The North Kivu outbreak is unrelated to the outbreak in Equateur, and it is proving far more difficult to stop. As of Oct. 4, the World Health Organization has identified 300 cases of Ebola and 186 deaths so far — and there are no signs that the outbreak is slowing down.
North Kivu is a conflict zone
Ebola outbreaks are tricky to contain in the best of circumstances — but North Kivu presents a host of challenges. While health-care workers are seeing positive signs from their use of experimental Ebola vaccines, containment relies on providing supportive care when people get sick and contact tracing to keep a close eye on people at risk of getting sick. This means the community needs health-care facilities and people on the ground, and this is the problem.
Why this strain of Ebola will be far more difficult to stop
North Kivu is simultaneously dealing with an Ebola outbreak and internal conflict. The region has been the site of ongoing violence for more than 20 years. While popular press accounts tend to blame the conflict on competition for natural resources, more careful analysis links the conflict to issues of land access, relationships with the central government in Kinshasa, and revenue streams from taxation and transportation schemes to explain the informal “economies of violence” generated by competition among at least 132 militias in North and South Kivu, at last count.
Health-care workers’ safety is at risk
As a result, at least 1 million of the province’s 8 million residents are displaced, and many have fled across international borders. This makes it incredibly difficult to conduct effective contact tracing operations or maintain health-care facilities. The United Nations worries that this could cause the outbreak to spread across the border into Uganda. The Ugandan government has started vaccinating health-care workers near the border, as a precautionary measure.
The conflict has also complicated vaccination and prevention efforts. Increasing violence in and around Beni, the North Kivu city where WHO teams are based, has forced health workers to suspend their operations. Community members attacked three Congolese Red Cross volunteers trying to assist with a burial, and one of the rebel militias shot and killed two health-care workers in late October.
Local politicians have stirred up opposition to health workers, claiming that they are stealing organs — or deliberately infecting people with Ebola. The local political dynamics at play in Congo are making any sort of response more difficult.
The United States has withdrawn health experts
This is where the international community could provide assistance by offering personnel, diagnostic assistance and financing. Instead, the U.S. government’s response has been to withdraw from the region — though other governments have kept personnel in place.
In mid-October, the Trump administration barred U.S. health experts from working in Beni — pulling back from the front lines of the response experienced people who have dealt with Ebola outbreaks elsewhere. Robert Redfield, the director of the Centers for Disease Control and Prevention (CDC) , said that he wanted the experts to remain in the field, but that Trump administration officials overruled him on security grounds.
Although it is true that North Kivu is a dangerous region, other governments and nongovernmental organizations have not withdrawn. Canada and Britain have personnel in the region, as do Doctors Without Borders and the Gates Foundation.
Ebola is back — and a threat to people in Congo. Are African public health systems ready?
One analyst attributed the Trump administration’s decision as reflecting “the post-Benghazi hangover of the US government’s risk aversion.” Interestingly, in a 2014 interview, Trump cited Benghazi as one of the reasons he didn’t trust the Obama administration’s response to the West African Ebola outbreak.
Other analysts see the administration’s unwillingness to address Ebola as part of a larger pattern. In May, during the first Ebola outbreak in Congo this year, Trump asked Congress to rescind $252 million in Ebola funding to cut “excessive spending.” This funding had been set aside for building local capacity and improving surveillance capabilities to respond to future Ebola outbreaks — exactly the sort of thing that the global community learned from the Ebola outbreak in West Africa and is needed to address this current outbreak.
When the U.S. funds global health, other countries do too
National security adviser John Bolton has also dismantled the NSC’s global health security and biodefense directorate, moving those experts to other areas of the NSC staff and arguably weakening the U.S. government’s global health response capabilities.
These steps are worrying for Congo — and elsewhere
What do these actions mean for the outbreak? As Stephen Morrison and Judd Devermont of the Center for Strategic and International Studies argued last week, an effective response to this Ebola outbreak will need to addresses security concerns, strengthen local response capabilities, and build trust with local communities.
While the United States is providing some support to those working on the frontlines of the crisis, the United States could still do much more by affirming that stopping the outbreak is in the U.S. national interest and embedding security personnel in the MONUSCO peacekeeping operation. All these efforts would bolster the international response without putting CDC workers in the field
The Ebola outbreak in the Congo won’t magically end if the U.S. does get more involved. But the United States is a long-recognized leader in global health. If it chooses to remain disengaged, that could be worrisome for the future of global health.
Editor’s note: This post has been updated with further information about the U.S. response.
Jeremy Youde is an associate professor of international relations at the Australian National University. Follow him on Twitter @jeremyyoude.