Eastern Congo marked an official end Thursday to the second deadliest Ebola outbreak in history, which killed 2,280 people over nearly two years, as armed rebels and community mistrust undermined the promise of new vaccines.
Thursday’s milestone was overshadowed, though, by the enormous health challenges still facing Congo: the world’s largest measles epidemic, the rising threat of COVID-19 and another new Ebola outbreak in the north.
“We are extremely proud to have been able to be victorious over an epidemic that lasted such a long time,” said Dr. Jean-Jacques Muyembe, who coordinated the national Ebola response and whose team also developed a new treatment for the once incurable hemorrhagic disease.
The announcement initially was set for April but another case emerged just three days before the Ebola-free declaration was expected. That restarted the 42-day waiting period required before such a proclamation can be made.
The epidemic, which began in August 2018, presented an unprecedented challenge for the World Health Organization, Congo’s Health Ministry and international aid groups because it was the first Ebola epidemic in a conflict zone.
Armed groups posed such a risk that vaccinations sometimes could only be carried out by small teams arriving by helicopter.
Only a few years earlier, West Africa’s Ebola epidemic killed more than 11,000, as at that time there was no licensed vaccine or treatment.
The COVID-19 outbreak in the region has been minimal so far, but the challenges of Ebola underscore how fraught it could be to test and treat those in areas under the control of armed rebels.
“Ebola has changed our culture,” said Esaie Ngalya, whose grandmother died from the virus. “Now I go to see my uncle but we don’t shake hands. In our culture that is considered disrespectful but now we have no choice because health comes first.
As Africa braces for a surge in coronavirus cases, its countries are dangerously behind in the global race for scarce medical equipment. Ten nations have no ventilators at all.
Outbid by richer countries, and not receiving medical gear from top aid donor the United States, African officials scramble for solutions as virus cases climb past 25,000. Even in the best scenario, the United Nations says 74 million test kits and 30,000 ventilators will be needed by the continent's 1.3 billion people this year. Very few are in hand.
"We are competing with the developed world," said John Nkengasong, director of the Africa Centers for Disease Control and Prevention. "The very future of the continent will depend on how this matter is handled."
Politicians instinctively try to protect their own people and "we know that sometimes the worst in human behavior comes out," said Simon Missiri, Africa director with the International Federation of Red Cross and Red Crescent Societies, urging an equitable approach to help developing nations.
The crisis has jolted African nations into creating a pooled purchasing platform under the African Union to improve negotiating power. Within days of its formation, the AU landed more than 100,000 test kits from a German source. The World Health Organization is pitching in, approaching manufacturers for supplies.
Africa also benefits from the U.N.'s largest emergency humanitarian operation in decades, with medical cargo including hundreds of ventilators arriving in Ethiopia this month and sent to all countries across the continent. Another shipment from the Jack Ma Foundation is on the way.
But Africa isn't holding out a begging bowl, Nkengasong said. Instead, it's asking for a fair crack at markets — and approaching China for "not donations. Quotas that Africa as a continent can purchase."
Such efforts are a response to a global thicket of protectionism: More than 70 countries have restricted exports of medical items, putting Africa in a "perilous position," the U.N. says. New travel bans have closed borders and airports, badly wrenching supply chains.
"It's like people hoarding toilet paper, which I still don't understand," Amer Daoudi, the U.N. World Food Program's senior director of operations, told The Associated Press. "Countries in Europe and North America are paying attention to their own internal needs, but we think that will ease off very soon."
While nations that are traditionally the world's top humanitarian donors are distracted, the WFP, the U.N.'s logistics leader, heaved the emergency operation into place with unprecedented reach. Normally in about 80 countries, this effort involves almost 120, Daoudi said.
The WFP seeks $350 million to keep the operation running for Africa and elsewhere, delivering aid for the pandemic and other crises like HIV and cholera that need drugs and vaccines to keep flowing. Africa imports as much as 94% of its pharmaceuticals, the U.N. says.
"I've never been involved in anything like this before. I don't think any of us have," said Stephen Cahill, WFP's director of logistics. "We're seeing countries taking measures we think aren't always rational. When you start closing borders, we start to get very nervous."
Some African nations, after securing medical equipment, have complicated delivery by causing cargo to stall at ports; 43 have closed their borders.
The global supply crisis is so pressing that the U.N. General Assembly this week approved a resolution urging countries to immediately end "speculation and undue stockpiling." Separately, China said it won't restrict exports of needed medical goods.
