Next Africa: Did Aid Cuts Make The Ebola Outbreak Worse?

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1:56Janice Kew:Radio. News. Eastern Democratic Republic of Congo seems to go from one crisis to another. It's faced natural disasters and is in an ongoing war. But now it's facing an outbreak of Ebola, a deadly virus that strikes fear across the world. It's one that the World Health Organization has already declared an emergency.

2:19Caitlin Brady:I'm deeply concerned about the scale and speed of the epidemic. Cases have been reported in urban areas, including Kampala and the city of Goma in the DRC. Dases have been reported among health workers, indicating health care associated transmission. There is significant population movement in the area.

2:44Janice Kew:Now, the DRC has faced many Ebola outbreaks over the years, helping it to build expertise in how to manage the virus. But with cases spreading in a conflict zone against a backdrop of shrinking international aid budgets, could this outbreak be a harder one to control? And citizens in eastern Congo are having to face yet another disaster.

3:07Jennifer Zabasajja:This disease that has appeared in our community is causing great concern. At this point, we do not really know what kind of disease it is. Every day, people are dying in Brumpara. This has been happening for about a week. In a single day, we bury two, three, or even more people.

3:23Janice Kew:On today's Next Africa podcast, we're looking at this latest outbreak of Ebola in the DRC, how cuts to international aid, including USAID, have affected the response, and how serious things are on the ground right now.

3:41Janice Kew:I'm Jennifer Zabasaja, and this is the Next Africa podcast, bringing you one story each week from the continent, driving the future of global growth with the context only Bloomberg can provide. So joining me today is our senior health care reporter. That is Janice Kew and also Caitlin Brady. She is the Democratic Republic of Congo country director for the NGO, the Danish Refugee Council. and she's currently in Goman near the Rwandan border right now. Janice, maybe we just start with you because this outbreak is fast moving. Things are changing quite rapidly. Maybe you can give us a lay of the land.

4:20Janice Kew:What do we know about where things stand at this current moment?

4:26Caitlin Brady:Jen, as you say, things are moving very quickly. At the moment, we are seeing 540 suspected cases and 131 deaths. But researchers are concerned that the estimate of the true number of infections is probably already larger than 800 cases. Just as a point of reference, we only had the notification of this come through late on Thursday. So less than a week ago, we had the notification come through. And one of the initial big concerns was that there were healthcare workers that were infected. And the reason that is a big concern is that they're obviously working with a whole lot of people. And so when you, at the point of healthcare workers being infected, people have come into facilities where the infection has likely occurred.

5:13Caitlin Brady:And then those healthcare workers have worked with other people. And if that had been going on for some time before anyone realised that it was Ebola, the options on contact tracing become far more complicated. It's also concerning that they've been travellers. We've seen that the first death in Uganda was from someone who'd come over the border from Congo. And when you have infections spreading amongst people travelling, that also raises concerns.

5:43Janice Kew:Caitlin, maybe we go to you as well, because this outbreak is really concentrated in the DRC. You're on the ground there. Can you give us a sense of what you're seeing, what you've been hearing over the past few days and maybe even weeks?

5:57Jennifer Zabasajja:I'm in Goma. As Janice was saying, we have had travelers come here from Maduri, and unfortunately one of them did fall ill while in Goma and has been hospitalized, and the local health workers are doing contact tracing for that individual. So that obviously complicates matters. We also have two positive cases in Butembo. North Kivu has been the site of several epidemics. This is the 17th epidemic and response that the DRC has dealt with. And the most ferocious response was the 10th in North Kivu. Ituri is the epicenter of this crisis. Ituri is the province in the far northeast on the border with Uganda and South Sudan.

