Ebola is back in the Congo — and America's Africa policies aren't helping contain its spread
Misinformation, distrust and a lack of resources remain huge challenges for health care providers who are racing against time to control the deadly disease.
A health worker puts on his personal protective equipment before entering the red zone of a MSF (Doctors Without Birders) supported Ebola Treatment Center in Bunia, Democratic Republic of the Congo in 2018.John Wessels / AFP - Getty Images file
By David A. Andelman, Executive director of The RedLines Project
Ebola is back. Deep in the heart of the northeastern regions of the Democratic Republic of Congo, a toxic blend of secular violence, traditional customs and a desperate lack of resources has led to a return of this deadly virus to the extent that the World Health Organization has now labeled it a “public health emergency of international concern.” Leading British medical journal The Lancet called “this outbreak the most complex and high risk ever experienced by the Democratic Republic of the Congo.”
Such fears have been leading medical workers and government officials in a race against time to prevent the international spread of a disease that five years ago held vast stretches of America and Europe in fear. Now, it is very much back — its spread accelerating across northeastern Congo, which shares borders with nine other major African nations. As of July 31, the WHO reported more than 2,700 Ebola cases had resulted in over 1,800 deaths (a 67 percent mortality rate.) But the same factors that have impeded treatment and containment mean it’s likely many more people may have either contracted or succumbed to the disease, or may be carriers.
Such fears have been leading medical workers and government officials in a race against time to prevent the international spread of a disease that five years ago held vast stretches of America and Europe in fear.
Thus far, there is no imminent threat to the United States, but in June, the U.S. Centers for Disease Control and Prevention activated its Emergency Operations Center for what it described as “the second largest outbreak of Ebola ever recorded.” It was the first real response to this reappearance of the disease, but appears to run counter to much of America’s recent Africa policies.
Last December, national security adviser John Bolton unveiled the Trump administration’s new Africa policy. There was not a single mention of the DRC. Indeed, the policy seemed to have been written based on the premise that what’s good for America is good for Africa — in short, what Washington wants, not what Africa needs.
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“Every decision we make, every policy we pursue, and every dollar of aid we spend will further U.S. priorities,” Bolton began. “All U.S. aid on the continent will advance U.S. interests.” It is quite clear that this is a multidimensional problem. As the WHO put it: “The high proportion of community deaths, relatively low proportion of new cases who were known contacts under surveillance, existence of transmission chains, persistent delays in detection and isolation, and challenges in accessing some communities due to insecurity and pockets of community reticence are all factors increasing the likelihood of further transmission.”
Outposts of Doctors Without Borders have repeatedly been attacked by armed insurgents in the mineral-rich region. These attacks seek to profit from the disease, from those who’ve come to treat the illness, and by extension the government which controls both mining operations and the health care system — seizing land, arms, extorting anything of value that can be sold, while seeking to accumulate power and influence.
Moreover, as in the last pandemic five years ago, the disease has spread from jungle communities to cities, with the first cases now appearing in Goma, a sprawling regional hub of nearly two million people with air and road ties across Africa and beyond. According to Reuters, the first Ebola-infected person to arrive in Goma was a gold miner who’d traveled more than 200 miles from the epicenter of the outbreak. He died in a Goma hospital, but not before infecting his wife and his 10 children.
Ebola is a particularly insidious disease. Even in survivors it can persist in various parts of a body that can allow routine transmission to individuals lacking immunity.
Justin Kabumba, a Congolese journalist who has visited the Ebola zone, told me by telephone from Goma that misinformation and distrust remain huge challenges for health care providers. “Villagers, not only those who live in the city, do not believe in Ebola,” he said. “They say that this disease does not exist and that it is a fabrication of the authorities in complicity with Westerners who want to get money. Some even flee when they are detected as a suspected case.”
Ebola is a particularly insidious disease. Even in survivors, it can persist in various parts of a body that can allow routine transmission to individuals lacking immunity. “Testicular persistence likely occurs in a high proportion of male disease survivors,” research from the University of Manitoba, Canada points out. “The unprecedented scale of the West African Ebola epidemic and the risk that persistent infections could result in the transmission to new geographic regions constitutes a significant threat to global public health.” The virus can also persist, undetected, in women’s breast milk.
“Everyone is scared when Ebola comes, and they are scared they are going to die,” Rasha Kelej, chief executive officer of the Merck Foundation, told me in a telephone conversation from Mauritius. “Will people will take care of them, or are they going to be a locked up with people more sick then they are? So they get worse. This type of disease thrives on a lack of awareness and lack of being in touch with health workers."
Still, Kelej points out, this time around, there are some differences with the last major outbreak, and some hope. “The vaccine we discovered during the first outbreak of 2013. And it is 99 percent effective but it's not for everyone yet.” Indeed, there are at least two different types of vaccines — a Merck product and one from Johnson & Johnson.
But while better treatments and a more widely available vaccination would certainly help mitigate the crisis, we’re likely to see another one crop up again if the DRC can’t find a way to increase national stability and cut down on rampant corruption. Only then can health workers and education reach the more remote villages where, even when one epidemic is declared finished, the seeds may remain for the next.
On top of this, trust needs to be built between villagers and health workers, many of whom are seen to be little more than agents of a corrupt government. Health workers have also sought to break ancestral practices that have played important roles in the spread of the disease. Citizens groups have also petitioned President Antoine Félix Tshisekedi to buy enough vaccines for the nation’s entire population, but to no avail.
Also, as the Lancet points out “The response teams have had to overcome major infrastructure challenges in multiple sites across a wide geographical area, such as intermittent electricity for essential laboratory and clinical equipment, absence of communication networks for transmitting data, difficult and inaccessible roads for contact tracing.” There are other issues, too, many involving ancestral traditions that are difficult to break. “Burial ceremonies that involve direct contact with the body of the deceased can also contribute in the transmission of Ebola,” the WHO warns.
In the end, however, the battle to eradicate Ebola will be a collective effort, transcending the interests of any outside nation. Vaccination, treatment and education must all go hand-in-hand without any sense that there is a winner — or that anyone is profiting, beyond those who would otherwise be victims of a horrific scourge.
David A. Andelman
David A. Andelman, formerly a correspondent for The New York Times and CBS News in Europe and Asia, is executive director of The RedLines Project. He is the author of three books, most recently "A Shattered Peace: Versailles 1919 and the Price We Pay Today." His next book, “A Line in the Sand: Red Lines Between Peace & War,” will appear in 2020.