Ebola Outbreak: Democratic Republic of Congo

Ebola Outbreak: Democratic Republic of Congo

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Updated July 25, 2019
Ebola Outbreak: Democratic Republic of Congo
Through annual appropriations, Congress provides funds to
Organization Stabilization Mission in the Democratic
control infectious disease threats like Ebola. In FY2019,
Republic of Congo (MONUSCO).
Congress provided $100 million to the U.S. Agency for
International Development (USAID) and $108.2 million to
As of July 23, 2019, WHO reported 2,612 Ebola cases,
the U.S. Centers for Disease Control and Prevention (CDC)
including 1,756 deaths (Figure 1). Concerns about the
to global health security and pandemic preparedness. The
outbreak spreading to neighboring countries without
Trump Administration’s FY2020 budget request included
experience in Ebola control (Rwanda, Burundi, and South
$90 million and $100 million for USAID and CDC global
Sudan) are heightening. Confirmed Ebola cases are being
health security programs, respectively. Congress also
treated with experimental drugs in Ebola Treatment Centers
provided over $5 billion in emergency funds in FY2015 for
(ETCs). As of June 9, 2019, 564 people had been treated
domestic and global efforts to contain the West Africa
and discharged from ETCs. As of July 21, 2019, more than
Ebola outbreak (P.L. 113-235). Some unspent funds are
171,000 people had been vaccinated, including more than
being used to fight the Ebola outbreaks in the Democratic
31,000 health workers (HWs) and front-line workers
Republic of Congo (DRC).
(FLWs) in the outbreak zone and over 8,000 HWs and
FLWs in South Sudan, Uganda, and Rwanda. Plans are
On August 1, 2018, the World Health Organization (WHO)
underway to vaccinate HWs and FLWs in Burundi.
reported a new Ebola outbreak in eastern DRC, about a
week after declaring that a separate outbreak had ended in
International and U.S. Responses
western DRC. The ongoing Ebola outbreak—the 10th to be
DRC Government and Nationals. Underscoring the
documented in DRC—is the largest in the country’s history
Congolese role in the international Ebola response, Dr.
(Figure 1). It is occurring in North Kivu and Ituri provinces
Michael Ryan, WHO Executive Director for Health
where a protracted conflict has caused a long-running
Emergencies, stated at a June 6, 2019, press briefing that
humanitarian crisis. In addition to classic public health
“there may be non-governmental organization (NGO) or
responses (surveillance, contact tracing, isolation, and safe
WHO badges on the tents but the doctors and nurses are
burials), health workers (HWs) are using an investigational
Congolese; surveillance officers are Congolese; 80% of the
vaccine to prevent the spread of disease. Armed conflict
vaccinators in this response are Congolese.” The DRC
and intermittent community resistance to these efforts are
government response is led by the Ministry of Health
hindering all aspects of outbreak control.
(MoH) and includes providing government personnel,
hiring local first line workers, organizing volunteers, and
Figure 1. Ebola Virus Outbreaks in DRC: 1976-2019
conducting information awareness campaigns. The
government has also begun offering certain health services
free of charge in selected government health facilities.
U.N. Emergency Ebola Response Coordinator. On May
23, 2019, the U.N. Secretary-General appointed
MONUSCO Deputy Special Representative David Gressly,
a U.S. citizen, to serve as a new U.N. Emergency Ebola
Response Coordinator to strengthen coordination. While the
WHO will continue to lead all health operations and
technical support activities to the government, Gressly is
expected to lead a broader UN-wide effort to strengthen
political engagement, financial tracking, humanitarian
coordination, and preparedness and readiness planning for
the DRC and surrounding countries. Gressly will continue

