Factors Impacting the Democratic Republic of Congo’s Ability in Disease Control:

Ebola is a severe disease affecting humans and is often fatal. The virus gets transmitted from wild animals to humans and further spreads via human-to-human transmission. Ebola virus disease was discovered for the first time in 1976 in the Democratic Republic of Congo (DRC) near the Ebola River (Sivanandy et al., 2022). Since then, Ebola has killed several individuals worldwide, especially in African countries. Most outbreaks of Ebola have occurred in the DRC (Mayhew et al., 2021). The paper aims to shed light on the prevention and control of Ebola disease. The report will particularly discuss the various factors impacting the DRC’s ability to control disease transmission and the control strategies adopted by the country to prevent the onset of the disease, and how the country was successfully able to contain the disease.

i. Host Factors:

Factors such as encroachment into forested regions, population growth and direct interaction with wildlife have led to the transmission of the Ebola virus. The fruit bat is the natural host for the Ebola virus. People have handled infected chimpanzees, fruit bats, gorillas and several other animals in the forest areas of Africa (Languon & Quaye, 2019). Humans got infected by coming in close contact with the infected animals’ secretions, bodily fluids, or blood. It spread in the community through human-to-human transmission and resulted in infection from direct contact with body fluids, blood, or other such fluids (Al-Halhouli et al., 2021).

ii. Environmental Factors:

Several infectious diseases can be found in Africa owing to their geographical location. It is a subtropical continent, and the climate is ideal for the survival of several animals. Wild animals like fruit bats, chimpanzees, and so on are the hosts of the Ebola virus. Human activities like urbanization and deforestation contribute directly to the virus’s transmission. Humans come close to animals due to deforestation, and the same food sources like vegetables and fruits are shared. Humans get infected by consuming contaminated food containing the virus (Platto et al., 2021). Urbanization has significantly contributed to the spread of the virus by bringing humans and animals nearby. Urbanization has led to the construction of new roads, and people easily travel from one place to another. In this way, the Ebola virus has reached areas previously not found. The virus can survive for many days within fluids present on the surfaces of new buildings. Thus, the climate and subtropical terrain of Africa, urbanization and deforestation have contributed to the spread and survival of the Ebola virus (Adegboye et al., 2021).

Key Factors Impacting The Spread Of The Infection And How Can They Be Modified:

Several socio-cultural factors in Africa have significantly contributed to the virus’s spread. The social stigma of hospitals and burial practices has contributed to Ebola thriving in Africa (Houéto, 2019). When an individual dies in Africa, there is a ritual to remove the deceased’s bodily fluids and handle the deceased’s body. Due to improper and unsafe practices undertaken during burials, the virus gets transferred from an infected deceased’s body to a new host as the virus can survive in a dead host. The political factors are responsible for the outbreak of the disease in cultural minority communities, negligence of colonialism’s influence, and several social determinants of health like poor sanitation, overcrowding, and poverty (Kapiriri & Ross, 2020). All these factors have enhanced the risk of Ebola disease, and people have become more vulnerable.

iv. Lifestyle Factors:

Travelling to regions where the Ebola virus disease (EVD) is prevalent can increase the risk of Ebola disease (Tuite et al., 2019). Exposure to body fluids of an infected person or coming in direct contact with a deceased’s body infected with Ebola without wearing any protective gear like personal protective equipment (PPE) increase the risk of Ebola disease (Ibrahim & Adekanye, 2021).

Wildlife to human transmission is one of the critical factors of the spread of EVD. It is crucial to raise awareness of the risk factors for the Ebola virus infection. While handling animals, wearing gloves and appropriate protective clothing is necessary (Raza & Rahman, 2020). Animal products such as meat and so on are required to be cooked thoroughly before consumption. Another critical factor is the human-to-human transmission which can be reduced by wearing PPE and gloves while dealing with Ebola-infected patients. Frequent hand washing is necessary after visiting infected patients in the hospital. Socio-cultural factors contribute significantly to the spread of the virus. Therefore, it is crucial to take appropriate measures for the deceased’s dignified and safe burial and identify and isolate individuals who have direct contact with an infected person. It is essential to maintain a clean environment and good hygiene to prevent the further spread of the virus.

Although DRC’s healthcare system is familiar with Ebola, there are still certain challenges encountered while addressing Ebola in DRC and other African countries.

