Ebola’s Return to DR Congo and Uganda Is a Brutal Indictment of Global Health Failure -By Fransiscus Nanga Roka

Ebola returns to DR Congo and Uganda, but the real scandal is that it was never really gone or at least not from those political conditions which enable its return We are not simply biological events in every new case. It is a sign not simply of national failure, or even subnational nor regional failure: it proves the intractable inability to harness momentum into protection within neglected state actors and complex international health regimes. Each time Ebola incursion happens in Central Africa, the world hits panic buttons with familiar solemnity and finds familiar ways to plead for funding as though it was a bargaining tool of urgency. It then makes their old error all over again: treating the outbreak as a standalone emergency rather than a foreseeable outcome of systemic neglect.

It still feels like the global health system is paying lip service to Ebola. They term it as a persistent threat, yet respond to each reappearance in the manner as if recurrence were inconceivable. It is not. Outbreaks of Ebola in DR Congo have historically arisen amidst contexts of fragile health infrastructure, insecurity, erratic surveillance and public trust related to underfunded frontline care. So many neighbors most with less outbreak management experience than Uganda’s have no option but to accept the simple truth: a virus is indifferent to borders and regional preparedness would be only as strong as its weakest link. Having to scratch your head every time Ebola goes from district to another, province or even frontiers is not cautious. It is institutional self-deception.

Whatever is now happening in DR Congo and Uganda ought to be seen not merely as an emergency for public health but a condemnation of our politics. The “Greatest Pandemic of Our Time” which had predictable spread, predictable containability and predictably-risky settings – should not expose such staggering systemic frailty. There is nothing magical about these tools: quick diagnosis, rigorous contact-tracing and community buy-in to the processes of safe burials, capacity for isolation of suspected cases or sick health care workers (HCW), provision with PPEs at all levels in the health system including risk communication locally managed and coordinated across borders along a seamless continuum from prevention through treatment on into longer-term financing. All this is not new in principle. But the repeated cycles of Ebola crises show that, in this case at least) science is not really the missing piece. It is political seriousness.

And here the international community, so often criticized. Global health solidarity bursts into flames in the planetary crisis inception days but fades to bone-weary ash and dust once it becomes fundamental institution work. They are better funded than retaining local workforces for emergency deployments. More attention to vaccine stockpiles than rural clinic resilience High level pronouncements outpace laboratory capacity. Internally, that means the world is still no better than for showmanship in responding rather more strategically about close to prevention. As a consequence, African outbreaks are reduced to spectacles fleetingly visible, thoroughly securitized and catapulted into the moral limelight of world attention only to be again relegated back into the shadows of donor fatigue or geopolitical distraction.

The double standard stares you in the face. Where infectious threats might overturn wealthier parts of the world, preparedness exercising language is urgent and strategic and well financed. However when the burden is borne unfairly but predictably by African states that are already shouldering the burdens of conflict, poverty and administrative fragility then its response all too often falls into a pattern of managed lament. Intended or not, the message is unambiguously distressing: some outbreaks are treated as world emergencies and others simply local tragedies tied to an international commentary. This hierarchy of human importance is painfully clear with regard to Ebola in the DR Congo and Uganda.

On the other hand, there is little excuse for individual nations shoring up blame on a global abandonment. In DR Congo and Uganda, the political will to put public health systems first is as significant a bulwark against outbreaks as any international response. Crisis task forces are easier to assemble than trustworthy primary care models. Emergency measures are easier to declare than curing long-standing shortages of trained personnel, transport networks, diagnostics and infection control capacity. If there’s one loan gorilla point here, it’s that while it is much easier to militarise health emergencies than it ever will be to win legitimacy in communities who have learnt through bitter experience to distrust distant authorities. The state arrives late, communicates badly and governs without legitimacy. The Ebola virus spreads in this soil.

The credibility is not an ancillary issue; it is the theater of war. When communities perceive the outbreak as manipulation, mask symptoms of illness or other deaths (or to disguise burial) and view health teams primarily as enforcers rather than protectors. Public health messaging cannot succeed through command alone, least of all in places already defined by conflict and displacement where these people have been left behind for generations. Trust is not a fluffy add-on to containment. It is containment. A communications afterthought is not merely an ineffective strategy when it comes to community engagement. It is dangerous.

This is why the Ebola return should demolish this comforting myth that preparedness is chiefly a matter of getting technical elements right. It is political, social and moral. Not only do labs matter, but whether or not citizens believe authorities are telling the truth matters. Vaccinations are important, however is whether or not well being methods can ship them shortly and equitably. Border screening: Yes, but does immediate data sharing occur with neighbors? Do agreement and execution exist or do nations yield to the instinct of the bureaucracy everywhere–to hide their own vulnerability from others (and themselves)? A weak state cannot substitute distrust with protocol, like an unequal global order cannot compensate for neglect with press releases.

What, then, must change? Second, an ongoing and integrated cross-border surveillance architecture is needed between these two countries that will not be improvised once transmission of disease starts to accelerate. The purpose of Ebola is not to prompt regional coordination, but rather for a system long-since made ready. This will require first building deeper, more resilient district and community health systems, the prevalent sites of detection for outbreaks but also all too often their earliest point of failure. Third, outbreak strategy must center on community trust by mobilizing local leaders, religious authorities and survivor networks not as symbolic partners but operational actors. Fourth, this funding must be reoriented from lurching between short-lived emergency bail-outs to an enduring focus on resilience that includes mechanisms of accountability for preparedness going beyond monitoring solely activities during crisis. Last, international agencies must abandon their rewards for performance-based emergency management and invest in the slower less showy work of institutional permanence.

The hardest fact is that there will be future deaths from Ebola in Central Africa, and they wont all been the result of the virus alone. They will also be caused by political amnesia, donor inconsistency, bureaucratic inertia and the universal tendency of averting a crisis with readiness. This is why this outbreak goes beyond a medical event. It is a reflection of a world that can speak the language of preparedness but has never really embraced its requirements.

Crisis of Ebola return to DR Congo and Uganda is not a weird as the virus itself. It is shocking because of this familiarity with the failures. The science exists. The lessons exist. Warnings have been in place for years. If the outbreak is to extend in these circumstances, then that could not be disease control which it appears seem generations. It is a question about the credibility of governments, institutions and indeed with an international order for health that all too often comes late to unstoppable preventable suffering.

Fransiscus Nanga Roka

Faculty of Law University 17 August 1945 Surabaya Indonesia