A rapidly unfolding Ebola crisis in the Democratic Republic of the Congo is a reminder of the value of maintaining robust global disease surveillance and response systems — and the dire consequences of weakening them.
The outbreak came to the public’s attention just days ago, but by Tuesday had grown to more than 500 suspected cases and 130 suspected deaths. Several of those cases were imported to neighboring Uganda, and a handful have been reported in urban centers — an alarming escalation for a highly contagious virus known to kill anywhere from 25 percent to 50 percent of those it infects.
Although the epidemic is occurring in a region with plenty of experience with Ebola, several factors have raised the stakes. The long lag in detecting the virus allowed it to spread for weeks unchecked. There are no approved vaccines or treatments for the strain of Ebola, called Bundibugyo virus, driving the spread. The already challenging project of containing the outbreak has also been complicated by the last year of cuts by the US to global health infrastructure.
Illustration: Louise Ting
It has all the ingredients of a disaster — one that seems likely to get much worse.
That is because the virus has a dangerous lead over public health officials. By the time the outbreak was on the WHO’s radar, it had already grown to hundreds of suspected cases and dozens of deaths. The scale and speed of the epidemic prompted WHO Director-General Tedros Adhanom Ghebreyesus to take the unprecedented step on Sunday of declaring a public health emergency without first assembling a panel of advisers.
To be fair, some degree of delay was likely inevitable. The outbreak began in a mining region rife with conflict, which can make it difficult to launch a fast public health response.
Moreover, health workers on the ground initially were using a test that could only pick up a strain of Ebola known as the Zaire virus, which had driven earlier outbreaks.
Still, it is hard not to see that long lag as a symptom of a weakened global health infrastructure. “How you get to 300 cases and 80 deaths, and not even a ProMED about it, is just astounding,” said Daniel Jernigan, referring to the early warning system that was the first to alert the world to mysterious flu cases surfacing in China in late 2019. Jernigan, a former director of the Centers for Disease Control’s (CDC) National Center for Emerging and Zoonotic Infectious Diseases, also served as the agency’s Ebola response team lead in Sierra Leone in 2014.
The CDC benefited from ears on the ground during that outbreak, which began in late 2013 and grew to more than 28,000 cases and 11,000 deaths. Some were CDC staff, others were contractors or physicians at partner organizations like USAID.
That “soft” surveillance network would call health agencies when something unusual happened, like a cluster of unexplained deaths, Jernigan said. If the situation turned serious, that group, particularly USAID staffers, also could step in to help, whether with logistics or providing care.
However, last year, the now-disbanded US Department of Government Efficiency (DOGE) took a wrecking ball to that network. USAID was shut down practically overnight, which led to Ebola-prevention funding being “accidentally” canceled, as Elon Musk cavalierly noted. Musk at the time claimed it had been restored, but ultimately the health infrastructure was dismantled. Meanwhile, the CDC faced its own steep cuts, and the US — which had long been the WHO’s top funder — withdrew from the organization entirely.
While it is too early to directly blame those cuts for the late detection of the current outbreak, one thing is certain: The decimation of USAID and the US’ exit from the WHO would make containing the spread much more difficult.
The medical field already has a clear playbook for addressing an Ebola outbreak: Quickly identify and isolate anyone infected, conduct extensive contact tracing, protect healthcare workers and ensure safe burials. Accomplishing all that, however, requires much more than rote logistics.
Responding to an Ebola outbreak “depends on relationships, local knowledge, trained workforces, laboratories, logistics systems and trust that are built over years,” said Krutika Kuppalli, an infectious disease doctor who was medical director for an Ebola treatment center in Sierra Leone amid the 2014 West Africa outbreak. “A rapid withdrawal of support can disrupt those systems and damage trust with communities and partners at exactly the moment when cooperation is essential.”
The earlier outbreak made clear that you cannot just “come in as a bunch of outsiders in full PPE and expect the community to just go along,” Jernigan said. Without respectful engagement, fear, stigma and misinformation can drive transmission underground, Kuppalli added.
One bright spot amid all of this is the speed at which global health players are mobilizing to stamp out the virus.
On Tuesday, the WHO said it was exploring whether candidate vaccines or treatments might be useful against Bundibugyo virus. Nature had previously reported that the global health agency was planning clinical studies of treatments.
Those efforts are encouraging. However, coordinating, paying for and — most critically — enrolling volunteers in those trials would be made harder by the US’ global health cuts. That could mean a slower path to answers — and more lives lost.
This outbreak might not have been avoidable, but it did not have to be this deadly, either. More disturbing is that this is only the first of surely many future outbreaks where the US’ turn inward would have terrible implications for global health.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, healthcare and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News. This column reflects the personal views of the author and does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
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