• Constraints from the country’s healthcare system: The healthcare system of DRC is weak. Very less healthcare facilities in DRC had provisions for providing basic medical care (Vivalya et al., 2021). The country’s healthcare system capacity weakened when health workers died due to Ebola.
• Governance and Security challenges: Political grievances, local tensions, and security threats are the most significant challenges. Political protests, healthcare staff strikes, and local goons’ attacks disrupted the response efforts. Poor infrastructure, community resistance, the weak democratic system of the country, and high rates of corruption all have hindered the process of preventing the disease. The Ebola treatment centres have been subjected to attacks by local militiamen. For over 20 years, the eastern part of DRC has experienced wars, and as a result, the population is constantly moving (Mayhew et al., 2021).

The Ebola responders in DRC implemented new strategies by expanding the Ebola vaccines application, deploying innovative treatments for Ebola, and ensuring the protection of healthcare staff.  

Vaccines: In DRC, a strategy called “ring vaccination” was employed, which involves vaccinating those who have been in close contact with Ebola-infected individuals (Schwartz, 2020). However, the effectiveness of the vaccination process was reduced owing to community resistance, isolation of infected people, limitations in quick diagnosis, population mobility, suboptimal infection prevention and control practices in the local health centres, and so on. The WHO started a vaccination drive to vaccinate the individuals of Ebola-affected regions of DRC. The North Kivu and Ituri provinces of DRC are the regions where the main outbreak took place. Several people in such provinces were vaccinated by the outbreak’s end (Rohan & McKay, 2020).

Challenges Encountered While Trying To Address The Modifiable Factors:

Therapeutics: A study conducted by the WHO, National Institutes of Health, USA, and National Institute of Biomedical Research of DRC reported two experimental treatments, namely, mAB114 and REGN-EB3, had shown positive results in Ebola patients in a trial. Many people were treated with such therapeutics when the Ebola outbreak in DRC (Iversen et al., 2020).

Coordination of response efforts and local engagement: The Ebola response activities have been subjected to persistent resistance from the locals. The DRC government, in 2019, took steps to address the Ebola issue in the country and helped enhance coordination and consciousness of the local people (Alonge et al., 2019). The peacekeeping operation of the United Nations in DRC in 2019 played a pivotal role in ensuring logistical, financial and policy coordination among the responders (De Coning & Peter, 2019). The DRC government and the WHO trained several health workers and provided the infected individuals with impartial access to treatment options and therapeutics. Several people were vaccinated with the highly effective Ebola vaccine known as the rVSV-ZEBOV-GP vaccine (Schwartz, 2019). The affected communities also helped in the response process. Several frontline responders of the country worked for hand in hand with WHO.

The Ebola outbreaks were devastating. The African nations were not prepared for an epidemic like Ebola before the occurrence, and hence the epidemic claimed the lives of several people. The countries failed to respond rapidly to the outbreak due to weak health infrastructure and a lack of effective surveillance systems (Nagai et al., 2020). As a result, poor infection control caused the disease to spread in healthcare facilities, and the healthcare system collapsed. The disease spread to several metropolitan cities, and insufficient reporting and surveillance disrupted the control effort.

However, the response and strategies changed over time. The vaccination programs aim to vaccinate individuals, especially those in risky groups and regions. The response to such outbreaks is more prompt now, that help in the quick tracking of vaccines, tests and treatments. Rapid laboratory testing implies that people can quickly access treatment and care. It helps increase the possibility of survival of affected individuals (World Health Organization, 2018). Every individual of DRC was provided with equitable and voluntary access to treatment as it was uniformly applied within the country. The design of centres of Ebola treatment also changed over time. “Biosecure Emergency Care Units for Outbreaks” have been set up in DRC to make treatment and monitoring easier (WHO, 2020). A “comprehensive programme of follow-up care”, implemented by WHO, helps survivors of Ebola by providing psychosocial, biological and clinical support. Community engagement has been incorporated into the Ebola response, and the WHO implemented an innovative “Health Emergencies Programme” (WHO, 2020). In North Kivu, especially, WHO assisted in training vaccination teams and local laboratory technicians, raised awareness among community groups, and included response operations. Ministry of Health of DRC and WHO developed a crisis management strategy to “definitively defeat” the epidemic (WHO, 2020).

Prevention/Control Strategies Currently Being Employed for Ebola in DRC:

The Ebola vaccine is recommended for individuals at high risk of contracting the virus. Local and international healthcare personnel are the frontline responders. The vaccine is also recommended for bush-meat hunters vulnerable to viral infection (Nkangu & Olatunde, 2017). The vaccines aim to prevent transmission. The chances of survival can be increased manifold with proper vaccination. Basic interventions also increase survival chances. It includes providing electrolytes and fluids intravenously or orally. Several medications are used to treat any secondary infection, manage pain, fever, and reduce diarrhoea and vomiting.

