Misinformation, porous borders and aid cuts challenge Ebola's frontline workers

0:00One of the largest Ebola outbreaks in history is spreading in Central Africa. The World Health Organization's tally of confirmed and suspected cases is around 1 ,000, and health workers say that's likely a major undercount. The epicenter of the outbreak is in the Democratic Republic of Congo, or DRC. What we are witnessing in Eastern Democratic Republic of Congo today is not simply an Ebola outbreak in isolation. It is an epidemic unfolding within an already fragile humanitarian context. That's Robert Petron Messi. He works for the international non-profit Oxfam in the DRC. And he sent us a voice memo describing why the epidemic is so hard to control.

0:48Not only is there no vaccine for this strain of the virus, which spreads through bodily fluids, but in the towns where it's running rampant, many people aren't able to quarantine. Families are frequently living in small shared spaces where isolation is simply not possible. In the DRC, several crises are coalescing. Prolonged economic hardship, a history of conflict, and now this outbreak. While the northeast region of the DRC is seeing the worst of it so far, Ebola has begun to make its way across the nearby border into Uganda, where workers and officials are racing to contain the spread. Uganda closed its official border crossings with Congo just a few days ago.

1:36Even so... We still have a number of porous border points whereby people continue to cross over. So that is one of the challenges we are having. Leonard Muzinguzi is a community and surveillance officer for the International Rescue Committee in Kiryandongo, Uganda, near the border with the DRC. Chiriyandongo was categorized as a very high-risk district. Muzanguzi's job is to track likely cases of Ebola, quarantine people showing possible symptoms, and prepare his community in case the disease begins to spread beyond the few confirmed cases so far. We reached Muzanguzi at a clinic where he's working.

2:15I asked him about one big challenge. We've been hearing in communities in the Democratic Republic of Congo that have been heavily affected by Ebola. that there's a lot of mistrust of health authorities, of health officials, of clinic workers. Some people don't believe that Ebola is actually what's causing people to get sick. I'm wondering if you are hearing similar concerns or mistrust from people where you are. There is a lot of misinformation and disinformation. However, with these actions that we are doing, a lot of behavior change is happening. Muzinguzi relies heavily on public health messaging using radio and TV.

2:54We do radio spot messages on Ebola in different languages. We have printed out posters talking about how we can identify symptoms of Ebola. Muzinguzi says these education campaigns are critical, but he says recent cuts in international foreign aid have meant not enough money to get public health information on the air. We have a number of gaps due to the funding cuts. If, let me say, you have to have five radio talk shows on radio, educating people on how they can identify cases, you're afraid because of reduced funding, you only have one. Consider this. Aid workers are doing what they can to stop a deadly disease.

3:36But they need help. And this outbreak is revealing how funding cuts have made it harder to stem the tide of sickness and death. and not just for this Ebola outbreak.

3:57From NPR, I'm Adrian Flerito.

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4:33It's Consider This from NPR. Aid workers in the Democratic Republic of Congo and Uganda are on the front lines of the Ebola crisis. They need more than they currently have to fight the disease. To understand the impact of these cuts, we reached out to Nicholas Enrich. He worked on global health policy for the United States Agency for International Development, known as USAID, coordinating the U.S. federal response to international public health threats. He was acting assistant administrator for global health in the first months of President Trump's second term as the agency was being dismantled, and he was placed on administrative leave for making details about that effort public.

5:12I first asked him about the severity of this Ebola outbreak. Yeah, I think that this is one of the most serious Ebola outbreaks that the world has ever seen, honestly. And part of that is because of how late we got notification and declaration of the outbreak. And part of it has to do with the strain of the virus as well as the location of it. But, you know, I was really surprised when we first heard about this, that already the number of cases were in the hundreds and the number of deaths were reported to be, you know, in the dozens. How important a role has the U.S. usually played in fighting an outbreak like this?

5:49You know, what does the U.S. role historically look like on the ground specifically? The U.S. has played a central role in coordinating with the host governments of an Ebola outbreak. USAID led the response often in coordination with local partners that, you know, work for community-based organizations and religious groups that were trusted in the communities. Is any of that happening now from what you can see? No. I think what we've really lost in this particular outbreak is the U.S. government's rapid response. And USAID had a playbook for responding rapidly. And that actually starts before the outbreak begins in terms of preparation, pre-positioning of PPE.

6:29By PPE, you mean personal protective equipment? Yes, that's correct. Right. It's the goggles, the masks, the gowns doing surveillance and community monitoring and investing heavily in training of community-based health workers. That would be the eyes and ears that would first detect a potential viral hemorrhagic fever like Ebola. That's the part of this that has been systematically dismantled. We're seeing the State Department responding much more slowly, kind of having to reinvent the wheel. and this is a time when decisions need to be made in hours, not the days and weeks that we're seeing from the State Department.

7:03This lack of time is actually costing lives. The State Department has said that it is sending$23 million to Central Africa to help contain the outbreak, and also that the U.S. is going to fund 50 clinics. Is that not a big deal? No, I think that that is a big deal, and they should continue to do that. However, I think it's very much future-looking, and that's not exactly what we're looking for in terms of an immediate response. I mean, I think that we're going to need those, unfortunately, as this outbreak continues. But the problem is that these are not the immediate response that is needed and that USAID had been famous for.

7:37What lessons should the U.S. be learning right now as we speak, as we look at this outbreak spread about the importance of preparedness for future global health emergencies? Yeah, I think that that's exactly the lesson is that preparedness is key and that it's much more effective to be prepared to prevent outbreaks in advance than to respond to them. And I think what we're seeing with Ebola is actually just unfortunately the tip of the iceberg of the damage that has been done to the global early warning system that USAID and its partners developed to help countries to be able to detect and respond to potential outbreaks before they developed into international crises like this one.

8:16I hope that the lesson to be learned is that infectious diseases do not respect international borders, and we need to reinvest in the kinds of surveillance and monitoring to make sure that we're aware of concerns before they turn into major outbreaks. We've been speaking with Nicholas Enrich. He worked in the Bureau of Global Health at the U.S. Agency for International Development until last year and is the author of Into the Wood Chipper, a book about the dismantling of USAID. Nicholas Enrich, thanks for joining us. Thanks so much for having me. We asked the State Department to respond to Enrich's claims.

8:51State Department spokesman Tommy Piggott told us that it's false to claim that the USAID reform has negatively impacted the U.S.'s ability to respond to Ebola. He said the U.S. mobilized within 24 hours of the first confirmed case and that the administration's highest priority remains, quote, protecting the health and security of the American people by working to prevent this outbreak from reaching our shores, unquote. Meanwhile, Robert Petron-Messi, the aid worker in the DRC, told us reductions in international funding and coordination have weakened essential services his organization can provide, like quarantining, at a critical time in this deadly Ebola outbreak.

9:31What is most urgently required is rapid and flexible funding as the situation evolves. With the right level of international support, but the trajectory can still be reversed. This episode was produced by Henry Larson and edited by Sarah Robbins. Our executive producer is Courtney Dornick.

10:04It's Consider This from NPR. I'm Adrian Florido.