6:39Jennifer Zabasajja:And unfortunately, where this started is it's a mining town in a territory that is heavily conflict affected, an area that potentially doesn't have a lot of humanitarian access that isn't very stable and potentially where education and exposure to modern medicine is potentially less. So for at least two weeks, it would seem there were some cases, some deaths before the alert was raised. And as John has said, when health workers started dying, what we've seen now is a very rapid response by the government and And also by the health agencies like MSF and Medic, for example, who are doing the very best to do the contact tracing and to identify among those contacts who shows preliminary symptoms, make sure those people are isolating.

7:29Jennifer Zabasajja:Obviously, as we've seen in the past, this is a very scary thing for the community to face. They don't necessarily understand Ebola. This is a very closed, these are closed communities. And in particular, in this area, they haven't dealt with Ebola before. If this was North Kivu, everybody would be sort of, okay, we know how to do this, we know how to do this. But it's not. It's a Tory and it's Jugu and it's conflict-affected. The access is very, very poor in this area, or at least it has been. Just last week, last Thursday, we were celebrating the announcement of a ceasefire by one of the armed groups who voluntarily declared a unilateral ceasefire starting Friday morning.

8:12Jennifer Zabasajja:Excellent, excellent news. Unfortunately, at the same time, we had the news of the outbreak. And we had to shift gears immediately into a public health response.

8:22Janice Kew:What has that looked like, Caitlin? Because as you mentioned, this country has seen quite a few outbreaks in the past. But this region, I mean, you speak to how this is a bit new for a lot of this community. What has it looked like differently than previous outbreaks that you've been on the ground for?

8:39Jennifer Zabasajja:So I've been on the ground for the West Africa Ebola crisis in Iberia and also for the 2018 to 2020 10th Ebola response here. I'd say actually there are a lot of similarities in that initially we heard rumors that people thought this was blackmatic. They thought that family was cursed. We've also already started hearing harmful rumors about the origin of this outbreak, that it was malicious, for example. Doing risk communications and community engagement, and in particular countering some of these rumors, is absolutely critical. And we need to educate people about how they can protect themselves.

9:21Jennifer Zabasajja:These are some of the most vulnerable people in the world. Itori hosts almost a million IDPs, and Jugu has a lot of IDP camps. So these are camps where internally displaced persons, people who have fled conflict, take refuge from violence, some of which host over 100 ,000 people. These are literally some of the most vulnerable people in the world. And they face violence and conflict and displacement. And now they could face Ebola. So it's a terrible situation and we really need to act quickly. And along with the nuts and bolts of the response, so the isolation of suspected cases, care of confirmed cases, the contact tracing, along with all of that, we really need to bring the community along with us.

10:10Jennifer Zabasajja:And I know that the WHO has already deployed some anthropologists to support the risk communications and community engagement work that the entire community will be doing to ensure that people do come to health facilities, that they do follow the advice, that they do call the hotline that the Ministry of Health has set up to report, hey, I'm not feeling well and these are my symptoms. Could it be Ebola? But they need to trust the health care system and they need to trust the responders. And they've had a really hard time. This area has been conflict affected since 2018 quite intensively. And then obviously previously during the first and second Congolese wars.

10:54Jennifer Zabasajja:So it's a vulnerable area and we're very worried about the situation.

10:59Janice Kew:Absolutely. Janice, maybe you can come in with some of the facts as well. Caitlin was speaking to what people may or may not think about what is currently going on. A lot of the discussion over the past few days has been about just how different this strain of Ebola is than previous ones. Can you just talk about how this Bundabugyo strain, what we need to know about it right now?

11:23Caitlin Brady:Congo is very experienced, actually, with Ebola outbreaks. This is their 17th Ebola outbreak. But only two previous outbreaks have been this specific strain that we're seeing now. and already this outbreak has exceeded in terms of case numbers and deaths the previous two outbreaks of that strain that is a difference the xia strain is far more researched and it already has an approved vaccine and therapeutics which this strain does not so that is a concern because even if tools can be deployed successfully which as caitlin's already described is challenging in and of itself. Whether or not they're actually going to be effective against this particular strain is not yet known.

