflict zone, an uncoordinated response could be counterproductive. Strategic and operational engagement, therefore, should be part of a unified response with clear coordinating authority, starting with the DRC and WHO.
Fourth, the United States should increase funding to the DRC to enhance local response capabilities. Congolese health leaders have much experience in containing Ebola outbreaks, but lack resources to detect, assess, and respond. Many health workers are not reliably compensated. African universities also have anthropology, communications, and health research capacities that could be resourced to deploy. Engaging the Congolese diaspora and using mobile communications for innovations in field epidemiology also may be valuable.
Fifth, with the epidemic likely to continue for many months, the US and WHO should immediately collaborate to expand the response workforce. Building on the CDC’s Field Epidemiology Training Program, the US and WHO should rapidly train and equip more health workers to sustain a prolonged Ebola response.
Sixth, longer term, the United States should craft a transparent framework for responding to epidemics in conflict zones. Risk aversion can impede early, effective intervention that prevents outbreaks from becoming crises. This is especially true when US agencies represent a significant part of global disease response capacity. The US, working proactively with partners, should develop a transparent framework for assessing and mitigating risk, balanced against the global public good of preventing PHEICs.
Seventh, the US and international partners should ensure sustainable funding for national action plans for health security. The US helped launch the Global Health Security Agenda in 2014 to expand capacities in key countries and recently recommitted at the Global Health Security Agenda Ministerial in Indonesia. Investing in preparedness is much less costly than crisis response and enables burden sharing, “smart” diplomacy, local leadership, and public trust.
Eighth, the UNSC should create a plan to safeguard public health action in conflict zones. In 2016, the UN secretary-general submitted specific recommendations to protect health workers under UNSC resolution 2286, but the council has not acted. It is certain that the UN will be called on to provide security in future health crises. It must prepare and maintain readiness for that eventuality.
