Eradicating Ebola: Lessons Learned and Medical Advancements, Ebola Virus Disease Outbreak: Democratic Republic of Congo, Challenges Including Unresolved Armed Conflicts, Shortfalls in Health Care System

This important House heard from witnesses about the Ebola outbreak in the Democratic Republic of Congo (DRC) that began in August 2018 which has eluded international containment efforts and posed significant challenges to local and international policymakers.

Broad challenges in DRC—including unresolved armed conflicts, shortfalls in the local health care system, political tensions, community grievances, and criminal activities—have hindered outbreak control. The main outbreak zone is an area of eastern DRC where long-running conflicts had already caused a protracted humanitarian crisis. In addition, the outbreak has coincided with a fraught political transition process in DRC, where a former opposition figure, Felix Tshisekedi, was inaugurated president in January 2019. The electoral process and tense negotiations over a coalition government have complicated Ebola response efforts, as well as coordination between national and provincial officials. Ebola and related response efforts have also diverted or interrupted already limited local health resources in affected areas. This phenomenon, in turn, has been linked to interruptions in routine immunization campaigns. Inadequate measles vaccine supplies have limited capacity to control a measles outbreak in DRC that began in January 2019 and has claimed more than 3,000 lives.

Since June 2019, a handful of Ebola-infected individuals have been identified in the large city of Goma in eastern DRC (a staging area for humanitarian operations and U.N. peacekeeping activities in the country), in the city of Bukavu (south of the main outbreak zone), and in Uganda. Suspected cases were reported, but not confirmed, in Tanzania in mid-September 2019. Transmission outside the outbreak zone has been limited to date, which may be attributable to internationally supported surveillance and prevention efforts, as well as the use of an investigational vaccine. Concerns nevertheless persist that cases could spread to new areas and/or countries. Uganda (which borders the most affected areas in DRC) has prior experience in Ebola control, but Rwanda, Tanzania, and Burundi do not. Minimal state capacity and protracted conflict in South Sudan and the Central African Republic suggest that a coordinated disease control response in either setting could be highly challenging.

This compilation includes a reproduction of the 2019 Worldwide Threat Assessment of the U.S. Intelligence Community.