July 24 2018 marked the end of the latest outbreak of Ebola in the Democratic Republic of the Congo (DRC). In light of this, Director-General at the World Health Organisation (WHO), Dr Tedros Adhanom Ghebreyesus, talks about the WHO’s lessons learnt in dealing with the West African Ebola epidemic of recent years and what needs to be done to prepare for future outbreaks.
The DRC’s latest Ebola outbreak was its ninth. In fact, the Ebola virus was first identified there in 1976. Previous outbreaks had been confined to isolated rural areas but this most recent one involved four separate locations, including Mbandaka, a major city with connections to the capital, Kinshasa, and its more than 10 million people, as well as the neighbouring country capitals of Bangui and Brazzaville. In addition, health workers were infected, becoming vectors for spread themselves.
One of the many lessons from the devastating West African Ebola epidemic of 2014 was that the world expected much more from the WHO than it was then able to deliver. We have since worked hard to make sure the world is better prepared, not only for Ebola but for the many high-threat pathogens, including pandemic influenza, that can cross the species barrier—from animals to humans—at any moment.
This time, when Ebola struck the DRC back in May the WHO was ready. Within hours of the first cases being confirmed, we had allocated more than $2 million from our Contingency Fund for Emergencies and deployed a team to the field. Before long, we had more than 250 people on the ground, including epidemiologists, logisticians, clinicians, data managers, anthropologists and planners, working with government teams and partners.
The United Nations Mission in DRC, MONUSCO, and the World Food Programme supplied fixed-wing aircraft and helicopters to ensure we could get people and supplies in and out. Besides the UN system several other partners such as Médecins Sans Frontières, and the International Federation of the Red Cross and Red Crescent Societies, were also quick off the mark, and donor countries answered the appeal for funds in full in within a couple of weeks.
Together, we made better use of the tools we have for fighting Ebola: strong surveillance to track where the virus was spreading; community engagement to ensure safe burials and awareness of symptoms; and care to treat the sick and prevent further transmission.
We also had new tools including a vaccine, and potentially, drugs. In the latter stages of the 2014 outbreak, the WHO used an investigational vaccine developed by Canadian researchers and licensed by Merck and none of the people immunised got infected.
This latest outbreak arrived before the vaccine had regulatory approval but Merck donated vaccines under the compassionate use protocol. In a show of solidarity, the government of Guinea sent more than 30 vaccinators who had been involved in that country’s trial to help with the vaccination campaign.
Life after Ebola
In the end, this recent DRC Ebola outbreak took 29 lives, and left 24 survivors. I met several of the survivors in June when I visited Itipo, one of the affected areas. One survivor, Marie-Noel, spoke for the group and told me something I did not expect to hear: they were hungry. The people I met survived Ebola but remain very poor in a country facing internal conflict, mass population displacement, food insecurity, malnutrition, and multiple outbreaks of other infectious diseases.
Ebola is more feared than most other diseases, but its toll is dwarfed by many other diseases that garner fewer headlines. Since the first outbreak in 1976, Ebola has killed over 11,000 people. Yet every year in the DRC, 300,000 children under five die from mainly preventable causes such as pneumonia, malaria and measles. The country now faces outbreaks of polio and cholera.
We have stopped Ebola but we cannot stop there
The best defence against deadly outbreaks is to invest in strong health systems that prevent, or detect and contain them early. In that sense, universal health coverage and keeping us all safe from health emergencies are two sides of the same coin. We need equity in global health, and this includes improving primary health care in vulnerable countries such as the DRC.
As we get to the end of this outbreak and turn to preparing for the next one – wherever it may occur, we have two clear lessons to guide us: first, we have demonstrated that we can save lives and prevent outbreaks from spiralling out of control if we act early and decisively with the WHO and the local health authorities providing strong leadership, the UN system working together, good coordination and collaboration between partners, and adequate funding from donors. Second, we need to go beyond the acute response and help countries strengthen their health systems. Country and regional preparedness for health emergencies is not what makes headlines- but it is what will keep us all safe from Ebola and other killer diseases.