A WHO nurse shows a bottle containing Ebola vaccine at the town all of Mbandaka, DR Congo on May 21, 2018 during the launch of the Ebola vaccination campaign. AFP PHOTO | JUNIOR KANNAH via The East African
Few countries in the world have a more inadequate healthcare system than the Democratic Republic of the Congo, the giant country in the heart of Africa whose cobalt is probably in the battery of the device you are using to read this.
Even fewer countries are better able to handle an outbreak of the recently-renamed Ebola Virus Disease. The reason behind this apparent contradiction might be the key to better healthcare in the country.
On May 8th, the DRC declared an Ebola outbreak. Cases had been confirmed in two villages in Bikoro, a remote part of Equateur Province, which is in the north-western part of the country. A short while later, more cases were reported in Mbandaka, a city of over a million people on the Congo River, which puts it in direct contact with Kinshasa, the capital and home to over 12 million Congolese people.
Oly Ilunga, the DRC’s Minister of Health, declared that this was the “the most challenging and complex outbreak the country has ever had to face.” He was not exaggerating. Ebola is a highly infectious and lethal disease. Introduced into human populations through contact with the bodily fluids of infected animals and transmitted the same way among people, it kills 50 percent of its victims, sometimes up to 90 percent. And that’s without taking into account the remoteness of Bikoro, or the fact that cases had been confirmed in Mbandaka.
To properly handle an Ebola outbreak, a quick and decisive response is needed. In this case, one was not lacking. Within days of the declaration of the outbreak, the Director-General of the World Health Organisation (WHO), Tedros Adhanom Ghebreyesus, was in the affected area. The response, which combined the efforts of the Ministry of Health, WHO, Doctors Without Borders, and a number of other organisations, quickly got underway.
Cases were traced, isolated, tested and treated. An experimental vaccine was used on over 3000 health workers and other people who came in contact (real and potential) with infected people, cutting a firebreak around the disease. A massive public awareness campaign was rolled out in the villages and in Mbandaka; community educators, brandishing loudspeakers and leaflets, shuttling from door to door and weaving between marketplace stalls, urging people to thoroughly wash their hands, limit bodily contact and report cases.
Apart from the nature of the outbreak however, the decisiveness of the response was also greatly motivated by the memory of the similar, but enormously more devastating, Ebola outbreak that cut short 11,000 lives in West Africa (particularly in Sierra Leone, Guinea and Liberia) between 2014 and 2016. The cloud of guilt hanging over organisations that could have done more to stamp out that outbreak before more lives were lost, especially the WHO, has never really cleared.
So thorough was the recent response that, on 3 July, after 53 cases and 29 deaths, the WHO declared that the outbreak was largely contained (pdf). By 27 June, the people exposed to the last confirmed case had gone 21 days, the incubation period for Ebola, without developing symptoms of the disease. The situation will still be closely monitored, but if it persists, the DRC’s latest ebola outbreak will be declared over on Wednesday 18th July.
There is a lot that can be credited with the defeat of the most severe outbreak of Ebola since the West African one a few years ago.
For a start, the name Ebola also belongs to a river in northern DRC. It was in villages on its shores, alongside Nzara in South Sudan, that the disease was first clinically detected after an outbreak in 1976. Since then, the DRC has weathered over 9 outbreaks. No healthcare system, however advanced, has professionals more acquainted with the disease than the Congolese one.
Much has also been made of the seriousness with which this outbreak was taken. Resources were mobilised with incredible alacrity (the WHO, for instance, obtained the USD 57 million it needed for the response almost immediately; the EU had another EUR 3.43 million waiting in the wings).
The surprising ease with which locals accepted vaccination also had an effect on the containment. Even the terrain of the affected area has been credited with helping contain the outbreak; although it made access for healthcare responders difficult, it also limited the movement of infected people, slowing the spread of the disease.
But perhaps a lot more emphasis should be put on the fact that a significant objective was achieved within the context of one of the most anaemic healthcare systems in the world. If it can be done for Ebola, it can be done for all the other diseases. Of course, the fact that the many other maladies from which Congolese people suffer every day are not as newsworthy as Ebola does complicate things a little.
Mathew Otieno writes from Nairobi, Kenya