Acknowledging the limits of public health solutions

The Ebola virus disease outbreak in DR Congo has taken an alarming turn. Between April 22 and May 12, 343 confirmed cases were reported, taking the total number to 1738 as of May 19. Despite this rapid and unprecedented deterioration, WHO has not declared the outbreak a Public Health Emergency of International Concern (PHEIC). Although calls to declare a PHEIC are understandable in the face of a worsening and precarious situation, such a declaration, and the increased technical response that it entails, will do little to address what is principally a political problem.

The response to Ebola virus disease relies on case management, ring vaccination and other prevention measures, and risk communication, social mobilisation, and community engagement initiatives. When done properly, these approaches can halt the spread of the virus. Yet these efforts are being compromised by a complex and dangerous security situation compounded by misinformation and mistrust. The outbreak is concentrated in the northeast of the country, where conflict among dozens of armed civil groups is common and health workers and health facilities have come under repeated attack. Rumours abound, with the postponement of elections in December, 2018, fuelling suspicion that Ebola virus disease is a political ploy. Against this backdrop, the containment of the outbreak within four towns and two provinces is commendable, and the responders on the ground deserve high praise for persevering in perilous conditions.

Nonetheless, a very real risk remains that the outbreak will cross into Rwanda or Uganda, in which case a declaration of a PHEIC would probably be needed to increase technical capacity and international coordination. For now, the focus remains on DR Congo's government and opposition groups. Sources at WHO told The Lancet that the organisation is working with the governments of the USA, the UK, and France to influence leadership within the country to address the security situation. There are limits to what the medical community alone can achieve—if the Ebola virus disease outbreak is to be ended, DR Congo's leaders on all sides of politics must step up and take responsibility for the response.