Simran Kapoor explores what the world can learn from the DRC’s success in combating Ebola, whilst they simultaneously grapple with political tensions, COVID-19, and a killer measles outbreak.
Earlier this year, the Democratic Republic of Congo (DRC) found itself in a dire situation. It was simultaneously confronting a measles outbreak and the COVID-19 pandemic, alongside the deadly Ebola outbreak which it had been battling since 2018. In an incredible feat, the DRC finally declared its 10th Ebola outbreak over on 25th June 2020 – 42 days following the last confirmed case recorded in the region. While COVID-19 continues to ravage the world, many countries could learn from the DRC’s remarkable resilience.
Declared in August 2018, the 10th Ebola outbreak had a devastating impact, infecting 3,470 people in the Ituri, South Kivu and North Kivu regions of the DRC. With its dangerously high mortality rate, the Ebola virus took the lives of 2,287 infected patients, making it the second deadliest outbreak of haemorrhagic disease. Compounded with political instability and rising security tensions in the DRC, the Ebola outbreak had become one of the world’s most complex and challenging health emergencies.
The development of a vaccine by Merck brought massive relief to the affected regions. First tested during the epidemic in West Africa, the rVSV-ZEBOV-GP vaccine was extensively used and highly effective in curtailing the 10th outbreak.
Soon, therapeutic interventions rolled out as well. Investigational drugs like mAB114 and REGN-EB3 reduced death rates in their clinical trials. These promising results encouraged healthcare practitioners to administer them to consenting patients, which helped lower the mortality associated with Ebola infections in the DRC.
The success of these scientific innovations was complemented by effective leadership and engagement of the community. The DRC government, supported by the World Health Organisation (WHO), partner agencies, and donors committed to a 22-month-long response plan to ramp up the public healthcare system and eradicate the virus from the region. Healthcare workers were trained and equipped with the means to trace and treat patients. Patients were provided with equitable access to treatments and vaccines. The plan took shape and was largely successful, with over 80% of the 303,000 vaccinated people staying disease-free.
“The outbreak took so much from all of us, especially from the people of DRC, but we came out of it with valuable lessons, and valuable tools. The world is now better-equipped to respond to Ebola. A vaccine has been licensed, and effective treatments identified.” said Dr Tedros Adhanom Ghebreyesus, the Director-General of WHO.
While the world eagerly waits for COVID-19 vaccines and therapies to develop, we could learn many lessons from the DRC’s relentless approach to tackling viral outbreaks.
For many countries, COVID-19 came as a wake-up call. Inability to cope with rising numbers of infected patients highlights the inadequacies of the public healthcare systems in place. SARS-CoV-2 and Ebola viruses require similar methods of control: hygiene practices like washing hands, safe burials, equitable access to healthcare facilities, and high levels of testing.
“The single-most important intervention for breaking chains of [COVID-19] transmission is not necessarily high-tech and can be carried out by a broad range of professionals. It’s tracing and quarantining contacts.” says Dr. Tedros. But in most countries, contact tracing programmes have not been nearly as successful as they need to be.
In the DRC, community healthcare workers could perform highly effective contact tracing using an advanced method of data collection. A smartphone app enabled them to capture up to 250,000 contact cases in real-time and avoid the redundancies of cumbersome paperwork. Using such technology to improve contact tracing globally can be a real game-changer to end the cycle of COVID-19 transmissions.
Credit for the DRC’s success against this Ebola outbreak also goes to the people of the DRC. Indubitably, community-level efforts played a major role in curtailing the spread and stamping out the virus. A community that does not trust the government will be wary of the intent of public health officials and are more likely to engage in risky behaviour.
“Community engagement and awareness-raising campaigns are key to winning the battle,” said Professor Jean-Jacques Muyembe, the Ebola and COVID-19 response coordinator and director of the National Institute for Biomedical Research in Kinshasa.
In the DRC, healthcare workers, anthropology experts and influential leaders went above and beyond to convey scientific information tailored to all sections of the community. Governments across the world must aim to replicate the efforts made by the DRC officials to engage their communities in the fight against the virus.
The end of the 10th Ebola outbreak is indeed a remarkable achievement for the DRC, but the health crisis is far from over, as it continues to fight measles and COVID-19. On the opposite side of the country, an 11th Ebola outbreak is looming. Rising Ebola cases combined with a poor state of healthcare in the Équateur region concerns Ebola responders. Moreover, Mbandaka – the capital of Équateur, is a trade hub. With a high risk of spread through trade routes, quick action is imperative, and WHO officials are already on the ground.
“The DRC is now better, smarter and faster at responding to Ebola and this is an enduring legacy which is supporting the response to COVID-19 and other outbreaks.” said Dr Matshidiso Moeti, the WHO Regional Director for Africa.
The positive news in the DRC provides hope, not just to the DRC, but also to many other countries battling COVID-19. These countries can draw valuable lessons from the DRC’s experience and incorporate whole-of-government and whole-of-society approaches to put an end to the COVID-19 pandemic and be prepared for future viral outbreaks.
Written by Simran Kapoor and edited by Tara Wagner-Gamble.
Simran’s thoughts… The DRC’s victory in its 10th battle against Ebola is truly remarkable and shows the tremendous impact that can result from the government and community working together. Fighting a virus is no easy feat. Many countries across the world have been struggling to eliminate COVID-19, in part due to a failure in adequate response from the government, but also due to the lack of trust people have towards officials. Protests against wearing masks are extreme examples of how this lack of trust can play out. In such situations, governments have to make stronger efforts to gain the trust of the people, through logic and reason, keeping their best interests in mind and guiding them through a well thought out, consistent strategy to preserve the public healthcare of the country and save lives. Viral epidemics affect everyone, and equal distribution of responsibility towards eliminating a virus, in my opinion, is the only way to stamp it out.
Tara’s thoughts… The situation in the DRC has been on my radar for a while now, and upon hearing that they had declared their Ebola epidemic over, I knew this was something that needed to be covered, and I wanted to add my thoughts.
To be able to combat three deadly diseases simultaneously, let alone end a major epidemic, is an amazing feat, and one that the rest of world can definitely learn from. Simran really hits the nail on the head – communication and cooperation is the main driver of the DRC’s success. Scientists can develop as many treatments as possible, but it is up to communities and their trust in their healthcare providers that makes the difference. Hopefully, the rest of the world – both leaders and communities alike – will be smart enough to follow this advice, both now, and in response to future outbreaks.
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