WHO / Lindsay Mackenzie Residents celebrate the return of Lucien Ambunga, the Catholic parish priest of the village, after he recovered from Ebola and returned to the village of Itipo, Equateur province, June 2018.

How Congo Beat the Last Ebola Outbreak

The Crucial Role of International Cooperation

On July 24, the World Health Organization announced the end of an Ebola outbreak in the Democratic Republic of the Congo’s Equateur Province that had infected 54 people and killed 33. Eight days later, the Congolese government reported that the virus had struck again, some 1,500 miles away, in North Kivu, an active conflict zone. As health officials race to assess the complexity of this new threat, the rare occurrence of back-to-back outbreaks underscores the growing danger that infectious diseases like Ebola pose to humanity.

The new outbreak is Congo’s tenth scrap with Ebola since the virus was discovered in 1976, and experience has been an exacting but effective teacher. In May, the Congolese government recognized the risk in Equateur immediately and alerted the WHO. Within hours of receiving laboratory confirmation, the WHO activated its emergency management system, which directs resources and personnel from across its organization to where they are needed. Within days, the UN began ferrying health-care workers and supplies to the center of the outbreak, and donor nations, including the United States, released emergency funds. Less than two weeks after the outbreak began, frontline health-care workers received the protection of a new tool: an Ebola vaccine. And perhaps most significant, the response demonstrated the value of investing in local health-care systems, as more than three-quarters of those deployed came from within the region. As a result, in less than three months, the disease had been detected in remote villages, tracked to Mbandaka, a city of more than one million people on the banks of the Congo River, and contained before it could spread to Kinshasa, Congo’s capital, or neighboring countries. 

That response required global cooperation, international institutions, and far-sighted investments in science, health, and governance that have enabled countries to tackle their own problems before they become everyone else’s. The work under way in North Kivu will require the same. As U.S. President Donald Trump and like-minded demagogues undermine the global order, defenders of liberal internationalism would do well to highlight the efforts in Congo as an example of what nations can achieve by working together. 

It is often difficult to make the case for the international system, an imperfect composition of institutions, norms, and rules built over seven decades to guide an unruly planet toward greater peace, prosperity, and freedom. The system’s components are diffuse and feel disconnected from everyday life. Even its name, the liberal international order, is devoid of inspiration and common meaning. In the United States, it is hard to explain how the day-to-day lives of Americans would change if NATO splintered, the UN withered, countries closed their borders, or democracy lost its appeal. But one thing is clear: without this system and countries willing to stand up for it, many more people would be dead from infectious diseases such as Ebola. 

THE FIRE LAST TIME

The world does not need to imagine what this nightmare scenario looks like. It happened just four years ago, when the international community missed a narrow window to stop an Ebola outbreak before it became an epidemic. In 2014, as the virus swept through Guinea, Liberia, and Sierra Leone, health-care systems collapsed and contagious bodies lay abandoned in the streets. Mismanaged and underfunded, the WHO ignored repeated warnings of a mounting crisis. It did not declare an international public health emergency until weeks after the disease had reached capital cities with populations in the millions. 

In early September, the United States recognized the risk of a global pandemic and stepped forward to lead the response, deploying some 3,000 U.S. troops and 10,000 civilians, including volunteers, and mobilizing dozens of other countries. By the time the virus was beaten back, it had killed 11,300 people, infected 28,600 people, orphaned more than 17,300 children, devastated local economies, and caused a wave of fear in the outside world that manifested in rabid hostility toward returning health-care workers and immigrant communities.

The crisis was a wake-up call. It was a reminder that the protection everyone derives from the international system requires continuous investment. Instead of decrying the burdens of global leadership, U.S. President Barack Obama embraced the unique role that the United States plays in bringing the world together, even as a chorus of voices rose in opposition to his approach. 

Although the actual risk to Americans from Ebola was negligible, the sense of alarm grew as three cases were diagnosed in the United States that October. In the lead-up to the 2014 midterm elections, politicized panic surged. Lawmakers called for a travel ban on people from the affected areas. General John F. Kelly, then chief of U.S. Southern Command, now White House Chief of Staff, warned of a stampede across the U.S. southern border if the disease reached Central America. Trump, who tweeted roughly 100 times about Ebola between July and November, called for flights to be stopped and American health-care workers to be cut loose if they became infected abroad. 

Yet Obama stayed the course, resisting calls for travel restrictions and quarantines that would have made it harder to recruit volunteers, deliver medical assistance, and end the epidemic. And even as it dealt with the current crisis, the Obama administration began to plan for the next one. Washington and its partners around the world resolved to make new investments in the international system, from supporting the development of Ebola vaccines, therapeutics, and diagnostics to strengthening the resilience of health-care systems in vulnerable countries. In September 2014, at the height of the crisis, Obama hosted senior officials from 44 countries in Washington to advance the Global Health Security Agenda, an initiative the administration had unveiled nine months earlier.

Congolese Health Ministry officials arrange the first batch of experimental Ebola vaccines in Kinshasa, May 2018.

Congolese Health Ministry officials arrange the first batch of experimental Ebola vaccines in Kinshasa, May 2018.

TEAMWORK

Countries have to cooperate on global health because epidemics resist unilateral solutions. Governments cannot build walls tall enough or seal their borders tight enough to keep diseases out. Obama’s decision to make the crisis in West Africa a U.S. responsibility and the international investments that followed have shown that the only way to beat diseases such as Ebola is to work together. 

The Global Health Security Agenda, which still exists under the Trump Administration, has strengthened the capacity of countries to prevent, detect, and respond to public health threats. One of those countries is Congo, where the U.S. Centers for Disease Control and PATH, an international global health NGO, have helped the Ministry of Health establish the country’s first Emergency Operations Center, the hub from which officials are tracking the spread of Ebola and coordinating the response. 

The new Ebola vaccine, which only works for the Zaire species of the virus, is another monument to global partnership. Developed by the Public Health Agency of Canada and licensed by Merck, it was supported in early trials during the 2014 epidemic by the WHO, the Norwegian Institute of Public Health, Médecins Sans Frontières, and Canada’s department of public health. Amid fears that development of the vaccine would stall after the emergency had ended and the world had moved on, Gavi, the Vaccine Alliance, which works to immunize children in poor countries, promised to buy $5 million worth of vaccines from Merck if the company would create an emergency supply. When health officials sounded the alarm in Congo in May, a stockpile of 300,000 doses was already available.

The occurrence of two separate Ebola outbreaks in such rapid succession foreshadows the peril the world will face from the next big pandemic. Yet in the United States, the global health security agenda has an uncertain future. The 2018 U.S. National Security Strategy identifies biological threats and pandemics as dangers to the U.S. homeland and pledges to work with other countries to detect and contain disease outbreaks and invest in basic health-care systems. In March, Congress gave the Trump administration six months to draft a comprehensive plan to strengthen global health security. While they await the report, advocates worry that the administration does not see global health security as a priority. On May 8, the same day the ninth Ebola outbreak was confirmed in Congo, Rear Admiral Tim Ziemer, the widely respected White House official responsible for global health security, was quietly ousted. The Global Health Security and Biodefense Directorate at the White House National Security Council was disbanded, and its responsibilities split between other offices responsible for development and weapons of mass destruction. 

More broadly, the Trump administration has eroded trust in government, disregarded scientific expertise, adopted punitive immigration policies, and abdicated global leadership. It is doubtful whether the United States could or would respond to a serious global health emergency today. A well-functioning international system may not sound exciting when you have it, but Americans will not like what happens when you do not.

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