Why has the Ebola epidemic returned? Are there lessons to be learned?

The recent Ebola epidemic in conflict-stricken Eastern Democratic Republic of Congo (DRC) seems to have reached its apex, and transmission rates are easing downwards. Still, the epidemic so far has claimed 2,500 victims and there are still risks of contamination across borders to neighbouring Uganda, Rwanda and Burundi. So, it is perhaps too early to call victory, but not too early to assess what has worked well and where there is scope for improvement so as to better prevent and respond to future outbreaks.

This, of course, is a story we have seen before. The last major outbreak of Ebola in Western Africa, which began in 2014 and captured the world’s attention, claimed 11,000 lives. It was the deadliest outbreak of the Ebola virus ever. The few cases of Ebola in the US and Europe were enough to send shock waves through the political systems. Beyond the human toll, the direct response costs reached a staggering $4bn, and Liberia, Sierra Leone and Guinea struggled for years to recover growth and investments lost. As severe as the economic and human consequences were, they could have been worse still. Had the Nigerian oil industry been shuttered, as was almost the case when Ebola cases briefly crossed into Nigeria, estimates suggest it could have cost the African economy 1% of GDP, amounting to $22bn.

A clear promise was made at the time: never again. Community resilience including basic health care should be improved. As a virus knows no borders, countries at risk should seek cooperation and work towards both internal and external reconciliation. Donors should align their funding to reduce vulnerability, vaccines should be developed and emergency response capacities should be enhanced.

Why, then, has there been yet another deadly outbreak? In part this is a consequence of the state of affairs in the DRC. The east of the DRC is an area subject to abject poverty, incessant conflict and plundering of natural resources. The government – which is based some 2,500 kilometres away in Kinshasa – distantly observes, if not outright condones, the corrupt and predatory behaviour. Illegal mining and smuggling of precious metals is rampant, while armed non-state actors continue to forcefully displace populations while playing cat and mouse with MONUSCO, the UN-sponsored stabilisation force. With famine widespread, and child mortality among the highest in the world, humanitarians are overwhelmed in the face of political corruption and economic plight. In sum, this is the kind of place where an epidemic like Ebola invites itself into the homes with the greatest ease and can push already strained communities into the abyss.

What, then, has the international community learned from past experiences? What changes can be made still? Let’s start with the positive: improvements have been made making a difference in the fight against the Ebola disease.

First, national authorities focused on early detection and recognised the first signs of outbreak as a serious concern requiring immediate international action. Emergency teams were deployed faster, and, to its credit, the World Health Organization (WHO) – having streamlined its command lines and improved its cooperation with international rescue services like MSF, ALIMA, IMC and others – was able to mobilise quickly.

That is not to say everything went smoothly. Cultural and ethnic barriers were not anticipated. The teams flown in from West Africa were met with rejection and forcefully attacked by locals as they turned up in spacesuits and packed corpses into black plastic burial bags – where the family could not see the victim’s face, as required by their religion. Precious weeks were lost.

Second, with the help of EU and US financing, the vaccines that were developed and deployed have proven effective. At least two out of four molecules are able to target the Ebola Zaïre strand. 250,000 doses have been administered in order to contain infected or at-risk groups from spreading the virus further. However, again the picture is mixed and successes were met by setbacks. Laboratories were in short supply, and donors reluctant to deploy in the face of security concerns. Occasionally the supply chain for vaccines and blood samples was broken, and contaminated samples were moving across the country without adequate safeguards.

Third, the epidemic was recognised as a multisector crisis, requiring a multisector approach. Health is not an isolated issue, but can be delivered only if there is logistics, protection and security, adequate food and clean water, as well as community engagement and outreach in place. This time around all relevant agencies did an excellent job in mobilising up front and responding quickly.

Fourth, neighbouring countries were alerted in real time and their preparedness fine-tuned. Authorities avoided excessive overreactions in the form of borders closings; screenings detected potential infections while allowing essential crossings. Several cases have been caught at or close to the border; thereby preventing the spread of the disease to Uganda, Rwanda and Burundi. A scary repeat of the scenario in the last outbreak in West Africa, where tens of thousands of health workers in Nigeria were deployed to track down four to five infected individuals and all their contacts, has so far been avoided.

Still, despite the successes and improvements, taking a helicopter view of the countries concerned as well as of the international donor community, not least the EU and its member states, the conclusion is clear: not enough has been invested in reducing the underlying risks and preventing health calamities. This in spite of the simple fact that it is much cheaper in terms of cost and more effective in terms of lives saved to act earlier than to start throwing money around after an epidemic has already gathered speed.

The fact remains that the risk of new infections remains unacceptably high and major outbreaks will continue to occur as long as these communities and countries remain unstable. Over the last decade the DRC alone has experienced ten Ebola outbreaks of one kind or another, each with a potential to spread beyond the region even into North Africa and Europe.

Three lines of action must be at the centre of the national development plans and supported by international donors:

First, good governance and security must be promoted, particularly in regions suffering from endemic conflict and vulnerability. This is a vast challenge, extending into every realm of society, from institutions, land ownership, literacy, law enforcement and the like. Once these parameters are met, then basic services can be delivered and private investment can boost growth and build infrastructure. The best survival strategy of any national leadership is to deliver on these basic public goods.

Second, the basic services in the health area must be part and parcel of any national development plan. This does not necessarily require high quality doctors in every village, but rather a network of basic health clinics deployed across the geography first and foremost to prevent and cure disease among the population, but also in the context of epidemics to heed the warning signals early enough to allow for an effective and timely response. Even in West Africa, in countries devastated by the 2014 Ebola outbreak, these standards have not yet been met. We can do better.

Third, the response capacity of the international system must still be improved. The UN agencies – lead by the WHO – must structure its partnership with NGO actors, and run drills and simulations to ensure that deployment is smooth once pandemics hit. The member states, donors from Europe and North America, and other international organisations and NGOs must not only spend money but also develop their capacity to deploy doctors and medical teams at short notice. In Europe, the European Centre of Disease control should include mechanisms and resources for immediate detachment to the field, and the so-called white helmets under the European Union’s Civil Protection service must be capable of deploying staff at short notice and in sufficient numbers.

It is encouraging that incoming European Commission President Ursula von der Leyen seems to have her eyes on this issue. A deep partnership with Africa is critical both to protect African and European citizens alike.