Deep foreign aid cuts allowed the deadly Ebola virus to spread undetected in the Democratic Republic of Congo and Uganda, while ongoing conflict has complicated efforts to build resilient health care services in the region, experts warned Monday.
Spanish Prime Minister Pedro Sánchez framed the crisis as a matter of security and justice at the World Health Organization’s annual meeting in Geneva, where the pressing question for health leaders is how to continue funding global health amid cuts from the U.S. and others.
“We have for the last 12 years been living with Ebola, and unfortunately, we are going through this crisis again,” Sanchez said at the World Health Assembly. “Investing in global health is investing in security for our people … This is not just a question of security, it’s a question of justice.”
There are “at least 395 suspected cases” across the two countries, and “more than 100 people” have died, Jean Kaseya, director general of the Africa Centers for Disease Control and Prevention, said.
But the real figures are likely much higher: A high rate of positive samples and increasing clusters point to a potentially much larger outbreak than currently detected, the WHO warned.
Health officials are also faced with a lack of vaccines or effective treatments.
“This is my biggest worry because we need to see how to stop the transmission,” Kaseya told the BBC, adding that Africa CDC was working with authorities in both countries to contain the spread.
Jennifer Serwanga, a Uganda-based Ebola expert at the London School of Hygiene and Tropical Medicine, said the Bundibugyo strain driving the outbreak was “very serious,” with a fatality rate of between 30 and 50 percent.
“It doesn’t have any vaccines, doesn’t have any treatments,” Serwanga, who is also principal research scientist at the Uganda Virus Research Institute, said. She warned that the outbreak appeared not to have been detected early, resulting in “already very many deaths.”
Conflict and little aid
The outbreak has especially alarmed global health officials because it is unfolding in eastern Congo, a conflict-ridden region where access to health care is already severely compromised.
Helen Clark, former prime minister of New Zealand and a longtime global health leader, said the crisis underscored the fragility of health systems in conflict zones.
“It reminds us of the need to look at how to boost basic resilience in conflict-affected areas, whoever’s occupying them,” Clark told POLITICO on the sidelines of the World Health Assembly.
Oxfam’s country director in Congo, Manenji Mangundu, said frontline health workers were already reporting widespread community transmission in Ituri province, on the border with Uganda.
“This outbreak is hitting a country already stretched to breaking point. Ongoing conflict and years of aid cuts have deepened a humanitarian crisis of staggering scale: one in four people are going hungry,” Mangundu said.
“Those same aid cuts left DRC effectively blind to Ebola, weakening the surveillance systems that should have detected this outbreak weeks earlier,” he added.
The U.S. slashed its aid funding in the past year, but it’s not alone, with Germany, France, the Netherlands and the U.K. also making cuts.
Despite the deteriorating situation, European officials insist that years of investment in African health preparedness are now proving critical to the response.
A senior EU official at the EU’s Health Emergency Preparedness and Response Authority (HERA) said European funding had enabled rapid genomic sequencing, allowing scientists in Kinshasa to quickly identify the Bundibugyo strain.
“Africa CDC told me yesterday that without this support and capacity building, it would have taken precious weeks to detect,” the official told POLITICO.
The EU also said its support for the WHO Africa regional emergency hub had enabled the deployment of 6.8 million tons of medical supplies to Congo, including testing kits, protective equipment and medicines, with a further 18 million tons being prepared.
“Our deliberate funding of the health ecosystem in Africa is paying off in this crisis,” the official said.
The European Commission said the risk to Europe remained “very low,” but stressed that the bloc was stepping up coordination efforts.
No formal request for assistance has yet been made through the EU’s civil protection mechanism, a Commission spokesperson said, but the bloc’s health ministers and disease agencies will meet Tuesday with WHO and Africa CDC representatives to discuss the latest developments.
Europe’s disease agency, meanwhile, is sending one expert “immediately, while additional specialists in infection prevention, epidemiology and surveillance could also be sent.
The European Medicines Agency warned that the Bundibugyo virus presents a major scientific challenge because no approved vaccines or treatments currently exist for the strain.
While the Ebola vaccine Ervebo has been effective against the Zaire strain of Ebola, the EMA said there is “currently no clinical evidence” that it would work against the Bundibugyo strain, adding that it could provide some “limited cross-protection.”
It’s a similar story for treatments. The regulator recommended studying antivirals such as remdesivir and related obeldesivir and broad-spectrum monoclonal antibodies, as well as vaccine candidates that can be “rapidly advanced.”
Business as usual on flights
Despite growing concern over the rapid spread of the disease, airlines operating between Europe and central Africa said there were no immediate plans to alter services.
Brussels Airlines, which operates daily flights to and from Kinshasa, said all services were continuing as scheduled.
“No cases have been detected,” the airline said in a statement, adding it was monitoring the situation closely and remained in contact with health authorities. No additional protection measures had been introduced beyond standard infectious disease protocols.
Brussels Airport told POLITICO it follows guidance and instructions from the Federal Public Health Service. “At this time, there has not yet been any instruction on this matter.”
That’s in stark contrast to the U.S. which on Monday said it was suspending entry into the country for 30 days for non-American travelers who have visited the area recently.
For Clark, the outbreak is another warning to WHO member countries gathering in Geneva this week, as negotiations over a global pandemic treaty once again stall after missing another deadline.
The crisis, she said, should “focus the mind” on the need to secure an international agreement designed to prevent the world from repeating the failures exposed by Covid-19 and now by Ebola.
Diplomats at the World Health Assembly have requested yet another extension to the talks — the third consecutive year negotiators have failed to finalize the politically sensitive accord.