In North Kivu, Ebola outbreak tests global emergency preparedness

BY RIDWAN SORUNKE

With two major outbreaks in 2018, the Democratic Republic of Congo (DRC) is facing an Ebola Virus Disease (EVD) outbreak four years after a similar outbreak occurred in West Africa. The current outbreak — in DRC’s North Kivu Province — started days after the World Health Organization (WHO) declared an end to the outbreak in DRC’s Equateur Province. At 185 confirmed cases and 107 deaths, the latest outbreak, which has more than doubled the Equateur’s outbreak of 54 cases and 33 deaths, raises an alarm. The outbreaks in DRC represent the largest Ebola outbreak since 2014.

In 2014, the EVD outbreak in West Africa exposed the inefficiencies of the global emergency response structure of the World Health Organization (WHO). Some of the factors that contributed to the ineffectiveness included the reduction of its emergency response budget, loss of key technical staff, bureaucracy, and the organization’s lack of sustainable financing. During this period, global actors -especially the United States (US)- played key roles in responding to the outbreak through financial assistance and technical support. Despite playing an active role in the 2014 outbreak, US intervention came relatively late with its first emergency teams arriving in Guinea and Liberia after 112 cases and 150 cases respectively.

Surprisingly, the 2018 outbreak has received relatively lower international attention than the 2014 outbreaks. The recently released article by the Kaiser Family Foundation (KFF) explained that the US is playing a less prominent role in the response to the outbreak in North Kivu. Although, the US currently budgets $3.7billion for international activities as part of its global health security strategy, however there are some concerns about the government’s commitment to global health security especially on international outbreaks such as the outbreak in DRC. Doubts over the US commitment to global health security has intensified after the government failed to appoint a senior official to oversee its international outbreak response.

Despite the modest support from the US and other international actors, the WHO — over the years and through its experience managing the 2014 outbreak — has enforced key reforms across its operations. Some of its reforms include the reorganization of emergency response teams, creation of the Contingency Fund for Emergencies (CFE) and the proactive engagement of new senior leadership in outbreak responses. The WHO also deployed the Ebola vaccine for the first time during the Ebola outbreak in the Equateur region earlier in the year and has so far vaccinated 18,000 people in DRC. Administration of vaccines clearly presents logistical challenges in DRC. However, its deployment represents a key step in the efforts to combat the outbreak. WHO’s experience from the 2014 outbreak paved the way to the success of the Ebola outbreak response in the Equateur region earlier in 2018. Additionally, DRC has experienced more Ebola outbreaks than any country in the world and as a result has a developed coordinated response system and a history of controlling the outbreak.

Despite both outbreaks occurring in the same country with same set of responders, the outbreak in North Kivu — with 185 confirmed cases and 107 deaths — presents complex challenges to WHO and other actors on the ground.Within security challenges, conflicts and an estimated 1 million refugees in North Kivu, public health efforts will be drastically undermined and will ultimately affect the efficiency of the emergency response. The WHO recently classified some areas in North Kivu as “red zones” making emergency response extremely difficult or impossible. In September, a case of a militant attack led to the suspension of Ebola response by 48 hours. In addition, North Kivu borders major economic players in the region such as Uganda, Rwanda, and North Sudan. The WHO declaredthat the risk of transmission to these countries through transportation links or movement of refugees is now “very high”.

A “potential perfect storm” as described Peter Salama, the Head of Emergency Response of the WHO — may occur if several dynamic factors, such as insecurity and resistance of vaccination, unite. Despite this concern, the WHO does not regard the current outbreak as an international emergency and has not yet reached out to international donors for emergency funds. Beyond the security challenges and geographical risks of the outbreak in North Kivu, residents are also showing resistance to accept the Ebola vaccination while some infected persons avoid isolation and treatment. In addition, local politicians are also exploiting the public’s fear of the outbreak to politicize government’s response as the country approaches its general elections.

The expansion of the outbreak in North Kivu clearly needs to be treated as priority by international donors including the US. An escalated outbreak could lead to an international health crisis affecting other countries with the likelihood of costly impacts. Vaccination, though proving relatively effective, is still in its experimental infancy and its production level may not be sufficient for an escalated scenario. With the doubling rate of new cases within the last month, WHO must start reaching out to donors for emergency funds should it fails to curb the current outbreak. More importantly, the United States needs to be at the forefront of the response by providing greater assistance and funding as key health stakeholders respond to the DRC outbreak.

*Article to be updated as event unfolds

Sorunke is an MA Candidate in International Economy and International Affairs at the Johns Hopkins University School of Advanced International Studies (SAIS).