Treatment and vaccination proved to be highly successful in the containment of the outbreak of Ebola. For the first time, in an Ebola outbreak, vaccines were widely used. Mab114 and REGN-EB3, the two drugs, significantly reduced mortalities among the patients who were infected by the virus and were hospitalized. In northern DRC, all consenting individuals received the drugs. Thus, new therapeutics and vaccination programs, community-level participation, and enhanced coordinated response to the epidemic contributed significantly to the containment of the outbreak of Ebola in DRC. Panic-driven behaviours result when an Ebola outbreak occurs. Interventions that are culturally relevant, and focus on effective communication at different levels like individual, international and community, can help reduce such behaviours. Cultural, social, and economic factors have influenced behaviour patterns in the past, but now they can induce positive change. DRC has successfully controlled the epidemic, and hence it will be successful in introducing the interventions. Thus, a behaviour change model that focuses on level-based communication has been demonstrated below.

Conclusion

Therefore, from the above discussion, it can be concluded that the Ebola outbreak in DRC and other African nations has severely affected the countries’ healthcare systems. The virus gets transferred from animals to humans, and the climate and the geographical location of DRC, environmental factors and lifestyle factors have contributed to the progress of the disease. DRC has implemented several innovative strategies that have helped the country contain the Ebola outbreak. International organizations’ participation with local people of the country, the vaccination programs, and the treatments have all contributed to the containment of the virus, despite the several challenges encountered while controlling the spread of the virus. Vaccinating the country’s citizens, especially those residing in risky areas or risky groups, has proved very effective. The change in strategies for controlling the disease has proved to be effective. The international organizations worked for hand in hand with the country’s local communities and were successful in the containment of the virus.

References

Adegboye, O., Field, M. A., Kupz, A., Pai, S., Sharma, D., Smout, M. J., … & Loiseau, C. (2021). Natural-Product-Based Solutions for Tropical Infectious Diseases. Clinical microbiology reviews, 34(4), e00348-20. https://doi.org/10.1128/CMR.00348-20

Al-Halhouli, A. A., Albagdady, A., Alawadi, J. F., & Abeeleh, M. A. (2021). Monitoring Symptoms of Infectious Diseases: Perspectives for Printed Wearable Sensors. Micromachines, 12(6), 620. https://doi.org/10.3390/mi12060620

Alonge, O., Sonkarlay, S., Gwaikolo, W., Fahim, C., Cooper, J. L., & Peters, D. H. (2019). Understanding the role of community resilience in addressing the Ebola virus disease epidemic in Liberia: a qualitative study (community resilience in Liberia). Global Health Action, 12(1), 1662682. https://doi.org/10.1080/16549716.2019.1662682

De Coning, C., & Peter, M. (2019). Africa and UN Peace Operations: Implications for the Future Role of Regional Organisations. Peace Operations in a Changing Global Order, 213. https://doi.org/10.1007/978-3-319-99106-1_11

Houéto, D. (2019). The social determinants of emerging infectious diseases in Africa. MOJ Public Health, 8(2), 57-63. https://www.researchgate.net/profile/David-Houeto/publication/331732224_The_social_determinants_of_emerging_infectious_diseases_in_Africa/links/5cebad0ea6fdccc9ddd2443b/The-social-determinants-of-emerging-infectious-diseases-in-Africa.pdf

Ibrahim, A. M., & Adekanye, S. (2021). DESIGN AND IMPLEMENTATION OF INTELLIGENT SYSTEM FOR DETECTION AND ANALYSIS OF EBOLA DISEASE. Theoretical & Applied Science, (5), 1-17. https://doi.org/10.15863/TAS.2021.05.97.1

Iversen, P. L., Kane, C. D., Zeng, X., Panchal, R. G., Warren, T. K., Radoshitzky, S. R., … & Saunders, D. L. (2020). Recent successes in therapeutics for Ebola virus disease: no time for complacency. The Lancet Infectious Diseases, 20(9), e231-e237. https://doi.org/10.1016/S1473-3099(20)30282-6

Kapiriri, L., & Ross, A. (2020). The politics of disease epidemics: a comparative analysis of the SARS, Zika, and Ebola outbreaks. Global Social Welfare, 7(1), 33-45.Languon, S. and Quaye, O., 2019. Filovirus disease outbreaks: a chronological overview. Virology: Research and Treatment, 10, p.1178122X19849927. https://link.springer.com/article/10.1007/s40609-018-0123-y

