The United States is struggling to support the Democratic Republic of the Congo and other partners in fighting what has become the world’s second-largest Ebola outbreak, federal public health officials on Thursday told members of the U.S. Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.
The United States currently is not meeting its target to diffuse the outbreak early. Such a defense calls for at least 70 percent of cases being isolated and contained over several months, testified Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention (CDC).
“The outbreak is not under control at this time,” Redfield said, noting that during the last 42 days alone, there have been 174 active cases reported in 16 health centers across the DRC and roughly half “have presented as community deaths.”
Senate lawmakers called for witness testimonies during the March 14 subcommittee hearing, entitled the “Review of the Ebola outbreak in the Democratic Republic of the Congo (DRC) and Other Emerging Health Threats,” to update them on emerging health threats to America’s security and economic well-being, said U.S. Sen. Roy Blunt (R-MO), chairman of the subcommittee.
“With the second-largest Ebola outbreak currently occurring in the Democratic Republic of the Congo, antibiotic resistance a global danger, and an impending flu outbreak every year, we need to remain focused on these threats,” Sen. Blunt said. “Disease knows no boundaries.”
The CDC’s Redfield said that the office is leveraging a variety of tools to confront the DRC’s outbreak of Ebola, a rare, highly infectious and deadly disease that’s spread by contact with the blood or body fluids of a person infected with the Ebola virus, or via contact with contaminated objects or infected animals.
Among several responses, for example, Redfield said that the CDC has been working with the DRC Ministry of Health and the World Health Organization (WHO), among others, to get the situation under control.
Thus far, according to Redfield, the CDC has deployed 133 expert disease detectives to the DRC, neighboring countries, and the WHO headquarters in Geneva to coordinate activities and provide expertise in surveillance, laboratory testing, vaccine administration, emergency management, infection prevention and control, health communications, and border health.
For instance, together they’ve already provided the vaccinations of some 87,000 people in the DRC and surrounding areas since the Ebola outbreak started in August 2018.
“Our operational expertise allows us to quickly and efficiently identify the unique scientific and social variables of outbreaks and address them with proven interventions,” he said. “However, the unique challenges of the current outbreak mean this fight is even harder than past responses.”
And there are numerous such challenges hampering the support efforts of the United States and its federal partners, according to federal officials, who said their direct participation has been limited at the outbreak’s epicenter because it’s located in an area threatened by armed conflict, crime and civil unrest.
“Disease control is challenging because of weak healthcare and hygienic infrastructure, including the lack of running water and safe waste disposal methods,” Redfield testified. “In addition, the affected population has low levels of trust in the government and international responders.”
In fact, according to U.S. Navy (Ret.) Rear Admiral R. T. Ziemer, acting assistant administrator of the Bureau for Democracy, Conflict, and Humanitarian Assistance at the National Institutes of Health (NIH), the distrust felt by people inside the DRC for those within its government and outside its borders has been one major deterrence to helping the country battle the outbreak.
“Security and community distrust are two major vectors that seem to be going in the wrong direction,” Ziemer said. “We understand the disease, but community engagement and the security plateau require us to make adjustments on the ground.”
At the same time, there’s heavy cross-border movement in the DRC, which is also experiencing outbreaks of other multiple infectious diseases such as cholera, vaccine-derived poliovirus, malaria, and measles, witnesses testified on Thursday.
“All of these factors make this an extremely challenging environment for an Ebola response,” said Redfield, adding that from late December 2018 until the end of January, the situation was compounded by the U.S. Embassy in the DRC being in an “ordered-departure status” that limited CDC staff presence. That status since has been lifted.
To date, the WHO reported that as of March 13 there were a total of 932 cases of Ebola in the DRC and 587 total deaths. Many of the dead include healthcare workers embedded in the north African nation who were working to identify and contain the disease — yet another hindrance to support efforts.
U.S. Sen. Patty Murray (D-WA), ranking member on the Senate Appropriations subcommittee, chastised the Trump administration for proposing in its fiscal year 2020 budget to slash federal funds for the nation’s Global Health Security Agenda (GHSA), which contributes to the U.S. government’s support in these efforts.
“During the current outbreak, it’s important we remember that in a world as connected as ours, one of the best ways to keep our country safe is to continue U.S. leadership on global health security, and that means investing in public health and preparedness systems here and abroad,” said Sen. Murray.
Such U.S. investments, she added, “have made a clear difference,” but they need to be increased and maintained, a sentiment echoed by the witnesses.
“Continued U.S. leadership is crucial,” Murray said. “So as we work to address this current crisis, we must remember the dangers of falling back on ‘America first’ rhetoric. We can’t do this on the cheap and we can’t pretend diseases are stopped by borders, walls or bans.”
Dr. Robert Kadlec, the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services (HHS), said that how effectively the United States helps the world respond to the current Ebola crisis in the DRC also will inform its future efforts in such instances across the globe.
Right now, Kadlec said, the Office of the ASPR is working with the CDC, the United States Agency for International Development, and the U.S. State Department to monitor the events within the DRC.
In January, the ASPR convened the Disaster Leadership Group to discuss the current situation in the DRC, added Kadlec. Participants included representatives from the CDC, the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and its Biomedical Advanced Research and Development Authority (BARDA), among others. Staff provided updates on vaccinations within the DRC, containment efforts, engagement with the State Department and other HHS officials, and general domestic preparedness efforts, he said.
Kadlec testified that BARDA and several partners currently have two vaccine candidates and two therapeutic candidates being put through clinical trials during the Ebola outbreak in the DRC.
Additionally, his office supported a patient transfer exercise to test planning, support infrastructure and general knowledge about how to handle, transport and treat infected or suspected infected people, Kadlec said.
“ASPR also continues to refine regional treatment centers to handle an influx of patients should an infectious disease outbreak occur within our borders,” he said.
Dr. Anthony Fauci, director at the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), said “hopefully by the end of the epidemic, we’ll know what works.”
Fauci testified that infectious diseases aren’t going to go away, “which is why we have to be perpetually prepared.”
The NIAID, he said, is coordinating with the CDC, FDA, HHS, ASPR and BARDA on continuing to inform its biomedical research response to emerging pandemic threats and has incorporated lessons learned in conducting research during the West African Ebola outbreak in 2014-2016 — now considered the world’s largest Ebola outbreak — into its response to the disease’s reemergence in the DRC.
“Data from prior NIAID-supported studies have provided evidence supporting the use of candidate Ebola countermeasures during the current outbreak,” Fauci said.
Additionally, the institute has entered a memorandum of understanding with the WHO to facilitate a research response to emerging infectious diseases that’s underpinning its Ebola efforts in the DRC, he testified during the subcommittee hearing.
The potential for Ebola to spread outside Africa and morph into an outbreak in the United States is “extremely unlikely,” Fauci said.
Sen. Blunt said he’ll keep the record open for one more week to gather any additional information on the current situation in the DRC.