Dr. Tedros Adhanom Ghebreyesus has met with President Felix Tshisekedi and his senior advisers to discuss management of Ebola

Dr. Tedros Adhanom Ghebreyesus has met with President Felix Tshisekedi and his senior advisers this February 13, 2020, to discuss management of Ebola, which remains a public health emergency of international concern (PHEIC) following the decision to extend that status during Wednesday’s meeting in Geneva in the context of the world’s focus on new coronavirus COVID-19, the head of the World Health Organization arrived to Democratic Republic of Congo on Thursday to assess the Ebola situation and the country’s health system.

“WHO’s risk assessment is that the risk of spread is high nationally and regionally, and low globally,” Tedros said. “Nonetheless, the signs are extremely positive, and I hope that by the time the (WHO) Emergency Committee reconvenes, we will be able to declare an end to the Ebola outbreak.”

According to the latest update from Congolese health officials, there were no new fatalities on Tuesday, no new confirmed cases, and no community deaths – those that heighten risk because they occur outside of a clinic or hospital. The outbreak that began in August 2018 has claimed 2,253 lives, with a total of 3,431 cases.

Yet DR Congo is not out of the woods yet, even as new challenges emerge. “The current outbreak of COVID-19 highlights why this is so critical,” Tedros added. “Our greatest fear remains the damage this coronavirus could do in a country like DRC. Even as the flames of one outbreak begin to die down, we are fighting another fire-front.”

The Ebola-affected zones in the country’s east also remain a security concern, with the United Nations refugee agency warning Tuesday that continued attacks from armed groups have left 252 civilians dead since December, with more than 100,000 people displaced.

The Ebola virus epidemic in the Democratic Republic of the Congo (DRC) remains a public health emergency of international concern, the World Health Organization (WHO) said on Wednesday.

"The Ebola Emergency Committee has indicated that the epidemic in the Democratic Republic of the Congo remains a public health emergency of international concern, and I accepted this advice," said the Director-General of the Organization, Doctor Tedros, during a press briefing in Geneva.

"As long as there is a single case of Ebola in an area as unstable and insecure as eastern DRC, the potential for a much larger epidemic will remain," he added.

According to the WHO risk assessment, the risk of spread is high at national and regional levels, and low at global level.

"Nevertheless, the signs are extremely positive in eastern DRC, and I hope that by the time the emergency committee meets again, we will be able to declare the end of the epidemic" , said Doctor Tedros.

Strengthening a health system may not be as sexy as responding to an epidemic, but it is just as important - Dr Tedros, WHO Director-General.

The head of the WHO, while noting that we are approaching the end of this Ebola epidemic in the DRC, deemed it necessary to act now to prevent the next one.

Recalling that the Ebola epidemic killed 2,249 people, he stressed, however, that in less time, measles had killed more than 6,300 people in the DRC.

Dr Tedros argued that only half of health facilities in the DRC have access to water and stressed the relevance of having an efficient health system.

"Strengthening a health system may not be as sexy as responding to an epidemic, but it is just as important," he said.

The head of the WHO said that the current epidemic of COVID-19 highlights the reasons why the situation is so critical, saying that the greatest fear of the Organization concerns the damage that this coronavirus could cause in a countries like the DRC.

Previously, World Health Organization Director General Tedros Adhanom Ghebreyesus attends a news conference following a two-day international meeting on coronavirus vaccine research and whether Ebola in Congo still constitutes a health emergency of international concern, on Jan. 12, 2020, in Geneva

The second-biggest Ebola outbreak in history, which has upended life in eastern Congo's North Kivu and Ituri provinces since August 2018, infecting nearly 3,500 people and killing about 2,250, is down to its last chain of transmission.

Despite ongoing violence that has hampered the response from its outset, and that has spiked again recently, new cases have dwindled. At its height last May, hundreds were contracting the disease every week.