Mayhew, S. H., Kyamusugulwa, P. M., Bindu, K. K., Richards, P., Kiyungu, C., & Balabanova, D. (2021). Responding to the 2018–2020 Ebola virus outbreak in the Democratic Republic of the Congo: rethinking humanitarian approaches. Risk Management and Healthcare Policy, 14, 1731. https://dx.doi.org/10.2147%2FRMHP.S219295

Nagai, M., Oikawa, M., Tamura, T., Egami, Y., & Fujita, N. (2020). Can we apply lessons learned from Ebola experience in West Africa for COVID-19 in lower income countries?. Global Health & Medicine. https://doi.org/10.35772/ghm.2020.01028

Nkangu, M. N., Olatunde, O. A., & Yaya, S. (2017). The perspective of gender on the Ebola virus using a risk management and population health framework: a scoping review. Infectious diseases of poverty, 6(05), 1-9. https://doi.org/10.1186/s40249-017-0346-7

Platto, S., Zhou, J., Wang, Y., Wang, H., & Carafoli, E. (2021). Biodiversity loss and COVID-19 pandemic: The role of bats in the origin and the spreading of the disease. Biochemical and biophysical research communications, 538, 2-13. https://doi.org/10.1016/j.bbrc.2020.10.028

Raza, A., & Rahman, M. A. (2020). Ebola virus disease prevention and control. International Journal, 3(1), 419. https://www.researchgate.net/profile/Mohmmad-Amil-Rahman/publication/340077855_Ebola_virus_disease_prevention_and_control/links/5e75ee65299bf1892cfc4655/Ebola-virus-disease-prevention-and-control.pdf

Rohan, H., & McKay, G. (2020). The Ebola outbreak in the Democratic Republic of the Congo: why there is no ‘silver bullet’. Nature immunology, 21(6), 591-594. https://www.nature.com/articles/s41590-020-0675-8

Schwartz, D. A. (2019). Maternal and infant death and the rVSV-ZEBOV vaccine through three recent Ebola virus epidemics-West Africa, DRC Équateur and DRC Kivu: 4 years of excluding pregnant and lactating women and their infants from immunization. Current Tropical Medicine Reports, 6(4), 213-222. https://link.springer.com/article/10.1007/s40475-019-00195-w

Schwartz, D. A. (2020). Being pregnant during the Kivu Ebola virus outbreak in DR Congo: the rVSV-ZEBOV vaccine and its accessibility by mothers and infants during humanitarian crises and in conflict areas. Vaccines, 8(1), 38. https://doi.org/10.3390/vaccines8010038

Sivanandy, P., Jun, P. H., Man, L. W., Wei, N. S., Mun, N. F. K., Yii, C. A. J., & Ying, C. C. X. (2022). A Systematic Review of Ebola Virus Disease Outbreaks and an Analysis of the Efficacy and Safety of Newer Drugs Approved for the Treatment of Ebola Virus Disease by the US Food and Drug Administration from 2016 to 2020. Journal of Infection and Public Health. https://doi.org/10.1016/j.jiph.2022.01.005

Tuite, A. R., Watts, A. G., Khan, K., & Bogoch, I. I. (2019). Ebola virus outbreak in North Kivu and Ituri provinces, Democratic Republic of Congo, and the potential for further transmission through commercial air travel. Journal of Travel Medicine, 26(7), taz063. https://doi.org/10.1093/jtm/taz063

Vivalya, B. M., Ayodeji, O. A., Bafwa, Y. T., Muyisa, L. K., Piripiri, A. L., & Mbeva, J. B. K. (2021). Analysis of the management of the tenth Ebola virus disease outbreak in the Democratic Republic of Congo: developing a multidisciplinary response model to strengthen the healthcare system during disease outbreaks. Globalization and Health, 17(1), 1-7. https://link.springer.com/article/10.1186/s12992-021-00775-4

WHO. (2020). Ebola then and now: Eight lessons from West Africa that were applied in the Democratic Republic of the Congo. Who.int. Retrieved 19 March 2022, from https://www.who.int/news-room/feature-stories/detail/ebola-then-and-now.

World Health Organization. (2018). Risk communication and community engagement preparedness and readiness framework: Ebola response in the Democratic Republic of Congo in North Kivu. https://apps.who.int/iris/bitstream/handle/10665/275389/9789241514828-eng.pdf