The current Ebola outbreak in the Democratic Republic of the Congo threatens to become uncontainable – because of politics, not the disease itself.
On Aug. 1, the Congo Ministry of Health declared an Ebola outbreak in North Kivu Province, which is in the northeastern part of the country. This is actually the Congo’s second Ebola outbreak in 2018; the earlier one on the other side of the country in Equateur Province was brought under control in only three months.
The North Kivu outbreak is unrelated to the outbreak in Equateur, and it is proving far more difficult to stop. As of Oct. 4, the World Health Organization has identified 300 cases of Ebola and 186 deaths so far — and there are no signs that the outbreak is slowing down.
North Kivu is a conflict zone
Ebola outbreaks are tricky to contain in the best of circumstances — but North Kivu presents a host of challenges. While health care workers are seeing positive signs from their use of experimental Ebola vaccines, containment relies on providing supportive care when people get sick and contact tracing to keep a close eye on people at risk of getting sick. This means the community needs health care facilities and people on the ground, and this is the problem.
North Kivu is simultaneously dealing with an Ebola outbreak and internal conflict. The region has been the site of ongoing violence for more than 20 years. While popular press accounts tend to blame the conflict on competition for natural resources, more careful analysis links the conflict to issues of land access, relationships with the central government in Kinshasa, and revenue streams from taxation and transportation schemes to explain theinformal “economies of violence” generated by competition among at least 132 militias in North and South Kivu, at last count.
Health care workers’ safety is at risk
As a result, at least 1 million of the province’s 8 million residents are displaced, and many have fled across international borders. This makes it incredibly difficult to conduct effective contact tracing operations or maintain health care facilities. The United Nations worries that this could cause the outbreak to spread across the border into Uganda. The Ugandan government has started vaccinating health care workers near the border, as a precautionary measure.
The conflict has also complicated vaccination and prevention efforts. Increasing violence in and around Beni, the North Kivu city where WHO teams are based, has forced health workers to suspend their operations. Community members attacked three Congolese Red Cross volunteers trying to assist with a burial, and one of the rebel militias shot and killed two health care workers in late October.
Local politicians have stirred up opposition to health workers, claiming that they are stealing organs — or deliberately infecting people with Ebola. The local political dynamics at play in the Congo are making any sort of response more difficult.
The U.S. has withdrawn health experts
This is where the international community could provide assistance by offering personnel, diagnostic assistance and financing. Instead, the U.S. government’s response has been to withdraw from the region — though other governments have kept personnel in place.
In mid-October, the National Security Council barred U.S. health experts from working in North Kivu — pulling back experienced people who have dealt with Ebola outbreaks elsewhere. Robert Redfield, the director of the Centers for Disease Control and Prevention, said that he wanted the experts to remain in the field, but that Trump administration officials overruled him on security grounds.
While it is true that North Kivu is a dangerous region, other governments and nongovernmental organizations have not withdrawn. Canada and the United Kingdom have personnel in the region, as do Doctors Without Borders and the Gates Foundation.
One analyst attributed the Trump administration’s decision as reflecting “the post-Benghazi hangover of the US government’s risk aversion.” Interestingly, in a 2014 interview, Trump cited Benghazi as one of the reasons he didn’t trust the Obama administration’s response to the West African Ebola outbreak.
Other analysts see the administration’s unwillingness to address Ebola as part of a larger pattern. In May, during the first Ebola outbreak in Congo this year, Trump asked Congress to rescind $252 million in Ebola funding to cut “excessive spending.” This funding had been set aside for building local capacity and improving surveillance capabilities to respond to future Ebola outbreaks — exactly the sort of thing that the global community learned from the Ebola outbreak in West Africa and is needed to address this current outbreak.
National security adviser John Bolton has also dismantled the NSC’s global health security team, weakening the U.S. government’s global health response capabilities. These cuts mean that even if the United States does not want to deploy its own personnel, it is doing nothing to strengthen the capacities of others to respond to global health emergencies.
These steps are worrying for Congo – and elsewhere
What do these actions mean for the outbreak? As Stephen Morrison and Judd Devermont of the Center for Strategic and International Studies argued last week, an effective response to this Ebola outbreak will need to addresses security concerns, strengthen local response capabilities, and build trust with local communities.
The U.S. could take a number of steps — affirming that stopping the outbreak is in the U.S. national interest, embedding security personnel in the MONUSCO peacekeeping operation, supporting the deployment of Congolese public health experts, and training health care workers. All of these efforts would bolster the international response without putting CDC workers in the field. Will the U.S. step up? As a long-recognized leader in global health, the apparent U.S. disengagement is worrisome for the future of global health.
The Ebola outbreak in the Congo won’t magically end if the United States does get involved, but the United States ceding its leadership role in global health speaks to a larger disengagement with this important multilateral issue.
Jeremy Youde is an associate professor of international relations at the Australian National University. Follow him on Twitter @jeremyyoude.