12:06Caitlin Brady:And so that is concerning. The other big concern really is just how extensive it may already be. We got reports over the weekend that we were also seeing Ebola cases in Kinshasa. Now, Kinshasa is very far away. That may be that we've had transmission, but it could also be that there was actually outbursts or hot spots in a lot of different places. And that is even more concerning in many ways because it shows that it's probably been going on undetected for a very long time. And the reason that could be is that the initial symptoms are quite confusing. They could be symptoms of diseases like malaria or typhoid, and that is deeply concerning.

12:54Caitlin Brady:The outbreak of 2014 to 2016, which really devastated West Africa, that infected more than 28 ,000 people. That's a lot of people.

13:03Janice Kew:Stick with us. We're going to take a short break. And when we come back, we'll have more on the international response to this latest outbreak. We'll be right back. The thing about AI for business, it may not automatically fit the way your business works.

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16:19Janice Kew:And I'm talking about the international community. And in particular, there's been quite a bit of discussion over the past few days about USAID and potentially what impact that could or couldn't have had on detecting earlier cases. Janice, I want to start with you and then Caitlin, I'll get your opinion as well. Where does that fit into this conversation, Janice?

16:41Caitlin Brady:It's difficult to pinpoint exactly how much of USAID funds exactly would have improved surveillance. But in very broad brushstrokes, funding internationally and not just from America, actually from many other partners, fell off a cliff last year. And that no doubt has an impact because clinics close, virologists who were looking at samples and doing trials, etc. A lot of that shuts down when there is no funding. There is an obvious repercussion to that. Again, how to pinpoint that to this specific outbreak is a little bit difficult. But by logic of the fact that there is less surveillance generally, and less research being done on possible vaccines and other therapeutics makes it difficult to say that it hasn't had an impact.

17:32Caitlin Brady:It has had an impact. The response has been swift. As soon as the DRC identified that this was Ebola, the WHO, Africa CDC have sent people in. We have had a lot of other organisations like Doctors Without Borders, etc., who have said that they've deployed people. The US has offered funding specifically for this outbreak. The US CDC is also involved at this point. So there has been a response. But in the bigger broad brushstrokes, when you've got the US pulling out of the WHO, for example, which is what they did last year, and there are other countries that have been talking about it as well, it really does leave the WHO in a weakened position.

18:17Caitlin Brady:And that definitely has ramifications. The WHO say that they've got quite a bit of funding, I think about 90 % for the current year, but that 10 % is going to be incredibly difficult to marshal. And one of the reasons that they called this global health emergency so early was in an effort to marshal resources. That was really what the main objective of that at that moment in time was.

18:42Janice Kew:Yeah, and we heard the director general talking about that. Caitlin, can you speak to how it's that the international response and also the receding of some of the aid from the international community has manifested in your work and what you've been seeing?

18:56Jennifer Zabasajja:As Janice is saying, we're a lot thinner on the ground than we used to be. And that's not just the withdrawal of USAID funding. It's also, frankly, reductions of funding coming from European capitals as well as priorities shift to, say, security. And while one might be sympathetic with their interests, the result is that there's just a lot less funding for humanitarian assistance. In terms of our work, yeah, we've definitely contracted. And so DRC would have had large-scale programming supporting displaced persons funded by USAID, which we no longer have. And normally, we would have been working in some of these camps in water and sanitation and hygiene.

19:42Jennifer Zabasajja:So would other people, because there's hundreds of thousands of people in these camps, and there's a ton of need. Having said that, these camps, the access was bad, we didn't have the funding, and so we weren't present on the ground, for example, for the past couple months, and so people are living in really unsanitary conditions, cheek by jowl, with shelters that are collapsing. They don't have latrines. What latrines they may have had are full, and so you will see open defecation and really just horrific sanitary conditions. The basic advice that we give to people about wash your hands, wash your arms frequently, They just can't do that.