The waning of the Ebola outbreak comes as a new one captures global attention and, potentially, funding as well. Global health officials have warned that while the novel coronavirus, now known as covid-19, racks up thousands of new cases a day, the hard work of ending the Ebola outbreak and preventing another is far from over.

“Funding needs [for the Ebola response] have not as yet been fully met, and currently there is a risk there will not be funding for WHO activities beyond February,” said Margaret Harris, a World Health Organization spokeswoman.

On Wednesday, an independent committee that advises the WHO unanimously agreed the Ebola outbreak “still constitutes a public health emergency of international concern” — a designation that was recently extended to the covid-19 outbreak.

Ebola and covid-19 are vastly different viruses; Ebola can be transmitted only through exchange of bodily fluids, but it killed nearly 70 percent of those who contracted it in eastern Congo.

How a recent wave of violence almost brought Ebola roaring back

The WHO’s director general, Tedros Adhanom Ghebreyesus, said Thursday that covid-19 “might have adverse consequences for the [Ebola] response efforts through diminishing focus” on it.

While the WHO, the U.S. Centers for Disease Control and Prevention, a constellation of nonprofits and the Congolese Health Ministry have mounted a relentless campaign to contain Ebola, little has been done to shore up the region’s health system, which is sorely lacking in even the most basic infrastructure. Ebola is endemic to Congo’s rainforest, and the likelihood of future outbreaks is high.

 “Only half of health facilities have access to water,” Tedros said. “Strengthening a health system may not be as sexy as responding to an outbreak, but it is equally important.”

Almost all of this month’s cases have been reported in the restive city of Beni, which has also been besieged by an Islamist militia that calls itself the Allied Democratic Forces, or ADF.

In late October, the Congolese military launched an offensive against the ADF, complicating the Ebola response and sparking a wave of retaliatory attacks that have killed hundreds of civilians. The offensive has been lauded by Congo’s president, Félix Tshisekedi, as nearly flushing the group out of Beni and the surrounding region, but a resurgence of ADF attacks in February has cast doubt on those claims.

Harris, the WHO spokeswoman, said that while officials were confident in asserting only one chain of Ebola transmission remains, ongoing violence has made it impossible to reach some areas that have had cases over the past few months.

Given the lack of access in some areas like Lwemba, it’s possible that there are other areas where there could be cases that we are not aware of, but it’s unlikely,” she said.

With the end of the outbreak in sight, some of the response’s protocols have shifted as resources have been freed up from emergency activities. Now, patients can be afforded a greater degree of comfort, instead of being confined to Ebola treatment centers where the dead and dying were present.

“Everyone who has been in contact with someone confirmed to have Ebola is now offered the option of voluntary isolation meaning that if they would like, they can be accommodated in a guesthouse where they are provided with food and health support so that they can be monitored as closely as possible, and if they develop symptoms they can be brought to care as quickly as possible,” Harris said. “Most people are taking up this offer.”

In addition to a shortfall of investments in eastern Congo’s health infrastructure, a large funding gap exists for an ongoing measles outbreak in the same region that has killed 6,300 people in far less time than Ebola.

Peace is also unlikely to return soon to the region, known as the Great Lakes for its defining geographical feature, as competition over minerals heats up between the Congolese, Ugandan, Rwandan and Burundian governments and local militias aligned with them.

“The Great Lakes region is increasingly on edge. Distrust is rife among Burundi, Rwanda and Uganda, all of which have connections to insurgents in eastern Congo,” said a recent report by the International Crisis Group. Plans by Congo’s Tshisekedi to invite armies from those countries to help defeat the ADF and other groups heighten the chances for an intensification of conflict.

“Were Burundian, Rwandan and Ugandan forces given a green light” to operate in Congo, the report said, “the danger would be all the graver, raising the specter of an interlocking proxy war wherein each Great Lakes country is backing its rivals’ enemies.”

Cassien Tribunal Aungane, Editor