It’s Time for the World to Redouble its Efforts on Ebola

The world’s second biggest Ebola outbreak is still raging in Africa, despite a coordinated response including measures such as vaccination, testing and monitoring those suspected of having come in contact with the sick.

According to Médecins Sans Frontières, until March 2019, more than 1,000 cases of Ebola Virus Disease (EVD) had been reported in the affected areas of Africa. However, between April and June 2019, this number had doubled, with a further 1,000 new cases reported in just three months.

The World Health Organisation, in its External Situation report issued on 30 July 2019, says:

“As of 28 July 2019, a total of 2671 EVD cases, including 2577 confirmed and 94 probable cases, were reported. A total of 1790 deaths were reported (overall case fatality ratio 67%), including 1696 deaths among confirmed cases. Of the 2671 confirmed and probable cases with known age and sex, 56% (1500) were female, and 28% (758) were children aged less than 18 years. The cumulative number of health workers affected is 146 (5.5% of total cases).”

The epicentre of the current outbreak is the Democratic Republic of Congo, a mineral rich country in Southern Africa, which has been impoverished by years of civil war. Efforts to curb the virus do not seem to be bearing any fruit, as fear grows over the possibility of it spreading to the neighbouring countries. Apart from creating a health crisis, the virus has greatly devastated the country’s economy.

The neighbouring Rwanda recently closed its border to restrict the movement of goods and people, a move which greatly affected trade between the two countries. This drew sharp response from the Congolese, who said that the action went against the World Health Organization’s directive that no country should close its borders.

WHO had strongly advised against the closure of borders or implementation of any restrictions on travel and trade, including general quarantine of travellers arriving from Ebola-affected countries. Such measures, it said, pushed the movement of people and goods to illegal border crossings that are not monitored, “thus increasing the chances of the spread of disease.”

It further emphasised that such measures do not support public health efforts as “they negatively and significantly affect response operations from a security and logistics perspective and can compromise local economies”. Although Rwanda later reopened the border, this is only likely to be temporary.

The situation is further complicated by an ongoing, violent military conflict in the eastern province of Kivu, which borders Rwanda and Uganda. Rebel forces made up of 134 separate armed groups have fought against the country’s central government since 2004, and displaced millions of people from their homes. The United Nations has currently deployed a strong force of 21,000 peacekeeping troops to the region, making it the largest UN peacekeeping mission currently in operation.

In February, two clinics operated by Médecins Sans Frontières were attacked by unknown assailants, prompting the organisation to pull out of Katwa and Butembo, two towns in the Ebola outbreak zone. The organisation feared not only for the safety of its foreign workers, but also for local staff and patients.

The greatest fear is that if the world doesn’t act now, there could be a catastrophic situation looming in the background, which will be more difficult to control. Already, the World Health Organisation (WHO), alarmed with the deteriorating situation, has declared the outbreak a public health emergency of international concern, with its Director General, Dr. Tedros Ghebreyesus, saying “it’s time for the world to take notice and redouble our efforts.” He emphasised and clarified that the international community must assist financially in combating the Ebola outbreak in the Congo and that an emergency declaration was not to get more money but to urge other countries to help in fighting the disease.

What is even more astonishing is the manner in which the crisis is myopically being looked at as a Congo problem. With enhanced connectivity and constant migration, the rest of the world cannot just sit and watch thinking that they are safe. Dr Emma Thomson, a Scottish medic who has been in East Africa to help in the prevention of the spread of the virus, recently warned in the Scotsman:

“I firmly believe that, if we do not track and stop viruses like Ebola at source, there is a risk that they will travel to the UK. As a junior doctor, I was always taught that Ebola and other haemorrhagic viruses would always be contained to remote areas affecting only small numbers of people, but that turned out to be wrong.

“Few believed that people in remote areas of Africa would travel and take it with them. Roads and transport have made travel routine. It only takes someone to get on a plane to Europe and bring it into larger cities to put huge numbers of people at risk… including the UK.”

Thomson’s warning could have been influenced by the 2014 Ebola epidemic, which resulted in thousands of deaths because of slow response. Economies were also destroyed, as airlines refused to fly to countries such as Sierra Leone, Liberia and Guinea, which were the most affected countries at the time. The virus extended to Europe, where a Spanish nurse became the first person to contact Ebola outside Africa . She had helped treat two Spanish missionaries who eventually died after returning from Africa with the disease.

In calling for international support, Dr Josie Golding, Programme Officer for epidemic preparedness and response at Welcome Trust, said:“A step-up in the response, led by the DRC and with full international support, is critical if we are to bring the epidemic to an end. This must include enhanced diplomatic, public health, security, and logistic efforts, as well as releasing much needed financial resources.”

Although great work has been done to combat the virus under the most difficult circumstances, a lot still needs to be done. So far, appeals by WHO for donors to provide the money they had promised have not been forthcoming. According to the organisation’s statement, only about half of the pledges came in. As Larry Gostin, the director of the O’Neill Institute in Washington DC, and an expert on global health law, warned: “Without a surge response, it will be impossible to bring the DRC Ebola epidemic under control.”