Ebola’s Reappearance an Early Test of Global Health Improvements

Hygienists disinfect treatment center facilities during a previous Ebola outbreak. Lokolia, Democratic Republic of the Congo, October 5, 2014. (Kathy Katayi/AFP/Getty Images)

Ebola has resurfaced in the Democratic Republic of the Congo (DRC), killing three people and infecting up to 17 others since April 22, the World Health Organization (WHO) announced this week. Foreign Policy reports that the outbreak, which was discovered in the northern province of Lower Uele, is so far “isolated, remote, and small” and unrelated to the 2014-16 Ebola epidemic in West Africa, which killed over 11,300 people in Liberia, Guinea, and Sierra Leone.

Now international responders led by WHO will need to work together to support the Congolese government as part of a coordinated, multi-sectoral approach to containing the virus. The outbreak is significant not only because it is a test of reforms made to WHO’s emergency response capacity in recent years, but also because it has the potential to test the readiness of the entire United Nations system, should the situation deteriorate

Congolese health officials deserve credit for detecting the outbreak in its current, incipient stage. The DRC has experienced eight separate Ebola scares since 1976, including most recently in 2014, and was therefore better prepared than countries in West Africa to detect additional cases. This includes the presence of a research laboratory in Kinshasa, which confirmed the identity of the virus using DNA sequencing technology. The response affirms the pivotal role of national health systems as the first line of defense in the fight against global pandemics.

Other signs point to a higher level of speed, coordination, and engagement than occurred during the initial stages of the West Africa response in 2014. Less than three weeks transpired between the first reports of suspected cases and identification of the virus by the Congolese health ministry; the WHO Regional Director for Africa met with national authorities in Kinshasa on Sunday and has deployed a team of technical experts to conduct a field investigation; and personal protective equipment has been shipped to the northern city of Kisangani. Epidemiologists backed by WHO are currently attempting to trace 125 people with suspected ties to the victims, according to reports.

In West Africa, by contrast, it took nearly three months for health officials to identity the Ebola virus in Guinea, by which time it had already infected hundreds of victims, entered urban population centers, and spread undetected into neighboring Liberia and Sierra Leone.

Numerous NGOs are also responding to the outbreak. Médecins Sans Frontières dispatched, along with medical equipment and supplies, a team of 14 experts to meet with officials from the national health ministry. They will discuss the possibility of vaccinating the local population with an experimental vaccine funded by vaccine alliance Gavi. The vaccine was developed by Canada’s Public Health Agency and manufactured by pharmaceutical company Merck.

Although the potential scale of the outbreak is still unknown, it appears likely to be brought under control fairly quickly given its rapid detection and remote location, following in the pattern of previous outbreaks in the DRC. If the situation escalates, multiple in-country partners, including the World Food Programme (WFP) and UNICEF, are standing ready to lend their support, according to an official WHO statement. This suggests a prudent recognition of the role that UN and NGO partners on the ground can play in stopping outbreaks.

The DRC already benefits from a sizable UN country team presence, which must be prepared to act swiftly to support the WHO-led response as needed. For instance, WFP might be called upon to provide logistical support and build Ebola treatment units, as it did in West Africa in 2014-15. The Office for the Coordination of Humanitarian Affairs (OCHA), which runs its largest field operation in the country and is currently fighting a cholera epidemic in the southeastern provinces, could act in the event of worsening humanitarian conditions.

At the heart of the UN presence is a major peacekeeping mission, known as MONUSCO. The mission is comprised of roughly 20,000 troops and 850 international civilian personnel. It, too, could be asked to support the response, such as by redeploying vehicles/ambulances, helicopters, and other operational assets. This was done by the UN peacekeeping mission in Liberia, which enabled the response to maximize the use of assets during that country’s struggle with Ebola.

As I argue in a recent International Peace Institute report (with Adam Lupel), the Ebola epidemic in West Africa offers lessons for how the UN can provide a whole-of-system response to a rapidly developing and complex crisis, if necessary . We concluded that the most effective countermeasures drew upon not a single agency, but the full range of UN tools and implementing partners, including peacekeepers and humanitarian workers.

However, this level of coordination took time to materialize. It also required the creation of a special health mission, known as UNMEER, which may not have been needed had focused action been taken earlier. According to a high-level WHO assessment panel, a crucial misstep by decision-makers was waiting too long to tap into the resources and expertise of OCHA and other UN agencies once the crisis became multidimensional. This revealed a need for the UN and WHO to build “a closer working relationship” that considers “the special nature of health risks.”

In the coming weeks, it will be incumbent upon decision-makers to recall these and other lessons of previous outbreaks and to be prepared for any contingency. To make the world safe from Ebola again, global health officials should consider putting in place a coordinated response framework that leverages a diverse range of available tools, resources, and strategic partners at the earliest possible stage.