to report to the head of MONUSCO and indicates his new
Source: CRS graphic, based on WHO data.
role reflects the need for “more than just a public health
In July 2019, the WHO announced the Ebola outbreak had
response.”
become a Public Health Emergency of International
Concern (PHEIC) and called for donors to address delays in
World Health Organization. The WHO is coordinating
funding. The declaration followed the identification of three
international Ebola control efforts with some 700 personnel
Ebola cases in Uganda in June 2019 and another one in the
deployed to the DRC. The WHO has also conducted
capital of North Kivu, Goma in July 2019. Goma has over 1
readiness assessments in neighboring countries. In February
million people and is an operational hub for the U.N.
2019, WHO called for $148 million to contain the outbreak
within six months. As of July 7, 2019, $109.3 million had
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Ebola Outbreak: Democratic Republic of Congo
been pledged. At a July 15 meeting on Ebola in Geneva,
Ideas that outsiders are profiting from the outbreak and that
WHO and other U.N. officials urged donors to provide
international concern is driven more by fear of contagion
additional support for Ebola control efforts. At the
than concern for locals’ well-being, appear to be fueling
conference, the United Kingdom pledged up to £50 million
conspiracy theories and community resistance. WHO
($62 million) and Italy pledged €300,000 ($338,000).
Director-General Dr. Tedros Adhanom Ghabreyesusi said
that Congolese in the outbreak zone had asked him whether
U.S. Responses. The United States is providing more than
international organizations were there to help the Congolese
any other country for the Ebola response in the DRC, as
or to prevent Ebola from spreading to their countries. Dr.
well as for humanitarian assistance and MONUSCO. As of
Tedros expressed his embarrassment and urged donors to
July 24, the United States had allocated more than $136
consider broader support for the Congo to counter this
million to Ebola control in the DRC. The Administration
perception. DRC’s Health Minister also asserted that
has placed strict constraints on U.S. personnel movement
perceptions of the response bringing cash into the region
due to security threats. U.S. personnel are providing
had fueled threats to health workers, including kidnappings.
technical support from Kinshasa, Goma, and neighboring
Health System Constraints. Perceptions among some
Rwanda and Uganda, while implementing partners (U.N.
Congolese that the infusion of Ebola resources are to
agencies and NGOs) are using U.S. resources for Ebola
protect the donors rather than to help the people of the DRC
control activities.
are also rooted in long-standing and ongoing health
Selected Challenges
challenges. Since January, for example, a measles outbreak
has killed almost 2,000 people in Ituri province. There has
U.S. Aid Restrictions Related to Trafficking in Persons.
DRC is currently ranked as “Tier III” (worst) under the
been little press discussion of this or other health issues,
such as high maternal and infant mortality, that have
Trafficking Victims Protection Act (TVPA, P.L. 106-386,
regularly killed more people than the Ebola outbreak within
as amended), which triggers prohibitions on certain U.S. aid
the same time frame. Further contributing to local
absent a full or partial presidential waiver. President Trump
frustrations, resource constraints have demanded that health
partially waived these restrictions for DRC for FY2018, but
resources in some areas be diverted to Ebola control.
not for FY2019. Thus, pursuant to the TVPA, no “non-
humanitarian, non-trade-related” assistance could be
Public health care shortfalls have also hindered Ebola
provided “to the government” of DRC. USAID’s IDA
control efforts. The WHO has reported that Ebola
account, the core source of funding for U.S. Ebola response
transmission is likely occurring in ill-equipped and
support to date, is exempt from the restriction.
understaffed health facilities. Inconsistent adherence to
infection prevention and control, periodic disruptions in
Although the TVPA indicates that support to NGOs is to be
supply chain systems, and limited access to water for
generally excluded from restrictions, in practice, the
handwashing in some health facilities have complicated
Administration has applied the prohibition to various
Ebola control efforts. In addition, some health workers have
programs funded through the Development Assistance
refused to wear personal protective equipment in health
(DA) and Economic Support Fund (ESF) accounts,
facilities or perform rudimentary infection prevention and
including some implemented by NGOs. Two bills
control measures due to threats of violence by some
introduced in the 116th Congress (S. 1340 and H.R. 3085)
members of the community. As of July 21, 2019, 140 health
would authorize the USAID Administrator to provide
assistance for Ebola control efforts, “notwithstanding any
workers had contracted Ebola. The MoH, WHO, and other
partners have identified health facilities of concern and are
other provision of law.”
addressing lapses around triage, case detection, and
infection prevention and control.
Insecurity. Security threats have hampered response efforts
by forcing temporary cessation of Ebola case management,
Outlook
interrupting contact tracing, and frustrating surveillance
One year later, the Ebola outbreak in the DRC continues to
efforts in high transmission areas. Dozens of armed groups
spread, with several new cases occurring outside known
are active in the areas most affected by the outbreak. Road
transmission chains. The 2015 Ebola emergency
travel is often dangerous, with frequent reports of militia
appropriations that are being used to fund U.S. Ebola
attacks, armed robbery, and kidnappings. State security
control efforts are expected to be mostly expended by the
force personnel reportedly maintain ties with armed groups
end of FY2019. The Trump Administration has requested
and have been implicated in abuses, including a series of
$90 million under the USAID Global Health Programs
civilian massacres in Beni since 2014.
(GHP) account and sought $100 million through CDC for
global pandemic preparedness efforts in FY2020.
Communities in Beni and Butembo have long opposed
DRC’s central government and complained of neglect and
H.R. 2166, the Global Health Security Act of 2019, would
persecution. WHO officials have urged broader
codify an Obama-era executive order setting out agency
international support for political mediation, engagement
roles in promoting global health security. Also, H.R. 826
with opposition, and negotiated solutions, asserting that
would seek to facilitate research and treatment of neglected
focusing exclusively on community engagement will not
tropical diseases, including Ebola. Members may continue
address deep-seated political issues that need to be
to debate what role, if any, the United States should play to
addressed at a higher level.
bolster global health security and whether to adjust funding
levels to address infectious disease threats.
Tiaji Salaam-Blyther, Specialist in Global Health
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Ebola Outbreak: Democratic Republic of Congo

IF11100
Alexis Arieff, Specialist in African Affairs

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