2018 Democratic Republic of the Congo Outbreak
The lessons learned from the West African Ebola outbreak were soon put to the test. On August 1, 2018, the Ministry of Health of the Democratic Republic of the Congo declared an outbreak in the North Kivu Province, the 10th Ebola outbreak in the DRC since the discovery of the virus. This came just eight days after the WHO announced the end of an outbreak in the Bikoro region of the country’s Equateur Province.
The ongoing North Kivu outbreak has become the second largest in history with more than 1,600 confirmed cases and nearly 1,100 confirmed deaths as of May 15, 2019. The virus has disproportionately affected women (55% of cases) and children (28% of cases), and the 67% fatality rate has gravely impacted the region. It shows no signs of slowing as new cases in recent months have increased at the fastest rates since the beginning of the outbreak. Despite mounting concerns, the WHO stated that the outbreak does not constitute a public health emergency of international concern because it has stayed within DRC’s borders.
While the outbreak is ongoing, the global community was quick to respond. WHO, which was criticized for a delayed reaction to the West African epidemic, swiftly employed its Health Emergencies Programme. This department was created in 2016 to provide centralized leadership and coordination of international response to contain disease outbreaks and aid in the recovery of affected regions. Scientific learnings and advancements from the outbreak in West African have also proven effective in DRC. The deployment of tested vaccines from the 2014-16 outbreak as well as an experimental vaccine has played an essential role in prevention efforts. The ring vaccination strategy has been used to vaccinate and monitor individuals who had been in contact with an Ebola case victim in the hopes of preventing spread of the disease.
Violence and Distrust
The situation in DRC has posed its own set of challenges for Ebola responders. The conflict-ridden region has presented security concerns not only for the affected communities but for the frontline healthcare workers as well. The outbreak is located in the middle of a war zone, which has significantly limited the ability of responders to slow the rate of transmission and contain the disease. There have been numerous attacks on treatment centers, forcing the evacuation of medical staff and the suspension of activities. The threat of violence has impeded access to certain communities and therefore restricted the ability to deliver treatment, perform surveillance or educate people about Ebola.
As a result, communities are instilled with a deep sense of fear and distrust. Responders in the West African epidemic faced similar suspicion and learned that community engagement is essential to combatting Ebola. Even with that knowledge, though, the circumstances of the DRC outbreak have made it difficult to put that learning into practice.
Due to hostilities in the region, armed police were used to force compliance with health measures, and elections were cancelled, which further escalated political tensions. Many believe that Ebola is fake news, a ploy by the international community to influence local government or extract resources. This distrust has been aggravated by the fact that the global response is Ebola-specific, though the country has long suffered from diseases like malaria.
Healthcare workers have seen that the majority of confirmed cases are a result of community deaths. This demonstrates that people are either unaware or unwilling to seek care from treatment centers. It is critical that the international response focus on community outreach to develop culturally appropriate strategies for treatment and prevention in order to avoid repeating the mistakes of the West African outbreak.