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On the Front Lines of the Trump Administration’s Ebola Response

The United States has mounted a wide-ranging response to the latest deadly outbreak, as only it can.

This op-ed originally appeared in Foreign Policy on November 4, 2019.

As three of the United States’ senior public health officials, we have helped lead the U.S. response to the ongoing Ebola outbreak in the Democratic Republic of the Congo since it began over a year ago. From the first reports of illness, the outbreak has been a top global health priority for the Trump administration.

Despite the ominous scale of the outbreak, we found real reasons for hope when we, along with Adm. Tim Ziemer of the U.S. Agency for International Development (USAID) and several top National Security Council officials, traveled recently to Congo, Rwanda, and Uganda to meet with leaders and witness firsthand the public health work on the ground that the United States has been supporting for over a year now.

In the outbreak area, centered on the city of Butembo, Congo, one young boy proudly showed us the certificate he would bring back to his family declaring him Ebola-free, after he received an investigational drug. We met volunteers who had survived Ebola and are now immune to this outbreak’s strain of the virus, working in clinics to care for sick children and babies. We saw a 23-day-old baby, free of Ebola, who had been born to a mother infected with the virus.

Many people in communities struck by Ebola once thought of treatment centers as places where patients go to die. Now, they witness these centers discharging healthy patients back to their families and their homes. In October, the 1,000th survivor of the current outbreak was released from care.

These are encouraging developments. But the outbreak is now the second-largest Ebola outbreak on record, and the response has been complicated by armed conflict, civil unrest, and other challenges that create a volatile security environment. Almost 3,300 people have become sick with Ebola, and almost 2,200 people have died. Cases have been reported across three provinces in Congo, and a few have occurred in Goma, a city with a population of about 2 million people and a regional transit hub.

In Kinshasa, Congo’s capital, we met with Congolese President Felix Tshisekedi and his new health minister, Eteni Longondo, as well as U.S. Ambassador to Congo Mike Hammer. They understand the serious challenges of the outbreak and the need for Congo to lead the response, with support from the World Health Organization (WHO), the United States, and other partners.

To support Congo, WHO, neighboring nations, and the U.S. Centers for Disease Control and Prevention (CDC) have been providing technical assistance to respond to the outbreak for more than a year. We visited and thanked some of CDC staff, both American and local, who are working in the region or who have been deployed to respond.  A total of 317 CDC staff have completed 492 deployments, and the United States is the single largest national donor of financial assistance to combat the crisis, with nearly $158 million in contributions via USAID.

Thankfully, since the 2014-2016 West Africa Ebola outbreak, new medical tools have been developed. An investigational Ebola vaccine that was developed with U.S. government financial and scientific support has been administered to more than 243,000 people in the region, including contacts of Ebola cases, contacts of contacts, and health care workers. The U.S. Department of Health and Human Services has spent more than $176 million on supporting the development and acquisition of this vaccine. USAID contributed $20 million toward an advance purchase agreement for the vaccine so that, once it becomes licensed, doses can be purchased at much lower cost by Ebola-affected counties and WHO.

An international consortium—led by the Congolese National Institute of Biomedical Research and the U.S. National Institutes of Health and coordinated by WHO—has partnered with several on-the-ground organizations to conduct a trial of investigational drugs for Ebola. Preliminary results from this trial provided evidence that two investigational drugs, also developed with American support, significantly improved chances of survival.

The availability of these tools has changed how we can respond to Ebola. But we cannot neglect the tried-and-true public health measures that are essential to containing a disease outbreak: early identification and isolation of all people with confirmed infection, effective tracing and vaccination of contacts, and strong community engagement to recognize cases early and encourage people to seek care at treatment centers.

Every day, hundreds of thousands of people cross the borders between Congo and Uganda, Rwanda, South Sudan, and other bordering countries, requiring intensive and organized screening procedures. Since the outbreak began, nearly 111 million travelers have been screened at health checkpoints in the outbreak area for signs of illness, as well as at airports and land borders in Congo. There have been just four confirmed cases of Ebola outside of Congo during the current outbreak, despite the logistical challenges associated with this undertaking.

This is thanks to not only the sustained and committed preparedness efforts of the Rwandan and Ugandan governments, but also their willingness to be fully transparent and cooperative while working with public health partners to end this outbreak. The risk of global spread of Ebola remains low because of this type of cooperation and vigilance, and the governments of Congo, Rwanda, and Uganda should all be commended.

Ebola does not respect international borders. The entire region must work together to ensure one new case does not spark a new cluster of Ebola activity. To that end, we have encouraged the government of Tanzania, which also borders Congo, to maintain its robust preparedness activities and be fully transparent and cooperative with international public health partners.

Leaders in the region also recognize that the Ebola outbreak is about more than just a single disease. It reflects systemic, but solvable, weaknesses in the health systems of the affected areas. We were profoundly impressed by the progress that communities have made in eastern Congo, thanks to considerable involvement from religious organizations, women’s associations, tribal leaders, businesses, and other stakeholders. What had been rudimentary Ebola treatment units in Congo earlier this year are now comprehensive care facilities.

We still have work to do, and we reiterated the ongoing U.S. commitment to our partners on the ground. Through the work of the CDC, the National Institutes of Health, USAID, and others, the United States was present in the region to help fight infectious diseases and support health long before this outbreak began, we will be there through its duration, and we will remain after it ends.

The Trump administration delivered the same message to health ministers gathered at the United Nations General Assembly in September: We stand ready to work with nations to promote better health for all people. We can, and will, help nations such as Congo emerge from infectious disease crises and build the capabilities they need to prevent and stop such outbreaks in the future. Doing so will save lives around the world and keep Americans safe.

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Global Health