Congolese health worker administers Ebola vaccine to a woman who had contact with an Ebola sufferer in the village of Mangina in North Kivu province of the Democratic Republic of Congo, August 18, 2018.
(photo credit: OLIVIA ACLAND/REUTERS)
Ebola Virus Disease (EVD) outbreaks in the Democratic Republic of Congo (DRC) are not new. In total, there have been 10 EVD outbreaks in the DRC. The first occurred in the Yambuku Region in 1976. The most recent occurred in the Bikoro Region in 2018. None of these EVD outbreaks rose to the level of a public health emergency of international concern.
However, some experts argue that the ongoing EVD outbreak in the greater North Kivu Region is different. In their eyes, this outbreak not only poses an acute public health risk for the DRC. It also poses an acute public health risk for other states. For this reason, they argue that it should be declared a public health emergency of international concern.
One factor that concerns experts is the scale of transmission. Prior to the North Kivu Province outbreak, the Équateur Province Outbreak (1976), Kwilu Province Outbreak (1995), and the Kasai Occidental Province Outbreak (2007) marked the most severe EVD outbreaks in the history of the DRC. These outbreaks resulted in 318, 315 and 264 reported cases, respectively. The North Kivu Province Outbreak has already exceeded these numbers. At last count, there are 366 reported cases. This not only makes it the most severe EVD outbreak in the history of the DRC, it also makes it the third most severe EVD outbreak in the history of the world.
Another factor that concerns experts is the proximity to shared borders. The current outbreak is located at the shared borders of the DRC, Rwanda and Uganda. Every day, thousands of people cross these borders. Some cross at formal border points. Others cross at informal border points. These crossings provide a possible pathway for the exportation of EVD to neighboring countries. Rwandan and Ugandan authorities appear to recognize this risk. They have increased EVD surveillance and detection along their shared borders with North Kivu Province. Unfortunately, similar measures have failed in the past. Most spectacularly, EVD was exported from Guinea into Liberia and Sierra Leone during the West Africa Outbreak (2014-2015). This was despite increased surveillance and detection along their shared borders. These failures led to simultaneous multi-country outbreaks that claimed the lives of 4,810 people in Liberia and 3,956 people in Sierra Leone. Far more than the 2,544 deaths in Guinea.
Yet another of the factors that concerns experts is that disease transmission is occurring within an active conflict zone. Peace in North Kivu Province has proved elusive since the end of the Second Congo War (1998-2003). Although it is difficult to estimate how many people have been killed as a result of the violence that has been carried out in the province over the past 15 years, some experts claim that there have been 764 violent deaths so far this year. Many residents have not stayed to find out if they’ll be next. They have fled in staggering numbers. Last year, the United Nations reported that 1,150,000 persons were displaced in North Kivu province. Almost half were newly displaced. Unfortunately, the current outbreak has neither reached a ceasefire nor brought an end to the displacements. Who knows what the future will bring? Maybe North Kivu will become the next Aceh? Right now, that seems unlikely. The province is a war zone just ask the UN peacekeeping force. Last week, eight of its soldiers were killed near the epicenter of the outbreak.
The North Kivu Province outbreak is testing the boundaries of what counts as a public health emergency of international concern. Although there is general consensus that this severe EVD outbreak within an active conflict zone along international borders far from major logistical hubs poses an extreme challenge for public health workers, there is no consensus over whether the North Kivu Province outbreak should be declared a public health emergency of international concern. This is not because of disagreements over whether the current outbreak constitutes a public health risk to other states through the international spread of disease. Most experts would concede that point. Instead, it is because there are widespread disagreements over whether the current outbreak constitutes an extraordinary event that demands a coordinated international response. The current outbreak clearly poses an immediate threat to people in the region, but it is not obvious that it poses an immediate danger to people worldwide. For some experts, that is the ultimate criterion upon which the case rests, and it probably should be. Otherwise, we run the risk of over-securitizing outbreak response.
The writer is a visiting scholar at The Johns Hopkins University. His research examines congressional oversight of overseas military operations. This includes Operation United Assistance. A former foreign correspondent and policy wonk, his work has appeared in dozens of international news outlets and think tank publications over the past decade. Most recently, these include the Center for Strategic and International Studies, National Bureau of Asian Research, and Royal African Society.
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