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Updated April 2, 2019
Ebola Outbreak: Democratic Republic of Congo
Congress has provided funds to prevent, detect, and respond
As of March 31, 2019, WHO reported 1,089 Ebola cases,
to infectious disease threats, including those with pandemic
including 679 deaths. Observers are concerned that the
potential like Ebola. From FY2014 through FY2018,
outbreak could spread to Goma, the capital of North Kivu, a
Congress provided annually $72.5 million to the U.S.
city of over 1 million people that is also an operational hub
Agency for International Development (USAID) for such
for the United Nations (U.N.) peacekeeping mission and
efforts and increased funding to $100 million in FY2019.
international relief efforts in DRC, or to neighboring
From FY2015 to FY2017, Congress appropriated annually
countries. While Uganda (which borders the most affected
$55.1 million to the U.S. Centers for Disease Control and
areas in DRC) has prior experience in Ebola control,
Prevention (CDC); in FY2018 and FY2019, it provided
Rwanda and Burundi do not. South Sudan’s current
$108.2 million; and from FY2008 through FY2020, it
minimal state capacity and protracted armed conflict
authorized an additional $50 million for global health
suggest a coordinated disease control response would be
security efforts. The Trump Administration’s FY2020
highly challenging.
budget request included $90 million and $100 million for
USAID and CDC global health security programs,
International and U.S. Responses
respectively. In FY2015, Congress also provided over $5
Confirmed Ebola cases are being treated with experimental
billion in emergency funds for domestic and global efforts
Ebola therapeutics in Ebola Treatment Centers (ETCs). As
to contain the 2014-2015 West Africa Ebola outbreak (P.L.
of March 26, 2019, 324 patients had recovered and been
113-235). Some unspent funds have been used to contain
discharged. As of March 23, 2019, roughly 96,000 people
two Ebola outbreaks in DRC since 2018.
had been vaccinated, including 27,000 health workers
(HWs) and front-line workers (FLWs) in the outbreak zone
On August 1, 2018, the World Health Organization (WHO)
and over 15,000 HWs and FLWs in Goma, South Sudan,
reported a new Ebola outbreak in eastern DRC, about a
and Uganda. Plans are underway to vaccinate HWs and
week after declaring that a separate outbreak had ended in
FLWs in Burundi and Rwanda. The WHO has conducted
western DRC. The ongoing Ebola outbreak—the 10th to be
readiness assessments in neighboring countries, and the
documented in DRC—is the largest in the country’s history
U.N. Central Emergency Response Fund has contributed
and has continued to spread (Figure 1). It is occurring in
$10 million toward regional Ebola control and preparedness
North Kivu and Ituri provinces, where a protracted conflict
efforts. In February 2019, WHO called for $148 million to
has caused a long-running humanitarian crisis: as of mid-
contain the outbreak within six months. As of March 19,
2018, 4.3 million people were in need of humanitarian aid.
2019, $74 million had been received.
In addition to classic public health response tools
When the outbreak began, USAID and CDC deployed staff
(surveillance, contact tracing, isolation, and safe burials),
to DRC and the region. In October 2018, USAID
health workers (HWs) are using an investigational vaccine
announced it had deployed a Disaster Assistance Response
to counter the spread of disease. Unpredictable armed
Team (DART) to coordinate the U.S. government response
conflict and intermittent community resistance to these
in support of the Ministry of Health (MoH), WHO, and
efforts are hindering all aspects of outbreak control.
other international partners. The United States, more
Figure 1. Ebola Virus Outbreaks in DRC: 1976-2019
broadly, is the top bilateral humanitarian donor to DRC and
the top financial contributor to the U.N. peacekeeping
operation there, which has provided “life-saving logistics
support to the Ebola response” in North Kivu and Ituri,
according to U.S. officials. U.S. support for outbreak
control also includes the following:
USAID: USAID is supporting nongovernmental
organizations (NGOs), U.N. agencies, and other partners
for Ebola response in DRC and Ebola preparedness in
neighboring countries. USAID funds are supporting disease
surveillance, infection protection and control, risk
communication and community engagement, safe and
dignified burials, water and sanitation aid, and
prepositioning of medical supplies.
CDC: CDC personnel provide direct support to the MoH,
WHO, and the DART and are supporting disease
Source: CRS graphic, based on WHO data.
surveillance, contact tracing, data management, infection
protection and control, risk communication and community
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Ebola Outbreak: Democratic Republic of Congo
engagement, laboratory strengthening, emergency
confirmed Ebola cases reported having visited a health
management, and surveillance at points of entry. CDC staff
center before developing symptoms, suggesting they may
are also supporting Ebola preparedness efforts in Rwanda,
have been exposed to the virus at the facility. The MoH,
Uganda, and South Sudan.
