Thanks to Mary Marshall for sending the link to this long article published by the Center for Strategic and International Studies: The Ebola Virus Is Winning in Eastern Democratic Republic of the Congo. The conclusion:
The outbreak is occurring in an area where the risk of cross-border and international spread is extremely high. Eastern DRC borders Rwanda, the most densely populated country in Africa; Uganda, which has already experienced a handful of cross-border cases successfully contained; and South Sudan, another active warzone lacking a functioning health system.
Yet the steadily expanding Ebola outbreak has not been exported cross-border in any significant numbers, a curious phenomenon for which there is no clear explanation. Nor has there been significant spread inside the DRC into Goma, a populous transport and trade hub on the Rwandan border. If there had been significant spread to Kinshasa; Goma; or neighboring urban centers in Uganda, Rwanda, South Sudan, or Burundi, far greater world attention would have been paid to what was happening in eastern DRC, including presumably how also to fix the insecurity and chaos.
Ebola also competes with other pressing health security demands. Ebola arrived in 2018 as other outbreaks unfolded in the east and across the vast reach of the DRC—malaria, diphtheria, cholera, and diarrhea. At the same time, the DRC’s longstanding, chronic humanitarian emergency has left over 12 million in need of humanitarian assistance.
Management Holes
A final critical barrier to success is weak management, implementation, and supervision of the response effort. There are poor lines of communication among the many players involved in the response. Public health data is housed in distinct databases, not shared with those who need it and not integrated to provide an overall picture. Standardization of and visibility into the response structure, protocols, and training are sorely lacking. International donors are increasingly frustrated with the lack of transparency. The coordination and communication fundamental to a unified and effective public health response are not yet in place.
Where Does This Leave Things?
The answer: far behind and in danger of further regression. The virus is winning and may continue to win. In the judgment of CDC experts, eastern DRC remains a long distance from the critical milestones that would signal transmission is being stopped and the outbreak ended. That sobering sentiment hung over the WHO declaration of a global health emergency on July 17, 2019, which reversed three previous emergency committee determinations that there was no emergency.
Previous hesitation reflected pressure from Kinshasa and neighboring capitals in Rwanda and Uganda, fearing disruptions of trade, transport, investment, and sovereign control. Awareness of mounting risks clearly informed the visits by several senior U.S. officials to the outbreak hot spots in the spring, their purpose to think through a “reset” in both U.S. approaches and broader multilateral strategies.
Ebola in eastern DRC is not going away anytime soon. Nor are the hard barriers to access rooted in insecurity and chaos and the companion barriers linked to DRC’s governance, major power indifference, an excess burden of health security challenges, and weak management.
The last year has delivered cutting, loud lessons. There are no ready-made solutions to fixing insecurity in eastern DRC or building lasting trust within communities. There does not appear to be any long-term strategy, articulated or advanced, that brings to the table much greater expertise outside public health: diplomacy, policing and mediation, intelligence, communications, and community trust and development. A narrow, overwhelmingly public health approach, even if it were implemented effectively, would still fall far short of what is required. Building the engagement of alienated communities and securing the ground require enhanced local knowledge and far more systematic outreach than has existed up to now.
If the seasoned teams of renowned U.S. Ebola experts cannot be deployed safely into the center of the fray at the earliest moment, the initiative is lost, critical public health interventions founder, and an enormous hidden price is paid. If management is not tightly coordinated and held accountable, there is waste, and that quickly becomes an excuse for donor inaction and excess caution, particularly given the DRC’s notorious brand of corruption.
We should press for immediate action in three areas.
The first is to provide answers to the basic question of what it is truly going to take to overcome the threats posed by the Mai Mai and the ADF, who is charged with fixing these threats, and how. Up to now, there have been no answers to these questions.
Second, a glaring high-level political vacuum remains to be filled. Guterres would benefit enormously from the active partnership of a small number of global opinion leaders committed to working with him to eliminate the security barriers and advance an adequately funded, integrated strategy.
Finally, the U.S. government should move ahead to reinstate its seasoned civilian Ebola experts to operate effectively and safely in the hot zone one year after withdrawing them. The benefits of having such a high-impact capability warrant assuming a higher risk tolerance and taking special measures. Beyond DRC, the frustrations and costly delays experienced in DRC are likely to be repeated elsewhere in the future in other austere, disordered settings.
In recognition of this problem, the CSIS Commission on Strengthening America’s Health Security is calling for the establishment of a U.S. global health crises response corps, which would receive special training and support to operate safely and effectively in diverse insecure settings. With this enhanced capability, the U.S. government would be equipped to intervene early, in collaboration with international partners, to stop outbreaks at their source and to save lives.
