Local capacity is critical to solid epidemic response

▶ Swift action on DRC Ebola outbreak should be followed by longer-term strategies

In 2014, Ebola tore through west Africa, stunning brittle health systems and killing more than 11,000 people. The byzantine World Health Organisation was rightly criticised for its slow response. Death toll aside, Ebola inflicted an economic cost from which Sierra Leone, Liberia and others are yet to recover. This week a fresh outbreak was confirmed in the Democratic Republic of the Congo, near the north-western town of Bikoro; so far 17 people have died. Rapid action to contain it is critically important.

This time there is some cause for optimism. The DRC outperforms its neighbours in spotting outbreaks, as it demonstrated when several cases of Ebola were recorded last year. Meanwhile, there has been change atop the WHO, which is now led by Ethiopian Tedros Adhanom Ghebreyesus who has prioritised epidemic response. This time the organisation was quick to liberate $1 million and deploy equipped personnel. On the other hand, Bikoro sits on a key river trading route and near an international border. A dearth of local resources and equipment is exacerbated by jungle terrain that will thwart the transportation of isolation units. Meanwhile in a grim fluke, US President Donald Trump took steps to rescind a $252m Ebola fund, to cut “excessive spending”, on the very day of the outbreak.

The DRC’s Ebola river gave the virus its name in the 1970s. Since then, the country has recorded nine outbreaks of the deadly fever, which kills roughly 50 per cent of its victims. While strategies currently in place to isolate infected individuals and trace their contacts are essential, it is bound to re-emerge. And institutional devotion to rapid response overlooks some larger, more endemic problems. Dealing with outbreaks requires rural primary care clinics, rather than the flashy urban hospitals favoured by donors. Local knowledge in diagnostics, treatment and control is too often lacking in areas and communities prone to infection. West Africa still bears the deep scars of the 2014 Ebola outbreak, but vast swathes of the globe are vulnerable to contagion. Today, swift action is needed in the DRC. But tomorrow, attention should be paid to building local capacity in infection-prone areas in Africa and beyond.