Developing regions are taking different approaches. China is the main source of help in Southeast Asia. In South Asia, several countries have committed to India's proposed COVID-19 Emergency Fund. Small South Pacific island nations have teamed up to get equipment. And some Latin American nations are trying to free equipment stuck in U.S. ports or making supplies themselves.
But the global disruptions are especially felt across Africa, where governments that have historically underfunded health systems are partnering in an effort that's been compared to going to war.
"Where a product cost, for example, a dollar before, it's now gone up a hundred-fold," said the Africa CDC deputy director, Ahmed Ogwell. While many African nations have money on hand, the trading companies they use face extreme challenges: "Country X can go and say, 'I'll pay you double what you're offered.'"
In the United States, the Trump administration has said coronavirus aid to at-risk countries would not include key medical equipment, to meet demand at home.
"I've heard no situation yet in any of our countries where the U.S. has made any medical supplies available anywhere," said Charles Franzen, director of humanitarian and disaster response for World Relief.
When asked how many ventilators and test kits have been sent to Africa, a senior U.S. administration official said aid has focused on water, sanitation and messaging: "We're also looking at the PPE and ventilator needs and will be making those decisions very quickly."
In response, African public and private health sectors have teamed up as never before. "Irresponsible behavior by richer countries" will not solve the pandemic, said Amit Thakker, president of the Africa Healthcare Federation, criticizing "any country that diverts supplies for the sake of their own citizens" at developing countries' expense.
In South Africa, Business for South Africa works closely with the health ministry to get supplies. With better-resourced countries more likely to score deals, "that's not great for Africa. ... Ventilators are like trying to spot a dodo bird at the moment, literally," said Stavros Nicolaou, who leads BSA's efforts.
But South Africa has used relationships with economic allies to obtain drugs from India and protective gear from China.
And yet, South Africa has only about four weeks' worth of protective gear, Nicolaou said. With the pandemic arriving in Africa later than elsewhere, "we have entered the fray quite late when the supply chain is highly, highly constrained."
Global powers must share, especially as the pandemic hits countries at different times, said one of Africa's most prominent philanthropists, Sudanese-born billionaire Mo Ibrahim. "This is the time for everybody to act together, not to compete."
Africa, which has been predicted to be hit hard by coronavirus, has recorded more than 1,000 deaths so far, the Africa Centers for Disease Control and Prevention said Saturday.
The victims include the Nigerian president's chief of staff.
A total of 52 of the continent's 54 countries have reported the coronavirus, with the overall number of cases more than 19,800.
Nigeria's government said Abba Kyari, chief of staff to President MuhammaduBuhari, died Friday of COVID-19. "May God accept his soul," the statement said.
Kyari had been considered by some as Nigeria's most powerful government figure, His infection had been one of the highest-profile in Africa. Several government ministers and a U.S. ambassador were infected with the virus earlier in Burkina Faso.
Kyari announced his illness last month, saying that "I have made my own care arrangements to avoid further burdening the public health system, which faces so many pressures."
He was reported to have been infected during a visit to Germany. He was criticized for not isolating upon his return to Nigeria and accused of infecting other top government officials.
Nigeria currently has nearly 500 cases of the virus.
The World Health Organization on Friday noted a 51% increase in cases in Africa and a 60% jump in deaths in the past week. But the WHO chief warned that because of a shortage of testing "it's likely the real numbers are higher than reported."
The Africa CDC has said more than 1 million test kits will be rolled out starting next week.
Under the best-case scenario, Africa could see 300,000 deaths from coronavirus, according to a new report by the UN Economic Commission Africa that cites modeling by the Imperial College London.
Under the worst-case scenario with no interventions against the virus, Africa could see 3.3 million deaths and 1.2 billion infections, it says.
Even with "intense social distancing" under the best-case scenario the continent could see more than 122 million infections, the report says.
Any of the scenarios would overwhelm Africa's largely fragile and underfunded health systems, experts have warned.
The continent as of Friday had more than 18,000 confirmed virus cases, but experts have said Africa is weeks behind Europe in the pandemic and the rate of increase has looked alarmingly similar.
Congo has been battling an Ebola outbreak that has killed thousands of people for more than 18 months, and now it must also face a new scourge: the coronavirus pandemic.
Ebola has left those living in the country's east weary and fearful, and, just as they were preparing to declare an end to the outbreak, a new case popped up. Now, they will now have to manage both threats at once.
