Center for Health Security researchers in NEJM: DRC Ebola outbreak at risk of spiraling out of control without CDC personnel on the ground, more investments in WHO

November 28, 2018 – Successful containment of the ongoing Ebola virus disease outbreak in the Democratic Republic of the Congo (DRC) hinges on the return to the region of US Centers for Disease Control and Prevention (CDC) personnel and an immediate ramping up of international financial commitments to the World Health Organization (WHO), write two Johns Hopkins Center for Health Security researchers in an article in the New England Journal of Medicine.

The article, “Ramping Up the Response to Ebola,” by Jennifer Nuzzo, DrPH, and Tom Inglesby, MD, was published Nov. 28. Nuzzo is a senior scholar at the Center; Inglesby is the Center’s director.

“Though there are risks in sending additional personnel to the DRC, high risks would also be posed by an outbreak spiraling out of control,” write the authors. “Unchecked, it could threaten the health and stability of neighboring countries. . . . Such spread would lead to travel, trade, economic, and security implications reaching far beyond the region, which would exacerbate the toll of the outbreak and increase the cost of response.”

CDC’s director reiterated concerns about security in the region at a recent event hosted by the Center on Capitol Hill to provide congressional staffers an update on US response. Though CDC has the requisite experience in managing Ebola outbreaks, the agency’s personnel were pulled back from the field by the US Department of State earlier this fall. More than 80 CDC personnel continue to help with the response, spread among the DRC Ministry of Health and the ministries of health in neighboring countries to work on preparedness and surveillance efforts. CDC also has personnel coordinating with the WHO in Geneva. But CDC staff still are not currently present in the areas where virus transmission is occurring.

Nuzzo and Inglesby say the US government ought to make security arrangements that would allow CDC staff to return to the field for as long as the WHO and fellow response agencies deem necessary. Circumstances are exigent: “If we do not act now,” write the authors, “the outbreak may become far harder and more expensive to stop.” If the virus spreads beyond the DRC, the United States would likely be forced to send personnel to the affected areas.

As of Nov. 24, the WHO reported 365 confirmed cases of Ebola virus disease and 189 confirmed deaths.

The outbreak is concentrated in the heavily populated provinces of North Kivu and Ituri, which are located along the DRC’s border with Uganda, Rwanda, and South Sudan. The provinces are experiencing “intense insecurity and a worsening humanitarian context, with over one million internally displaced people and continuous movement of refugees to neighboring countries,” according to the latest WHO situation report. Containment is being hindered by the struggle to identify and monitor contacts of known Ebola cases and rapidly isolate anyone who develops symptoms. This full and complete contact tracing is also necessary to support Ebola vaccination efforts. Those and other challenges have this Ebola outbreak on track to become the DRC’s largest in recorded history.

That’s why Nuzzo and Inglesby argue the international community should act now, despite the absence of a formal Public Health Emergency of International Concern (PHEIC) declaration. The WHO declined to declare a PHEIC during its emergency committee meeting in October.

“The United States and other countries [have] made investments to help reform the WHO to enable it to play a more operational and coordinating role during epidemics,” write Nuzzo and Inglesby. “But the WHO, the DRC, and local partners won’t be able to succeed without sufficient human and financial resources.”

They note that the WHO remains dependent on international support, both technical and financial. Its Contingency Fund for Emergencies—funding for responses to disease and other crises—has received from member states less than a third of its $100 million annual target. The WHO’s response to the DRC Ebola outbreak alone will cost an estimated $44 million.

Their full article is available nejm.org.

About the Johns Hopkins Center for Health Security:
The Johns Hopkins Center for Health Security works to protect people from epidemics and disasters and build resilient communities through innovative scholarship, engagement, and research that strengthens the organizations, systems, policies, and programs essential to preventing and responding to public health crises. The Center is part of the Johns Hopkins Bloomberg School of Public Health and is located in Baltimore, MD.