WHO, and other partners have identified health facilities of
concern and are addressing lapses around triage, case
Department of Defense (DOD): DOD has supplied
detection, and infection prevention and control.
laboratory training to Ugandan researchers and has
partnered with them to conduct clinical trials of Ebola
Early symptoms of Ebola and malaria are similar, and a
vaccines.
spike in malaria cases in and around Beni City has
compounded pressure on its health facilities and ETCs. A
Challenges
January 2019 WHO report indicated that up to 50% of
Insecurity. Ebola cases have been concentrated in North
people screened in ETCs had malaria. In November 2018,
Kivu, a site of armed conflict since the 1990s. Dozens of
the DRC National Malaria Control Program, supported by
armed groups are active in the most heavily affected area,
WHO, the United Nations Children’s Fund (UNICEF), the
including the Allied Democratic Forces (ADF), a nebulous
Global Fund, and the U.S. President’s Malaria Initiative,
organization implicated in attacks on U.N. peacekeepers,
launched a prevention and treatment campaign to curb
local military forces, and civilians. Elements of the state
malaria deaths and reduce pressure on the health system.
security forces reportedly maintain ties with armed groups
and have been implicated in serious abuses. Road travel is
Outlook
often dangerous, with frequent reports of militia attacks,
The ongoing Ebola outbreak is in its ninth month, and
armed robbery, and kidnappings.
control efforts have shown mixed results. Recent days have
seen a spike in new cases, many of which are occurring
Fear and misinformation have prompted community
outside known transmission chains. Insecurity in North
resistance to Ebola control efforts. Health workers and
Kivu has disrupted response activities, raising questions
facilities have repeatedly been attacked, and community
about how to carry out disease control in unsafe settings.
resistance to conducting safe burials has hindered
Protracted conflict in Pakistan and Afghanistan, for
containment efforts. Political unrest related to DRC’s
example, has stymied global polio eradication efforts, while
national elections in December 2018 also posed challenges.
political instability in Venezuela has contributed to the
The DRC government postponed voting in opposition-
resurgence of malaria in the country, imperiling the rest of
leaning Beni and Butembo districts, citing risks of
the region.
contagion (a decision many viewed as politically
motivated)), which spurred protesters to ransack and burn
Political instability aside, the inability to control disease
down part of an ETC in Beni.
outbreaks is largely a symptom of weak domestic health
systems. To address this challenge and improve countries’
The U.S. government has placed constraints on the
ability to prevent, detect, and respond to infectious disease
movement of U.S. personnel due to security threats. In
threats, the United States and WHO co-launched the Global
September, USAID and CDC withdrew their personnel
Health Security Agenda (GHSA) in 2014. The United
from the outbreak zone pursuant to security concerns,
despite CDC’s stated
States, the largest donor to this multilateral effort, pledged
preference to maintain staff in the
to support it with $1 billion from FY2015 through FY2019.
field. U.S. personnel continue to provide technical
The emergency appropriations that have been used in
assistance from the capital, Kinshasa, from Goma (as of
support of GHSA and to control the ongoing Ebola
early 2019), and from neighboring Rwanda and Uganda,
outbreak are expected to be largely expended by the end of
while implementing partners (WHO and NGOs) are
FY2019. The Trump Administration has signaled support
continuing Ebola control efforts with U.S. resources.
for continuing the GHSA, has requested $90 million under
Health System Constraints. Low health worker density,
the USAID Global Health Programs (GHP) account, and
low health spending, and prolonged conflict have weakened
sought $100 million through CDC for related efforts in
DRC’s health system and hindered Ebola control efforts. A
FY2020.
ratio of at least 2.3 health workers per 1,000 people is often
In the 115th Congress, H.R. 7290, Global Health Security
used as a proxy for measuring minimum health delivery
Act of 2018, would have codified an Obama-era executive
capacity in a given country. According to the latest
order setting out agency roles in supporting the GHSA. In
available data from WHO, DRC had roughly 1.1 health
the 116th Congress, H.R. 826 would seek to facilitate
workers per 1,000 people as of 2009. WHO reported that as
research and treatment of neglected tropical diseases,
of 2015 (latest available), health spending accounted for 5%
including Ebola. Members may continue to debate what
of government spending, which would amount to roughly
role, if any, the United States should play in supporting
$3.30 per capita, one of the lowest rates in the world.
global health system strengthening efforts to bolster global
The WHO suggests that Ebola transmission may be
health security and whether to adjust funding levels to meet
occurring in ill-equipped, untrained, and/or understaffed
ongoing and looming infectious disease threats.
health facilities. Inconsistent adherence to infection
prevention and control, periodic disruptions in the personal
Tiaji Salaam-Blyther, Specialist in Global Health
protection equipment supply chain, and limited access to
Alexis Arieff, Specialist in African Affairs
water for handwashing in some health facilities is putting
IF11100
health workers and patients at risk. As of March 26, 2019,
78 health workers had contracted Ebola, 27 of whom died.
From December 1, 2018, through January 28, 2019, 18% of
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Ebola Outbreak: Democratic Republic of Congo
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https://crsreports.congress.gov | IF11100 · VERSION 3 · UPDATED