The ninth and latest outbreak of the deadly Ebola virus in the Democratic Republic of the Congo (DRC) is now over. I did not think I would be able to utter these words so soon after it all started on 8 May. This outbreak, the most challenging the country has ever faced, had all the makings of a major crisis. Ebola surfaced simultaneously in two remote rural zones, with health workers among the confirmed cases. The virus quickly spread to Mbandaka, a city of more than 1.2 million inhabitants in the Congo, a heavily used transportation corridor. It could have spread to other major cities including Kinshasa, our capital, where more than 12 million Congolese lives, and neighbouring countries, but it did not. So what went right? The global community’s ability to contain the spread of the Ebola virus has greatly improved since the 2014 West Africa Ebola epidemic. With our partners, we applied many of the lessons learned from our experiences in both west Africa and DRC.
Local ownership remains the cornerstone of a successful response. The Ministry of Health stepped up to lead the efforts on the ground. By the time international support arrived in DRC, the major elements of a full-blown response were already in place and functioning. A swift mobilisation of finances is another key factor. The government’s $56.8m (£43.3m) three-month action plan was fully financed within 48 hours of it being released, starting with the DRC government putting forward $4m. International partners including donor governments and the World Bank also stepped up – the latter triggered its newly operational pandemic emergency financing facility for the first time and swiftly repurposed funds through its existing health programme in DRC to support the effort. This is in stark contrast with West Africa, where it took months to raise the necessary funds, while the death toll kept rising and finally reached 11,000.
The use of the Ebola vaccine, which proved highly effective in a clinical trial in Guinea in 2015, was one of the most innovative components of this response. The new vaccine has not just proved safe and effective against Ebola; it also changed community perceptions of the disease, which is now seen as treatable. Throughout the outbreak, more than 3,300 people were vaccinated. I was vaccinated myself to show the vaccine’s safety and break the stigma around it. I learned that working with the community, especially on public health information campaigns, will get you a long way. Church and traditional leaders are your best allies to carry public health messages that require communities to change age-old habits and challenge their traditions. In Mbandaka, our strongest health advocates became the 4,000 motorcycle taxi drivers, whose daily work put them at risk of transporting infectious people. They started promoting vaccination and hygiene messages on local radio. The pan-African nature of this response was quite exceptional. Epidemics do not stop at national borders. The importance of regional cooperation for outbreak prevention and management cannot be overstated. Health responders from Guinea participated in the vaccination efforts, epidemiologists from the newly created Africa Centres for Disease Control and the African Field Epidemiology Network worked with our experts on surveillance. This regional collaboration sends a strong signal that Africa is willing to take the driver’s seat in solving its problems.
While Ebola remains a formidable challenge for DRC and the rest of the world, we raised the bar on our ability as a country to detect and respond effectively to outbreaks despite highly challenging circumstances. We must continue to improve our capacity to contain diseases and prepare for Ebola outbreak number 10, which we know will happen. This ninth Ebola outbreak in DRC was unlike any other, but the lessons learned here can be applied anywhere in the world. With increased levels of global trade and travel, there is a higher risk of outbreaks increasing in frequency and spread. In this respect, all countries are equally vulnerable, and it is in our common interest to achieve global health security. The first step is to learn from each other and take responsibility by improving our capacity to detect and respond to an outbreak that starts within our national borders.
Credit: Oly Ilunga Kalenga for The Guardian, 25 July 2018.
Oly Ilunga Kalenga is the Minister of Health in the Democratic Republic of the Congo.