Ebola transmission rate triples in DRC as US expertise is sidelined

At the close of the fourth episode of the HBO mini-series Chernobyl, the highest ranked TV show ever scored by Rotten Tomatoes, we learn that Lyudmilla, the pregnant wife of the heroic firefighter Vasily Ignatenko, survives an otherwise fatal dose of radiation because her unborn fetus absorbed the radioactivity. This did happen. Lyudmilla is alive today and living in Kiev.

This reminded me of a story I heard from a doctor who battled the 2014 Ebola outbreak in West Africa. Ebola is one of the most lethal-known pathogens; the 2014 outbreak left more than 11,000 persons dead, 28,000 infected, and a generation of orphans behind.

Dr. Wannie Scott-McDonald, the administrator of Liberia’s John F. Kennedy Memorial Medical Center, told me of a young mother who came to the center in full-onset-labor, heavily bleeding, with no outward signs of the virus. Even so, the baby presented still-born, destroyed by Ebola. Once the child was delivered, the active virus latched on to the mother, and within minutes, her fever shot up to 104 degrees. She died eight hours later. Unlike radiation, Ebola spared no one.

When West Africa was declared Ebola-free in January 2016, the international community — having realized how the world’s weakest health systems threaten global health security — vowed that never again would we let such a health crisis fester until it became a calamity. A period of unprecedented attention to global health security began.

We had learned the importance of a rapid mobilization after the World Health Organization’s (WHO) egregious failure to sound the alarm until months into outbreak. We saw the necessity to declare the highest level of global emergency to secure political commitments and mobilize scarce resources.

We discovered that distrust of government often obstructed the response, and that every means must be sought to vest the affected populations, enlisting traditional leaders, priests, imams, midwives, youth leaders, civil society, local journalists, anyone with a trusted voice.

And it was the United States that led the global scale-up, including the deployment to Liberia of the 101st Airborne.

Three years later in the Democratic Republic of the Congo (DRC), it feels like many of the lessons learned were learned in vain — and with the White House decision to bar U.S. officials, including the Centers for Disease Control (CDC), from entering the worst-affected zones as well as a strict interpretation of the Trafficking Victims Protection Act resulting in the withholding of non-humanitarian assistance, we have an unprecedented sidelining of U.S. expertise that — until now —has been on the frontlines for every Ebola outbreak.

This first week of June, aid agencies in the DRC announced that more than 2,000 people had been infected with Ebola since the outbreak was declared in August of last year. Even with vaccines and experimental treatments, the rate of transmission is accelerating. It took 224 days for the landmark figure of 1,000 confirmed and probable cases to be reached. It only took 71 days to reach 2,000.

Karin Huster, field coordinator for Médecins Sans Frontières, explains: “In the volatile context of North Kivu — a region where armed groups, distrust of government, and socioeconomic injustices violently intersect — the Ebola response has been met with distrust and violent attacks on health workers and health facilities.”

Some think the national government was first to use the Ebola crisis as a political tool. David Gressly, the UN emergency coordinator for Ebola, said that just days before national elections, officials announced that voting would be suspended in the two largest cities in the outbreak zone, Beni and Butembo, both known to be opposition strongholds. That “created a perception that the Ebola outbreak was manufactured,” he said.

Tariq Riebl, emergency response director of the International Rescue Committee (IRC) said the rage over vote suspension is still palpable: “If you need a seminal turning point, it’s that one,” he said.

Today, 10 months into the outbreak, we have a witches brew of political disenfranchisement, distrust of authorities, rebel militias, mercenaries, opportunists, and militants loyal to the Islamic State fueling a deadly epidemic by preventing the medical response from getting ahead of the virus.

This is no longer just a health emergency, it is a political, security and diplomatic crisis, with non-state actors who benefit from disrupting lives and sowing panic. As we learned in 2014, this outbreak will only end when communities are engaged and leading the response efforts themselves.

To stabilize the Ebola outbreak, the international community needs to heed the advice of its first responders, the global charities, including MSF, OXFAM, Mercy Corps, the International Rescue Committee (IRC), and the International Federation of Red Cross and Red Crescent Societies (IFRC).  

The good news is, that the UN is beginning to listen. On May 29 the United Nations Office of Humanitarian Affairs (OCHA), confirmed the designation the DRC’s Ebola outbreak as a level-three emergency(L3), activated when agencies are unable to meet needs on the ground, a list which currently includes Yemen, Syria and Mozambique.

Whitney Elmer, country director of DRC for Mercy Corps, said the level-three emergency declaration could bring “manifold benefits”, but noted that, “there has never been an epidemic of this complexity or size in the DRC.”

Last month the UN appointed emergency Ebola coordinator Gressly, a recognition that management of the Ebola response can no longer be left solely to health officials and that the alignment of key political and armed groups behind the response effort is essential to stop the violence against health care workers.

The charities remain skeptical that Gressly can tame the forces that have been unleashed in Eastern Congo. A senior Red Cross official said that while it might lead to stronger leadership and more funding, “it’s not a panacea.”

Moreover, in 2014 it took the creation of the United Nations Mission for Emergency Ebola Response (UNMEER) to establish unity of purpose among responders, and a formal declaration by the WHO of a Public Health Emergency of International Concern (PHEIC) to mobilize resources.   

A single UN Ebola response coordinator is no UNMEER, and L3-designation does not come close to the firepower of a PHEIC declaration. And it is unclear if the political will exists to escalate before — not after — the next set of alarming data points makes world headlines.   

Ebola was defeated in West Africa when a global declaration of emergency created the conditions for charities and frontline healthcare workers to get ahead of the Ebola transmission curve. The disease was brought under control only after it was acknowledged that you don’t isolate the communities, you work with them, to isolate the virus. And it was defeated with U.S. leadership.

K. Riva Levinson is president and CEO of KRL International LLC, a D.C.-based consultancy that works in the world’s emerging markets, award-winning author of “Choosing the Hero: My Improbable Journey and the Rise of Africa’s First Woman President” (Kiwai Media, June 2016). You can follow her @rivalevinson

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