A Virus Amid Violence: U.S. Efforts to Stop Ebola in a Conflict Zone

July 24, 2019 By Zach Cohen

An earlier post on the outbreak of Ebola in the Democratic Republic of the Congo (DRC) concluded that “the best defense is a good offense.” Despite a new vaccine, the outbreak has since escalated into the second most deadly Ebola outbreak in history and crossed the border into neighboring Uganda, in part because conflict and violence are preventing an effective response. On Wednesday, July 17th, after the disease was found in the populous Congolese city of Goma – home to nearly 2 million people – the World Health Organization declared the outbreak a Public Health Emergency of International Concern (PHEIC).

What’s Different?

In 2014, the United States helped lead the response to the Ebola outbreak in West Africa that killed over 11,000 people but ultimately was contained.  What’s different today is that the outbreak is happening in a region of the DRC that has seen 25 years of conflict. Over 100 armed groups are currently active in the North Kivu and Ituri provinces, the epicenters of the outbreak, and, recently, ISIS claimed responsibility for several attacks in the region. This conflict has contributed to more than 300,000 people fleeing the region over the past two weeks.

The ongoing violence in the DRC has weakened the Ebola response by preventing health care workers from reaching and treating those in need. Effective treatment requires health care workers to be able to trace the virus as it spreads – but in the DRC as few as 32% of new confirmed cases have been linked to known contacts of the cases, highlighting the challenge of responding to the outbreak in the midst of conflict.

Health care clinics and workers have also been the target of violence in the DRC, with 174 attacks this year alone, leading international aid groups like Doctors Without Borders to suspend operations in the country. This is occurring as a new Ebola vaccine with a 97.5% effectiveness rate has been distributed to over 130,000 people. Yet, only 145,000 doses of the vaccine remain. And according to Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention, this supply will only allow for “about 20 percent of the people” at risk to be vaccinated. Though Merck recently announced it would produce an additional 450,000 doses of the vaccine, it could take another 12 months before the supply is fully available.

A New Global Health Security Strategy

Against the backdrop of the Ebola crisis, the Administration released a new Global Health Security Strategy, which reaffirms its commitment to tackle global health threats around the world and recognizes global health security as a national security priority. The strategy commits the U.S. to “prevent, detect, and respond to infectious disease outbreaks,” in part through strengthening health systems in partner countries, such as improving vaccination campaigns for Ebola and other infectious diseases. USAID Administrator Mark Green called the strategy a critical piece of building resilience against diseases like Ebola that “jeopardize the health, security, and prosperity of all countries, including the United States.”

Unfortunately, there is a risk that the U.S. Ebola response in the DRC will be limited by the State Department’s annual Trafficking in Persons (TIP) Report, which last year designated the DRC as a Tier 3 country – assigned to governments with poor records on combatting human trafficking including the DRC. This restricts all non-humanitarian and non-trade-related U.S. assistance from going to the government which is already struggling to respond to the Ebola crisis. These restrictions have been waived in the past but have not been waived this year. 

Congress Raises the Alarm

Members of Congress on both sides of the aisle have expressed concern about the possible impact of these restrictions on the Ebola response. In a hearing earlier this month, Rep. Chris Smith (R-NJ) argued that TIP restrictions that obstruct our response to threats like Ebola do not “comport with the intent behind the legislation.” Rep. Karen Bass (D-CA) argued that “not focusing resources on health, education, and community outreach hinders the success of countering the Ebola outbreak in the DRC.”

While USAID has responded that its current Ebola response is not funded by resources affected by the TIP Report, Assistant Administrator Tim Ziemer acknowledged in Congressional testimony that “it’s clear that additional funding would complement the current outbreak response.” Many in Congress share the same sentiment. Senator Bob Menendez (D-NJ) recently introduced the Ebola Eradication Act of 2019, which would authorize immediate assistance to the DRC, and redouble USAID’s response to end the outbreak.

The threat of this Ebola crisis spreading is pressing, and American efforts to strengthen local health systems can help stop this disease at the source and prevent future outbreaks from occurring. But our inaction now – and cutting assistance to deal with Ebola – will almost certainly result not just in continued deaths, but an even greater global threat.