On October 1, 2019, the UN Foundation held a congressional briefing called “On the Frontlines: How the UN Responds to the Ebola Crisis” in a Senate office building in Washington, DC. The panel discussion included leaders and responders from the current Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) and outlined how United Nations (UN) agencies and the United States government are involved in response activities. Outbreak Thursday has previously addressed developments in the EVD outbreak and other outbreaks in DRC. This Outbreak Thursday post will focus on describing how multilateral and bilateral agencies and organizations have come together to fight this outbreak and the major takeaways of this congressional briefing panel that a member of the Observatory was able to attend. 

Panelists included:

  • Mr. David Gressly: Assistant-Secretary-General and UN Emergency Ebola Response Coordinator

  • Dr. Carlos Navarro: Principal Advisor for Public Health Emergencies for UNICEF

  • Mr. Kevin Ousman: Coordinator for Infection Prevention and Control of the Health Emergencies Program of the WHO Africa Region and Strategic Advisor for the Office of the Regional Director of the WHO Africa Region

  • Ms. Sheri Ritsema-Anderson: Chief of the Ebola Response Team for OCHA

  • Dr. Henry Walke: Director of the Division of Preparedness and Emerging Infections and Incident Commander for Ebola Response at the United States Centers for Disease Control and Prevention (CDC)

  • Dr. Zabulon Yoti: Acting WHO Regional Emergencies Director for the WHO Regional Office for Africa. 

UN Agencies & Response

The UN is made up of many individual agencies that play a part in responding to humanitarian emergencies, including the current EVD outbreak in DRC. Each of these agencies has a defined role. For example, the World Food Programme often leads logistics, emergency telecommunications, and, in conjunction with the Food and Agriculture Organization of the UN, food security operations. 

Some of the major UN agencies were represented on the congressional briefing panel, including the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). According to panelists and panel materials, UNICEF has focused on risk communication, community engagement, education, handwashing, and infection prevention and control as well as psychosocial support. WHO has focused on surveillance, contact tracing, vaccination, risk communication, community engagement, strengthening lab capacities, and follow up with survivors. OCHA, as panelist Sheri Ritsema-Anderson noted, “greases the wheels of coordination,” helping to support information management, operational coordination, and linking the EVD response to the broader humanitarian responses in the area. 

State of the Response

Mr. Gressly started off the panel by describing the current state of the response, echoing many of the trends that have already been described by various response agencies regarding the outbreak. The response and challenges faced are incredibly complex, which is why the EVD outbreak in DRC is one of the UN’s top global priorities. Insecurity and community mistrust continue to pose a threat to the response. Mr. Gressly acknowledged that rebel forces and other militia have perpetrated attacks against health care workers and the general population in the past but may be more open to cooperation now that a new national government is in place in DRC. Violence and criminality continue, in some cases to exploit profits from EVD-related activities. EVD-affected areas are often hard to reach. The health system in DRC is rudimentary with many so called “clinics” consisting of only two rooms, untrained health personnel, and limited or no running water. 

By the numbers, per day, there are approximately 3,000 alerts of suspected cases, 400 lab tests, and 22,000 contacts being followed. Dr. Walke noted that while medical countermeasures such as vaccination have helped immensely, contact tracing must continue to be pursued and bolstered - particularly as most cases aren’t registered contacts of other cases. Additionally, these issues with contact tracing may have impacted vaccination strategies; Dr. Yoti spoke of utilizing the ring vaccination approach, but Dr. Walke mentioned that there may be a shift to pop-up vaccination days. Dr. Navarro also outlined extensive plans to combat community mistrust that were already being executed, utilizing community leaders and influencers to spread awareness. Other response priorities are detailed in the DRC Response Plan 4

Capacity Building Works 

Dr. Yoti is no stranger to EVD response - he has responded to 14 of the 30 EVD outbreaks that have occurred. He noted that investments made long ago in capacity building are finally beginning to pay off. When he responded to the 2000 Gulu outbreak, it took 8 days to confirm a case of Ebola. Now, with diagnostic advancements such as GeneXpert, it only takes 2 hours to confirm a case. Noting successes in Goma and Uganda at preventing EVD transmission in country, Dr. Yoti stated that capacity building for EVD preparedness and response has clear, positive results and must be continually invested in. He also noted that US investment has been critical to this progress. 

DRC capacity building is already underway - for example, according to Dr. Yoti, only 13% of responders are foreigners, the rest are Congolese nationals. These individuals have been trained on EVD response and could therefore assist EVD responses both domestically and internationally in the future. Mr. Ousman agreed, also mentioning that health workers trained to assist with EVD vaccination could also easily assist with vaccination for other concurrent outbreaks in DRC such as measles. Dr. Walke noted that further investments in DRC such as strengthening their incident command system could help even more. 

Looking Ahead to Post-Response

As EVD incidence appears to be slowing down according to David Gressly, the Assistant Secretary-General is already looking onwards to post-response issues. During the panel, he seemed fairly confident that if the current trends continue, the EVD outbreak may be under control or even over by some time in 2020. He noted that at that time, it will be vital to fulfill promises made to DRC citizens that foreign responders and organizations don’t abandon the country to their other issues after the last case of EVD has been isolated. Instead, health issues of EVD survivors will need to be addressed. Surveillance for EVD will need to be maintained in case of reintroduction. Essential services, particularly those that address the ongoing concurrent outbreaks of measles and cholera, should be bolstered. Public health systems must be invested in, and security and reconciliation must continue to be pursued.

Conclusions

Coordination of organizations working on the ground to support the Ebola response is vital. The UN plays a large role with the contribution of many response organizations, yet challenges such as insecurity, low healthcare capacity and community mistrust remain. However, as Dr. Yoti and other panelists noted, capacity building must remain a priority in order to combat future outbreaks in the region. 


Photo courtesy of Pixabay.

Outbreak Observatory aims to collect information on challenges and solutions associated with outbreak response and share it broadly to allow others to learn from these experiences in order to improve global outbreak response capabilities.