Beyond the virus: Ebola outbreak exposes cost of conflict, aid cuts and Covid lessons unlearnt

For low- and middle-income countries tackling disease outbreaks, pathogens are only half the problem — and often the more manageable half. What they really reel under are politically driven budget cuts, spiralling armed conflicts, and the dismantling of the international cooperation that shaped their healthcare systems.

The Democratic Republic of Congo (DRC), the epicentre of the ebola virus outbreak in Africa, is currently in the grip of multiple armed conflicts that have displaced around 7-8 million people across the country — 90 per cent of them in the eastern provinces where the outbreak is concentrated.

WHO Director General Tedros Adhanom Ghebreyesus has warned that the DRC faces a "catastrophic collision of disease and conflict" that makes the authorities’ work nearly impossible — the Rwanda-backed M23 group is active in North and South Kivu provinces and an Islamic State offshoot has battered Ituri province.

"Ongoing clashes are driving mass displacement, pushing exposed contacts into overcrowded camps and severing critical containment corridors. Frontline workers are risking everything, while attacks on health facilities make tracking cases and their contacts nearly impossible. We cannot build community trust or isolate the sick while bombs are falling," said Ghebreyesus.

More from World

ALSO READ — ‘Nobody is ready’: Experts warn world is unprepared for Disease X, hasn’t learnt lessons from Covid-19

For the DRC, one of the poorest countries in the world, Prof Gautam Menon flags that everything that could have gone wrong has gone wrong with the outbreak.

"Political instability, cross-border refugee movement, and healthcare funding cuts have made the ebola outbreak far harder to tackle. Presently, it is hard to say what we might expect in the near future. The only positive is that ebola does not transmit easily between people. India faces no direct threat, but it would be good to ensure that we remain responsive to the needs of global public health and concentrate on improving surveillance as infectious diseases do not know any borders," says Menon, an epidemiologist and Professor of Physics and Biology at Ashoka University.

Budget cuts, lessons unlearnt, and hundreds of deaths

It is known that the Ebola virus circulated undetected and unchecked for several weeks as initial strain-specific tests checked only for the more common Zaire species of the virus whereas this outbreak is being driven by the rarer Bundibugyo species. What is less well known is that the delay in detection and declaration of the outbreak was also caused by US President Donald Trump’s destruction of foreign aid and international healthcare cooperation.

The delay was partly a result of samples being taken to the national lab in the capital Kinshasa at the wrong temperatures, according to The New York Times.

The paper reported that the task would previously have been done by US Aid staffers, who were no longer involved because of the agency’s gutting. Moreover, personnel from the US Centers for Disease Control and Prevention (CDC) had also been removed from the country.

These decisions also became self-goals as the United States did not learn about the outbreak until nine days after the WHO announced it because the administration has removed healthcare personnel almost entirely from the region. As diseases do not know borders, observers say such withdrawals do nothing to make America healthy again. Instead, unchecked circulation of a disease in one part of the world raises the chances of wider spread across the world.

But the blame does not just rest on Trump

For all the guidance the WHO is providing and the courage local authorities are showing, Prof Padma Venkat says the world has failed to learn lessons from the Covid-19 pandemic and it is reflecting in the spiralling outbreak.

"Nothing notable has been done in terms of building capacities in low- and middle-income countries like the DRC to prevent and tackle epidemics. Precious little has been done to address the root causes like conflicts and migration of populations, environmental degradation, and human encroachment into wildlife areas and expanding settlements. Ebola is zoonotic and endemic reservoirs exist in fruit bats in the wild. Proximity can expose humans to the virus," says Venkat, the Dean of School of Health Sciences & Technology at UPES, Dehradun.

Venkat stresses that one region’s healthcare crisis is not the problem of that region alone and says countries like India must step up to fill the gap left behind by the United States in retreat.

"Countries like India can increase donations for WHO to survive and perform. India can also strengthen WHO’s operations by sharing expertise and frugal and innovative technologies and products with low- and middle-income countries. India can also contribute through South-South cooperation under the Brics framework to better support WHO," says Venkat.

Despite the criticism that it could have done better, Venkat says the WHO is an absolutely essential organisation that should not be abandoned.

"The WHO should continue to exist as it is the only organisation constantly monitors global health issues, including those of the low- and middle-income countries and diseases neglected by the wealthy members. It would be massively cumbersome, time-consuming, and expensive to prop an alternative to the WHO. We need to think of ways to strengthen it instead of creating alternative. Maybe, it requires a revamp in its structure and function," says Venkat.

Despite the funding shortfall and criticism, Venkat says WHO has continued to do the job.

"Under such circumstances, the WHO has done its job of declaring isolated maritime incident of hantavirus and ebola. It is coordinating and facilitating other agencies like the World Foor Programme (WFP), Red Cross, and Doctors Without Borders (MSF) to reach out to the affected areas," says Venkat.