World Health Organization (WHO)

The world could learn from Taiwan’s success in responding to the coronavirus pandemic, yet it doesn’t have a seat at the World Health Organization.

A new coronavirus that originated in China has spread worldwide, sickening hundreds of thousands and halting economic activity. Many countries have imposed unprecedented measures to stop local outbreaks.

Officials from Democratic Republic of the Congo (DRC) and the World Health Organization (WHO) announced that the last Ebola patient has been discharged from a hospital in Beni. The patient’s discharge follows two weeks in which no new cases of Ebola have been reported. However, forty-six of those that had been in contact with the last Ebola patient remain in quarantine. Once there has been no new cases for forty-two days, the outbreak can be officially declared over. This threshold has already been met in certain areas, which are now “non-active zones.” The current Ebola outbreak in the eastern DRC started in August 2018. Some 3,300 fell ill from the virus and about two-thirds of those died. There have been ten outbreaks total since the disease emerged in 1976. The Eastern Congo outbreak was the second-deadliest, with the first being the 2014–2016 Ebola outbreak in West Africa, during which 28,652 people contracted the disease and 11,325 died from it.  The Eastern Congo outbreak was the first time Ebola emerged in a war zone. Fighting the disease was especially difficult given the high levels of distrust among the local population of officials from the government or international organizations, and the poor security situation. Hence, the apparent end of the current Ebola outbreak is a major achievement of the international organizations, non-governmental organizations, and Congolese authorities.  While there are experimental vaccines and pharmaceutical treatments, there was no “silver bullet” that ensured success. It appears to have been overcome through a slog involving quarantining the sick, tracing the contacts of those with the disease, the rigorous application of hygiene, especially hand-washing, and the use of protective clothing.  Success against Ebola gives hope that the eastern Congo will respond well against the new threat of the new coronavirus. DRC was one of twelve other countries identified as most at risk of coronavirus because of its close travel links with China. Officials from the UN Population Fund commented that eastern Congo may be better prepared against coronavirus because of the procedures learned from Ebola. After all, measures such as quarantine, contact-tracing, and hygiene are applicable to both diseases. 

The WHO’s weak response to China’s mishandling of the COVID-19 outbreak has laundered China’s image at the expense of the WHO’s credibility. The time is ripe for clear leadership from the WHO based on science not politics.

The number of cases of Ebola in the eastern Congo continues to fall, and there had been speculation that the World Health Organization’s Emergency Committee would remove the designation of Public Health Emergency of International Concern (PHEIC) from the outbreak. However, at its February 12 meeting, the Committee voted unanimously to keep the designation. The original designation was made on July 17, 2019.  In its report, the committee put the Ebola risk as high at the national and regional levels, but low at the global level. The committee noted that sustained progress is dependent on improvement in the security situation, and security incidents had actually increased in recent months. The poor security situation and deep distrust of outsiders by locals has made this Ebola outbreak particularly difficult to tackle. The meeting also noted that outbreaks of other infectious diseases, notably measles and cholera, continue in the Democratic Republic of Congo and merit international attention and support. From the beginning of the current outbreak to February 10, the WHO states 3,308 confirmed and probable Ebola cases in eastern Congo, and that 2,253 people had died, about two-thirds. The WHO estimates the death rate from the coronavirus is about 2 percent, but cautions that it is too early to be definitive. Nevertheless, it is clear that Ebola is vastly more deadly, if still largely confined to eastern Congo. 

International attention—and panic—are focused on the coronavirus. In Africa, observers are acutely aware of how ill-prepared most countries are for responding to a major pandemic. With more than a billion people undergoing rapid urbanization, stuck with weak healthcare systems, and with growing economic ties to China (it is estimated that there are more than a million Chinese immigrants on the continent) Africa would appear to be highly vulnerable to the spread of the coronavirus. Ethiopian Airlines continues its China service, and some 1,500 passengers arrive in Addis from China every day, many of whom transit to other African destinations. Yet, as of February 12, there have been no reported cased of the disease in Africa. Nor have there been any cases in South America.  It may be that the virus is present but thus far has been undetected. Africa’s weak medical infrastructure makes detection of mild forms of the disease especially difficult. There may be other factors at play specific to the virus. For example, there has been media speculation that the continent’s hot and humid climate is inhospitable to the disease. On the other hand, there are many parts of Africa where the climate is temperate, and two major international airports—Johannesburg and Addis—which both serve cities of about 8 million each, including a significant slum population, enjoy cool, dry climates. Still, neither city has reported any cases of corona virus. Ebola appears to be much more deadly than coronavirus, but it has been concentrated in eastern Congo. The disease has killed some 2,300 people since 2018, with death rates of those who contract Ebola often over 50 percent. Coronavirus has thus far killed 1,107 worldwide as of February 12, with about 2 percent of those who contract the virus dying. The World Health Organization (WHO) is cautiously optimistic about Ebola, and its Emergency Committee will meet soon to discuss whether the disease still constitutes a global health emergency. That is good news.

The virus appears to be less dangerous than SARS, but there are still concerns of a wider outbreak in Asia.