The new virus has overwhelmed some of the world's best hospital systems in Europe and ripped through communities in New York. In Congo, it could spread unchecked in a country that has endured decades of conflict, where corruption has left the the population largely impoverished despite mineral wealth, and where mistrust of authority is so entrenched that health workers have been killed during the Ebola outbreak. It's also unclear how forthcoming international support will be at a time when the whole world is battling the coronavirus.
"It all feels like one big storm," said Martine Milonde, a Congolese community mobilizer who works with the aid group World Vision in Beni, which has been the epicenter of the Ebola outbreak. "Truly, this is a crisis within a crisis within a crisis. The community suffers from insecurity, and suffered under Ebola, and now may have to face COVID-19."
In early March, an Ebola patient whom many hoped would be the last was discharged, and the outbreak was supposed to be officially declared over Sunday. But the World Health Organization on Friday announced a new case in Beni.
The outbreak has claimed more than 2,260 lives since August 2018 — the second largest the world has ever seen, after the 2014-2016 outbreak in West Africa.
Still, there is some hope: Many of the tools used to fight Ebola — hand-washing and social distancing chief among them — are also key to combating the coronavirus.
In Beni, which has reported two cases of the new coronavirus, "the communities here hold onto some hope that they are going to overcome this pandemic the way they had been working to overcome Ebola," said Milonde. "They are counting on the caution, vigilance and hygiene practices that they have been performing to save their families."
Community advocates in Beni — who walk around with megaphones to talk about Ebola — have started to include warnings about the coronavirus.
Messages explaining COVID-19, the disease caused by the virus, and where to go if sick are being spread on radio stations, through text message blasts and by religious leaders. Schools, churches and mosques are already armed with hand-washing kits.
Beni's mayor, Nyonyi Bwanakawa, says many of the measures will be familiar — but the recommendations to stay home are more stringent than what is required for Ebola, and officials are prepared to take "dramatic measures" if people resist.
Unlike Ebola, which kills about half of the people it infects, the new coronavirus causes mostly mild or moderate symptoms in about 80% of people. Spreading Ebola typically requires an exchange of bodily fluids, and people have often been infected when caring for loved ones or mourning in traditional funerals that involve close contact with the body. In contrast, the new coronavirus is far more contagious and mostly spread by people coughing or sneezing, including those with only mild flu-like symptoms.
That means the task of controlling the virus' spread in Congo will be massive: The government has only limited control in parts of the vast country, there are also some dense population centers with poor sanitation and infrastructure, and the country's mineral-rich east is beset by violence from various armed groups.
Dr. Michel Yao, program manager for emergency response at the WHO's Africa office, said implementing robust testing and contact tracing will be key. But getting the community fully involved in fighting the disease might be even more important.
That means not just speaking at communities, "but giving them responsibility and roles to play."
Initially, efforts to control Ebola were met with resistance, one of the major contributors to its spread. Amid the insecurity in the country's east, superstitions arose, and some clinics to treat Ebola patients were attacked and health workers killed.
The capital, Kinshasa, a tightly packed city of 14 million located on the country's western border, remains another major worry, said Yao, who is based at WHO's African headquarters in the neighboring Republic of Congo.
"If it reaches this place, it would be a big disaster," he said.
"Africa is only partly ready," said Yao. "If we stick to sporadic cases, this can be managed."
But many more developed countries have seen cases surge, and a sizable outbreak in Congo could easily overwhelm its hospital system. Advanced equipment to deal with severe respiratory illness, which the coronavirus can cause, is lacking: The Health Ministry says there are about 65 ventilators — all in Kinshasa — and 20 more on order for a country of more than 80 million people.
There have been 215 confirmed cases of the new coronavirus in Congo, with 20 deaths, the ministry said Friday.
And health workers will also need to find a way to continue to treat people infected with the many other diseases that regularly torment the population. Over the past year, for instance, a measles outbreak killed more than 6,000 people in Congo.
In addition, because donor countries are themselves dealing with outbreaks, help from abroad could be less forthcoming. The key, Yao said, is training more people locally to care for the ill.
The challenge will be rallying again after many months of trying to contain Ebola.
"The job wasn't yet finished, and we have to deal with another emergency," Yao said.
Katungo Methya, 53, who volunteers for the Red Cross in Beni, expressed a weariness many feel.
"It's so upsetting to have this second disease. We lost so many people through Ebola, a lot of deaths, now corona," she said. "Everyone is really afraid."