While Ebola outbreak ends in eastern DRC, WHO says no room for complacency

MANILA — After almost two years, the Ebola outbreak in eastern Congo is finally over. But the continuing outbreak in Equateur province and the ongoing coronavirus pandemic continue to pose threats to health security in the country, region, and the rest of the world.

The government of the Democratic Republic of the Congo declared the end of the Ebola outbreak in North Kivu province on Thursday. The outbreak, which started on August 1, 2018, was the second-largest Ebola outbreak and claimed the lives of 2,287 people. Response to the outbreak was characterized from the start by numerous challenges and controversies, and it had been disrupted several times because of conflict and violence.

The World Health Organization had intended to declare the end of the region’s outbreak in April, but this was halted after new cases were reported just a few days before the scheduled announcement.

“It wasn’t easy, and at times it seemed like a ‘mission impossible,’” said Matshidiso Moeti, WHO regional director for Africa, referring to the response launched to end the outbreak.

“Ending this Ebola outbreak is a sign of hope for the region and for the world — that with solidarity and science, and courage and commitment, even the most challenging epidemics can be controlled,” she said.

The outbreak has allowed the government and multiple stakeholders to build the response capacity of DRC and neighboring countries to manage emergencies, Moeti said. In place now are coordination mechanisms, surveillance platforms, screening at point of entry, contract-tracing strategies, isolation facilities, and some of the best practices in engaging and enabling communities to be part of a response effort.

These will be tested as the DRC battles a fresh Ebola outbreak in Equateur province and the global pandemic.

To date, 23 cases have been reported in the new Equateur outbreak, with 13 deaths across five health zones, according to the latest bulletin published by the WHO African region. The fatality rate among confirmed cases is high at 57%.

DRC Health Minister Eteni Longondo said during a press briefing Thursday that the main difficulty the country is facing with the new outbreak — the 11th in DRC’s history — is its spread. The outbreak started in Mbandaka but has now expanded to four other health zones.

Unlike in earlier outbreaks, though, the availability of an Ebola vaccine is a critical component of the latest response, the minister said. This, combined with a highly engaged population in Mbandaka that is helping run awareness campaigns about the disease, makes the battle against Ebola less daunting, he said.

“Thanks to this, the fight will be easier. But the disease is migrating. So we're currently developing strategies to counter the expansion of the disease in other regions,” he said.

The outbreak in Equateur province takes place against the backdrop of a larger outbreak of COVID-19. The coronavirus has affected countries at all income levels, and cases have started to increase in the African continent, with over 337,000 cases and 8,800 deaths. WHO’s Moeti said that this week, “Africa is no longer the WHO region least-affected by COVID-19.”

Some countries appear to be more heavily affected than others. In the past week, Moeti said, 10 of 47 countries in the region accounted for 89% of new cases and five nations accounted for 80% of new deaths. In some African countries, more than 5% of infections were among health care workers. Supplies of personal protective equipment and test kits are limited, she also said.

Lessons from Ebola and COVID-19

Moeti identified three key lessons from the Ebola and coronavirus outbreaks. One is the need to engage, work with, and enable communities to be empowered and play a role in the response. The second is how to innovate in the middle of a pandemic, while the third is the importance of investing in health systems when there are no ongoing outbreaks.

Longondo, the DRC health minister, said that despite the declaration of the end to the Ebola outbreak in eastern Congo, the government and partners will make sure to conduct follow-up checks and continue to strengthen capacities in communities.

That was lacking in Equateur province after its Ebola outbreak in 2018, he said, as the government and partners scrambled to respond to the outbreak in North Kivu.

“So we'll now make sure that local communities have enough capacity to properly monitor the situation in the eastern part of the country and in Mbandaka,” he said.

WHO Director-General Tedros Adhanom Ghebreyesus said that while it is worth celebrating the outbreak’s end, “we must resist complacency.”

He said that “viruses do not take breaks,” noting the potential of case flare-ups.