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DRC Ebola Outbreak 2019 Blog 7 Political Environment Surrounding DRC's Ebola virus Outbreak
7. Political Environment Surrounding DRC's Ebola Virus Outbreak in Summer 2019
The 2014 West African Ebola virus epidemic uncovered many global vulnerabilities of our biosecurity against EID pandemics that were only solved through new organizational cooperatives and international government collaborations. By 2018, funds were available from donor nations and non-governmental sponsors which strengthened surveillance networks, training, detection tools and policies in developing nations. Many of the new initiatives, funding and efforts to revamp international pandemic preparedness came from the USA. The WHO’s mission and structure were strengthened. Annual budgets and monies for emergency outbreak funding became a regular fixture for the WHO and its affiliated non-profits (48).
Over these 5 years, there were also other tangible gains. Several new or improved rapid screening tests for Ebola virus exposure were vetted in smaller controlled outbreaks. The initial screening of people with a questionable history of contact with Ebola-infected patients was streamlined with these on-site tests, decreasing backlogs of cases waiting at Ebola treatment centers. Mobile diagnostic field labs, used for confirming diagnoses, took the place of flying collected specimens outside the affected countries, cutting the diagnosis time from days to hours. Finally, a newly introduced Ebola vaccine was effective in helping end Ebola virus transmission during these outbreaks (49-52).
However, in early 2018, the USA President Trump’s administration signaled that it would defund the CDC by one billion dollars in the 2019 budget, over a tenth of its usual annual budget. During an interview Dr. Peter Salama, WHO’s Deputy Director-General of Emergency Preparedness and Response discussed the importance of recent collaborations between the CDC, WHO and international partners, sharing many success stories, including intervening in over 1,000 events over the last four years. Dr. Tom Frieden, prior CDC Director, and many prominent international health specialists were asked about the proposed cuts and said that the world was far safer because of the CDCs expertise and its vast resources—resources and global collaborations that would be lost in this policy decision (3, 9).
The CDC mandate covers many other areas of national and global health for the US and the world. Over 200 agencies, physicians and scientists requested a meeting with the Trump administration to show that money spent in improving world health, prevented diseases and catastrophes and saved an immense number of lives and assets, validated the CDC’s role as a buttress for global biosecurity. The Trump administration did not modify its position of proposed cuts for the fiscal year of 2019. Because of policy changes threatening funding loss, agencies pulled out of 39 of 49 global initiatives, including training local technicians for detecting and testing for EIDs, expanding local healthcare networks and supplying and educating communities on various health care topics (9, 49, 53). More recently, while the US Congress has consistently overridden Pres. Trump’s efforts to defund some of these institutions, funding losses and threats of funding loss forced organizations to pull back from many areas where the US traditionally played a major role in world health and global pandemic preparedness (54).
During late July and into August 2018, the DRC northeastern provinces of North Kivu and Ituri were alerted to an Ebola virus outbreak occurring in their region through an enhanced surveillance, testing and communication system. The CDC’s experts and support staff, having decades of experience with this killer microbe, were on the job, alongside their skilled international partners, within days of the outbreak. New, rapid, field EID diagnostic tools, developed over the previous five years, and a new Ebola virus vaccine were deployed, significantly slowing the outbreak’s expansion.
In early October 2018, North Kivu’s regional violent flair up by militias and understandably disturbed the Trump administration. Elements in the Trump administration had concerns about another Benghazi-type incident, where US citizens from the CDC might be endangered during militia violence in North Kivu and Ituri. The Trump administration decided to withdraw the CDC’s collaborating teams from the DRC Ebola outbreak regions. The WHO and other international teams stayed in the region, waiting for the violence to stop. Dr. Robert Redfield, Director of the CDC, aggressively advocated for the CDC’s presence in DRC to bolster the efforts to control the outbreak. Despite his warning that control of the DRC outbreak would be significantly weakened by the CDC pullout, Dr. Redfield was overruled (55-56).
In mid-October 2018, the WHO declined to declare this outbreak a Public Health Emergency of International Concern (PHEIC), which would have prompted more international funding and intervention. (The PHEIC section has more details.) Citing a return to stability, the WHO again made progress in controlling the Ebola virus outbreak. Yet, Dr. Peter Salama recalled that the 100 million dollars for emergency contingency funds, much of which had already been spent, would get only partial future support from international government sponsors (22). Some prominent international non-governmental public health organizations, ever-present during these crises, filled in the critical gaps to control the outbreak. The new reality is that there are few consistent sovereign international governmental economic resources made available to neutralize EID outbreaks.
Historically, although it was generally contained by 2015, stop-and-go funding problems were among the reasons that the 2014 Ebola epidemic took another full year to end. Insufficient funding for outbreaks that are not completely controlled can resurrect the infection cycle. By early 2018, the WHO received almost no new funding to fight pandemics from donor nations. The magnified effects of the CDC’s October 2018 pullout, WHO’s rejection to declare a PHEIC and funding losses amplified this DRC outbreak’s potential threat (21-22, 56).
Dr. Peter Salama of the WHO and John Johnson, project coordinator of Doctors Without Borders/ Médecins Sans Frontières (MSF), confirmed that because the new Ebola vaccine program was activated early in the 2018 DRC outbreak, 10,000 new Ebola virus disease cases did not appear by early December 2018. To put this number into context, the 2014 Ebola epidemic took many more months to cross the 10,000-case mark, with the assistance of thousands of regional and international healthcare workers in West Africa helping control that outbreak. The population density of this East African region is upward of four times that of West Africa, and violence forces large groups of people to leave one area for another transporting the Ebola virus to new hosts. Under those conditions had 10,000 new Ebola virus cases materialized by December 2018, 4 months after the outbreak began, the Ebola virus would have probably already spilled over into other regions (21).
Copyright © 2019 Na’eem A. Abdullah All Rights Reserved
Morning fog on the African river Sangha. Congo. Sergey Uryadnikov Photographer/ Shutterstock Photos.
Many emerging infectious diseases originate in tropical ecosystems. See About Page - Sangha River.
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