On September 8, a woman in her mid-thirties died in Tanzania of apparently Ebola-like symptoms. Tanzanian health officials conducted an autopsy, but ruled that Ebola was not the cause of death. The problem for many, however, is that Tanzanian authorities have reportedly not been entirely forthcoming with information about the woman’s death. According to the World Health Organization, Tanzania is refusing to share test samples related to the woman’s death and other information on what could be a case of Ebola. The American and British governments have issued travel advisories for Tanzania calling for the exercise of increased caution due to health issues. American Secretary of Health and Human Services Alex Azar has also criticized the Tanzanian government for not sharing information.  Officials are right to be suspicious. Tanzanian President John Magufuli is cracking down on dissent and is restricting access to information. A new law criminalizes the distribution of information that contradicts the government. This fuels concerns about a Tanzanian cover-up of the possible presence of Ebola. Yet, if Ebola is in fact present in Tanzania, the sooner preemptive measures are taken, especially vaccination, the stronger the likelihood of controlling the outbreak.  Like other African countries, Tanzania is urbanizing rapidly. The population of Dar es Salaam, where the victim died, is estimated to be about five million. But 70 percent of its residents are estimated to live in informal communities, and it is the ninth-fasted-growing city in the world. Hence, there is concern that if Ebola spreads to urban areas, the rate of transmission will increase, as happened in Eastern Congo. Tanzania borders Uganda, which, in June, reported its first cases of Ebola, ostensibly spillover from the outbreak in Eastern Congo.   Meanwhile in Eastern Congo, Ebola continues unabated, where by mid-September there had been some three thousand cases and two thousand deaths. There are disagreements over vaccination strategies between the World Health Organization and Doctors Without Borders. Health workers continue to be attacked by armed groups and public trust in such workers is low.

In a world awash in troubles, nothing less than catastrophe will spur policymakers to forceful action on global health. Unfortunately, concerted action could come too late to prevent local crises from becoming global emergencies.

In Foreign Policy, Shannon Kellman and Mark Lagon of the Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, make the point that disease outbreaks in states with weak governance and high rates of poverty often spread to other countries. With respect to eastern Congo’s Ebola outbreak, they highlight the fact that the disease has spread out of eastern Congo to the border with Rwanda and into Uganda. The World Health Organization has designated the outbreak as a “public health emergency of international concern.”  Disease outbreaks like Ebola also exacerbate other health issues in weak states; in Congo’s North Kivu province where the Ebola outbreak started, they cite an eight-fold increase in the incidence malaria. In addition to Ebola, eastern Congo faces myriad other issues, including endemic militia activity that is often hostile to government and widespread distrust of medical professionals trying to bring Ebola under control. The authors advocate increased international health assistance to fragile states such as Congo, especially by the United States. Though the Trump administration has proposed cuts, they highlight bipartisan congressional support for global health assistance. They suggest that increased assistance has the potential to improve governance and stability in affected areas, both of which are in the interest of the United States. In fact, it is likely that U.S. funding for global health could be increased, as it was last year. The authors argue that such health crises should be seen in the context of combating state fragility, the spread of terrorism, and of improving governance.  The outbreak has become a security issue that is already affecting Congo’s neighbors. Like the Ebola epidemic in West Africa in 2014, Congo’s outbreak could lead to disruptions to international travel and trade, and its knock-on effects in health and security could threaten the stability of an already unstable region. However distant the outbreak may seem at present, its far-reaching effects are yet more reason why aggressive and substantial support for disease-fighting efforts must be advanced.  

The recent designation of Ebola as a “public health emergency of international concern” by the World Health Organization (WHO) is a positive development in efforts to contain the disease. The decision highlights the importance of containing the disease to an international audience; the WHO’s designation is being widely carried by the international media.  It will likely unlock badly needed international assistance, though WHO is careful to say that designation is not a fundraising strategy. The WHO states that it has received only $49 million in donations since February, about half of the amount it needs. Representative Karen Bass, the top Democrat on the Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations, welcomed the designation. In June, she introduced legislation to expand the amount and type of resources the U.S. is authorized to commit to fighting Ebola. Meanwhile, the pharmaceutical giant Merck has donated 195,000 doses of the apparently effective vaccine. Much more is needed, but it takes a year to produce the vaccine. There is a second vaccine, developed by Johnson and Johnson, which the WHO would like to use, but the Congolese authorities have not authorized it because of residual popular suspicion of all vaccines that has led to attacks on health workers. According to the New York Times, there are ongoing discussions between the WHO and Congolese authorities.  The WHO moved because the disease has been present for twelve months and continues to spread, most recently to Goma, a city of more than two million people on the border with Rwanda and near Uganda, raising the possibility that the disease could spread internationally. Congolese officials are reportedly concerned that international hysteria could lead to travel and trade restrictions. Given the hysteria in the United States (among other places) during the 2014 Ebola outbreak in West Africa, with calls for such restrictions, those officials’ concerns are not misplaced. Fear of disease can translate into a political cause that is easily exploitable for domestic political purposes in many countries. Thus far, the eastern Congo Ebola outbreak has infected 2,512 people, with 1,676 deaths in the twelve months of the outbreak. The eastern Congo is riddled with competition among militias for, among other things, access to minerals, resources, and tax revenue amid a breakdown of governmental and societal structures. Many people in the affected region do not trust the government in Kinshasa; anybody apparently associated with it, including health workers, can be at risk of violence. As recently as last week, two health workers were murdered in their homes.   

An outbreak in the DRC has spread to neighboring Uganda, and conflict and mistrust of health workers is impeding international efforts to contain the disease.