Strong country leadership is critical for global health security

Author: Lenias Hwenda

Picture: Dr Oly Ilunga Kilunga: Minister of Health Democratic Republic of Congo

We can all breathe a collective sigh of relief after the recent announcement by the Minister of Health of the Democratic Republic of Congo (DRC) Dr Oly Ilunga Kalenga that the ninth and most deadly Ebola epidemic in the DRC is now under control. This is welcome news in an international system rife with bad news. The speed and success of the DRC’S responses to an Ebola outbreak that had all the hallmarks of a potentially devastating epidemic has much to do with strong and decisive leadership, testament to what happens when governments take ownership of national health security challenges and work effectively with partners to overcome the threat. 
 
The previous eight Ebola outbreaks in the DRC had typically shown two characteristics - isolated rural outbreaks that were self-limiting as a result of their location or urban outbreaks that had significant spreading potential. This ninth outbreak was showing both features and it threatened to become an unmitigated crisis in a country that was already facing massive population displacement, a cholera and a vaccine derived polio epidemic. At the time we received a briefing on the progress of outbreak control efforts in Committee A of the World Health Assembly (WHA), fifty-eight cases had already been recorded as suspected, confirmed and probable. Six new confirmed cases, 2 new suspected cases and others still to be investigated served as a strong notice to the global community that the worst of this outbreak may yet still come.

We were briefed by the Permanent representative of the DRC to the UN in Geneva and the WHO leadership since Dr Kalenga had taken the wise decision to miss the largest gathering of the world’s leaders in health in order to deal with the unfolding health security crisis at home. The Regional Director of WHO Africa, Dr Moeti stressed the need for a robust response with speed and agility. The government of the DRC would prove itself equal to the task with its rapid and decisive response and its ability to align its resources of those of partners to ultimately avert a major disaster. Rapid risk assessment provided a clear understanding of the nature of the risk, its severity and how best to deploy resources for maximum impact. The risk was considered highest at national and regional level, but lower internationally. An outbreak with three separate chains of transmission all of which had potential to expand separately that is, funerals, visits to healthcare facilities and visits to places of worship added complexity to already challenging control efforts. 
 
The government initiated a strong campaign of contact tracing capable of covering vast distances with motorcycles to great effect. Two weeks after the outbreak was declared on 8 May and only two days after the first case was identified, vaccination began with the Minister of Health personally overseeing the launch of a highly targeted vaccination campaign to protect frontline health workers first. This was coupled with contact tracing to form protective rings that would prevent further community transmission, the same strategy that was used during small pox control. Authorities were able to assure the public of the safety of the vaccine by getting vaccinated themselves. All these steps would prove critical to limiting the spread of the outbreak in the weeks that followed.
 
Evaluation of the risk to other countries took into consideration specific factors including their proximity through a shared border with the epicentre of the outbreak or through physical links by land and by the River Congo. Readiness teams were deployed to six of nine countries identifies as facing the greatest risk, that is, the Central African Republic, Congo Brazzaville, Angola, Burundi, Tanzania, Rwanda, Angola, Zambia and Uganda. WHO AFRO regional office tasked readiness teams with evaluating preparedness contingencies and to coordinate responses so that countries could preposition the medical supplies that would be needed such as rapid diagnostic tests, surveillance and case management. Multisectoral teams were placed at major point of entry to the six priority countries and the training of health personnel in the management of Ebola would commence imminently.
 
The DRC’s response was riddled with a myriad of challenges including not having the necessary cold chain facilities and difficulties in transporting medical resources. That it was still able to rapidly curtail a major global health security threat underscores the huge importance of country ownership in effective and sustainable outbreak control. Only with strong country leadership and ownership could the DRC have successfully leveraged the cumulative knowledge from its past experiences, those of the international community in the control of smallpox and other public health emergencies and effectively coordinated and aligned the interests of all partners to pool their resources and expertise to avert a national disaster before it could spread beyond the DRC.