Heartbreaking news that Ebola has spread from a rural area of the Democratic Republic of the Congo to Mbandaka, a city of 1.2million people, is ringing alarm bells. In a densely populated urban environment with poor sanitation, there is rising concern that cases of Ebola could rise exponentially.
To add to that concern, Kinshasa, the capital of the DRC, with a population of over 10million people is just 400 miles downstream from Mbandaka on the Congo, a major national and international river and a transport hub with several road and domestic air routes. This connectivity escalates the risk of Ebola spreading within the Democratic Republic of the Congo to neighbouring countries such as Central African Republic and Republic of Congo, and further afield.
On a trip last year to Liberia, I visited West Point slum in Monrovia where people remain scarred by the trauma of the Ebola epidemic of 2014-2016. Bitter memories remain of the closure by the government of Ellen Johnson Sirleaf of the only road into the slum, placing the entire community under enforced quarantine. The lockdown was finally abandoned after seventeen days, but only after crowds had been fired on by the authorities and dead bodies had piled up.
I also visited Sierra Leone, another country deeply affected by the last Ebola epidemic. Communities there are still unable to overthrow the stigma of being an Ebola survivor. Families deny that a loved one died of the disease for fear of being boycotted by the community and losing their livelihoods.
Ebola strikes fear in these communities. It is a highly infectious disease, transmitted by contact with bodily fluids of people infected by the disease or who have died of the disease. It is a disease the control of which demands unnatural behaviour from the family of infected individuals. It requires giving up a child, a grandparent, a wife or husband to masked individuals, in effect forsaking them. It demands abandoning entrenched cultural practices such as, before burial, washing the bodies of those who have died.
However the fact remains that the current outbreak in the DRC, with its fear of urban transmission coupled with a mobile population and a practically non existent health system, requires a speedy response – all within an exceptionally complex and challenging environment. The authority charged with monitoring the severity of the outbreak and directing the international response is the World Health Organisation. The challenges it faces in containing this outbreak in a fragile state such as the DRC are patently immense.
Is it up to the job?
Not judging by past experience. The last tragic Ebola epidemic of 2014-16 exposed the WHO to scathing accusations of a tardy and bungling response to what came to be designated a Public Health Emergency of International Concern, in which over 11,300 people lost their lives.
A damning report published in the Lancet medical journal in November 2015 concluded that the WHO should be stripped of its role in declaring disease outbreaks to be an international emergency, having failed to act on calls by Medecins Sans Frontieres, amongst others, to take the Ebola outbreak more seriously at an earlier stage.
One of the key findings of the House of Commons International Development Committee’s report on the 2014 Ebola crisis was that a significant factor in the spread of the disease was cultural practices, such as unsafe burial, and this, coupled with distrust in the authorities and health sector, threw up major obstacles. So to avoid this pitfall, it is crucial this time that there is early engagement with communities through trusted local tribal and faith leaders.
The initial response of the WHO seemed to indicate that the criticism had hit home, putting the international community on standby to release money, equipment and people.
They appeared willing to deploy all weaponry at their disposal, including a vaccine, which although not yet licensed has nevertheless been shown to be very effective against the virus. We were told that 7,450 doses would arrive in Kinshasa to add to the 4,300 doses already there. The vaccine’s job is to stop the outbreak in its tracks by protecting health and funeral workers and create safe ‘rings’ around cases.
The only problem is that this vaccine is unstable at temperatures above -80 degrees Celsius, making it difficult to manage in a hot country with little reliable electricity. This will be a costly but necessary operation, requiring mobile generators - preferably deploying solar PV rather than diesel. However early indications were that the WHO were up to the challenge.
This initial promising activity came to a halt last Friday when at an emergency meeting WHO experts said that, “The conditions for a Public Health Emergency of International Concern have not currently been met.”
This latest announcement has echoes of past head in the sand attitude of wishful thinking rather than grasping the nettle with both hands. Reports in the last few days of a group of people infected with Ebola leaving hospital surreptitiously with family members to go to church, reignite fears that trust of health workers and the authorities has not been won, and people will not easily give up sick kinfolk to those they do not trust.
The WHO is the directing and coordinating authority on International Health. Part of their core role is providing leadership on matters “critical to health and engaging in partnerships where joint action is needed”.
This latest outbreak of Ebola is a chance for the WHO to put past criticism behind them and show that they are up to the job. Friday’s announcement shows that the jury is still out.
Baroness Sheehan is a Lib Dem peer and the party international development spokesperson