The killing on Friday of a World Health Organization-deployed responder to Ebola in the Democratic Republic of Congo came a week after a WHO committee determined that the status of the ongoing outbreak there does not constitute a Public Health Emergency of International Concern (PHEIC).
The committee’s chair explained that the outbreak does not meet the criteria of a PHEIC because it has not been reported to have crossed national borders. At the same time, the death of Cameroonian epidemiologist Dr. Richard Valery Mouzoko Kiboung should be a turning point in the series of heartbreaking and harrowing events where health-care workers are being killed. This demonstrates that efforts to contain the spread of a deadly disease in a war zone are international concerning and must receive greater support and recognition than they have so far.
{mosads}Whether the current outbreak in the DRC — the second-largest recorded anywhere — receives the official recognition of a PHEIC, it is time now for the United States to heed the committee’s call for a greatly increased investment in the response.
As the medical director of an Ebola treatment center in Sierra Leone 2014 at the peak of the West Africa Ebola crisis, I saw the difference that the belated infusion of funds and expertise from countries worldwide made in controlling the spread the virus. It allowed health workers to engage the community and develop trust which was essential to ending the outbreak, improve infection control practices, develop laboratory capacity to expedite diagnoses, and re-open a hospital in the midst of the epidemic to once again provide routine care, as well as to work with recovered Ebola patients suffering from the aftereffects of the virus.
In short, the support helped to fill gaps that were essential to address, not only to contain that epidemic but to build capacities needed to respond to those in the future. In the time since, money allocated to that response has expanded the Global Health Security Agenda, a U.S.-led international partnership to build resources and expertise worldwide to prevent, detect, respond to and contain infectious disease outbreaks where they originate. That partnership’s work has only begun.
The DRC, unlike the West African nations overcome by the 2013-2016 outbreak, is experienced in confronting Ebola, but the challenges in responding to this one are, if anything, more daunting. Violent conflict and civil unrest in the affected areas present unprecedented obstacles.
Decades of political divisions and violent upheaval have led to the displacements of millions of people, while fueling deep-seated suspicion of both government agents and outsiders. That the current outbreak has continue to elude control in a country with a history of nine prior outbreaks, exemplifies the breakdowns in basic public health prevention, detection and responses that have been worsened by these factors.
These are among the reasons gaps persist, in spite of a response that WHO characterizes as “excellent,” a vaccine with recently released data shown to be about 98 percent effective, and an ongoing clinical trial showing efficacy of treatments for Ebola. These gaps — have led public health experts, including U.S. Centers for Disease Control and Prevention Director Dr. Robert Redfield, to suggest that the current outbreak could stretch on for at least another year. During that time, continuing displacements among the dense population in North Kivu and Ituri provinces allow opportunities for the outbreak to spread to neighboring countries.
Those countries, Uganda, Rwanda and South Sudan grapple with health infrastructure, resource and political challenges of their own. While the outbreak might then be declared a PHEIC, the resources needed to contain it will have exponentially multiplied.
Immediately needed now is a deep investment in community outreach, education and engagement. If the United States doesn’t want to pay more later, it and the rest of the international community must make that investment now.
The obstacles that have strewn the path of this response demand increased investments in local response and capacity building, including in laboratories to expedite diagnoses with point of care tests, access to therapeutics that improve the odds of people who are already sick, and research to improve the odds for all of us next time.
To do this the United States should match or exceed its 2014 response to the crisis in West Africa. In addition, as Congress approaches another spending bill, it must fully fund the Global Health Security Agenda.
Without an allocation of new funds, the CDC will be forced to abandon efforts in multiple low resource countries developing the infrastructure necessary to detect and contain outbreaks of infectious diseases threats, increasing the likelihood of delayed detection and greater spread of life-threatening outbreaks.
All of this will come at small cost compared to those of responding to continuing and inevitable public health emergencies without strengthened resources and capacities both here and abroad.
U.S.-led efforts now should aim to ensure that the sacrifices of Dr. Richard Valery Mouzoko Kiboung, the more than 30 other health workers who have lost their lives to the virus during the current outbreak, and the more than 500 who died during the West Africa crisis, not be accepted as a routine part of a public health response.
Krutika Kuppalli, MD is an infectious diseases physician at Stanford Healthcare. She is an Affiliated Assistant Clinical Professor in the Division of Infectious Diseases and Geographic Medicine and a faculty fellow of the Center for Innovation in Global Health at the Stanford University School of Medicine in Palo Alto, and a member of the Infectious Diseases Society of America Global Health Committee. She served as medical director of the Ebola Treatment Unit of the Port Loko Government Hospital in Sierra Leone during the Ebola Outbreak there from 2014 to 2015 and served at senior technical advisor and country director of Joint Mobile Emerging Diseases Intervention Clinical Capability in Uganda in 2017.