While the COVID-19 pandemic continues to spread, a sliver of good news came out of the Democratic Republic of Congo (DRC) on June 25, when the government officially declared an end to the country’s long-running Ebola outbreak. The announcement, following 42 days since the last confirmed case, brings an end to the country’s tenth and largest outbreak of the hemorrhagic fever. The DRC’s success also serves as a lesson in resilience to other countries now battling COVID-19.
First detected in August 2018, the Ebola outbreak was contained after 22 months of intense control efforts by the World Health Organization (WHO), the DRC Ministry of Health, and other international and local partners, including UNICEF and Médecins Sans Frontières. All told there were 3,470 cases and 2,287 deaths, making it second in size only to the 2014–16 Ebola epidemic in West Africa. The outbreak’s epicenter was the restive eastern provinces of North Kivu and Ituri—an active conflict zone which is also facing a large-scale humanitarian crisis.
The outbreak was notable for its challenging security environment, which became a key obstacle to the response. At the height of the crisis, health workers faced near daily attacks by armed militias patrolling the region, which prompted military escorts from United Nations peacekeepers. Violence against health workers limited access to affected populations and interrupted contact tracing programs, resulting in numerous unaccounted-for chains of transmission. Community resistance was also high compared to previous outbreaks. The response turned the corner in 2019 when officials redoubled their efforts to educate, engage, and empower communities in support of the public health response.
The outbreak was also aided by several scientific innovations. It was the first Ebola outbreak to widely utilize a licensed Ebola vaccine, which was trialed during the West Africa crisis. It was given to over 300,000 high-risk individuals, including close contacts of Ebola patients and front-line health workers. A second, experimental vaccine—which this month received regulatory approval in the European Union—and multiple therapeutics were employed in clinical trials under a compassionate use authorization.
Comparisons to COVID-19
Despite the availability of a safe and effective vaccine, the Ebola outbreak evokes many similarities to the global fight against the COVID-19 pandemic. In both cases, the actions of ordinary people have emerged as critical to suppressing viral transmission. Fostering behavior change, including handwashing and safe burial practices, was central to the Ebola response since the disease spreads primarily via direct contact with bodily fluids. National governments have likewise promoted behavior change to protect against COVID-19 in the form of social distancing, wearing masks, and taking other precautions.
Jean-Jacques Muyembe, Ebola and COVID-19 response coordinator in the DRC, credited his nation’s success in this area to “community engagement and awareness-raising campaigns.” Risk communication and community engagement (RCCE), important in any outbreak response, was a key pillar of the Ministry of Health’s Strategic Ebola Response Plan. The plan called for deploying community health workers, anthropologists, and psychosocial experts to convey scientific knowledge and information in an accessible way, tailored to local attitudes and customs. Countries battling COVID-19 can follow the DRC’s example by proactively engaging local communities in town halls or other settings and identifying and recruiting influential voices to support the response, such as faith leaders, community-based organizations, and other “champions.”
Both Ebola and COVID-19 have exposed deep social and political rifts and a lack of trust between the public and government institutions. Suffering from years of neglect and political instability, the population of eastern DRC was highly suspicious of outsiders and questioned the motives of public health officials. According to a survey, less than a third of respondents in North Kivu “trusted that local authorities represent their interests,” and a quarter believed that “the Ebola virus was not real.” These beliefs were associated with engaging in risky behaviors and skepticism of vaccines.
Similarly, Rachel Kleinfeld of the Carnegie Endowment for International Peace has argued that countries with low levels of trust in government, regardless of regime type, have had the least effective responses to COVID-19. By contrast, governments in which there is a high degree of confidence and legitimacy, in combination with strong public health systems, can “effectively maintain onerous lockdowns” and promote compliance with public health guidance.
Both outbreaks have highlighted the need to invest in essential public health infrastructure and capacities, including laboratory testing and contact tracing programs. WHO Director-General Tedros Adhanom Ghebreyesus has called contract tracing “the single-most important intervention for breaking chains of [COVID-19] transmission.” Yet, many countries have been slow to finance, coordinate, and scale up their COVID-19 contact tracing programs.
The DRC’s epidemiological workforce, which ranks high among its peers in the Global Health Security Index, can serve as a model in this regard. Despite a challenging security situation, contact tracers in the DRC registered 250,000 Ebola contacts and used a smartphone app to streamline the process of data collection in the field. In stark contrast, many state and local health departments in the United States still use cumbersome paper forms.
The DRC’s health challenges are far from over. The country must now contain a new outbreak of Ebola—its eleventh—which was confirmed on June 1 in the northwestern province of Équateur. It also faces a devastating measles epidemic, and has been battling COVID-19 since the first case was detected on March 10. Its resilience in the face of multiple public health crises shows it is up to the task. National governments and international organizations should draw on its experience to effectively mobilize a whole-of-society response against the deadly coronavirus, ultimately interrupting and putting an end to the cycle of COVID-19 transmission.