In early January, the World Health Organization (WHO) announced that the number of people killed by a measles epidemic in the Democratic Republic of the Congo (DRC) has passed 6,000. It added that the epidemic, which affected more than 310,000 people since the start of 2019, is the world’s largest and fastest moving. According to Doctors Without Borders (MSF), three-quarters of those who have died are children.
Measles, a highly contagious airborne infection causing fever, coughing and rashes, can be prevented through a two-dose vaccine, which has been available since the 1960s. Eradication of the disease, however, has not been possible, especially in developing countries like the DRC, for multiple reasons.
According to the WHO, about 86 percent of the world’s children received one dose of measles vaccine by their first birthday through routine health services in 2018 – up from 72 percent in 2000. As a result, the number of measles deaths across the globe decreased by about 80 percent between 2000 and 2017, despite a recent surge in the number of infections in Europe and North America, caused by the growing anti-vax movement.
However, “a low vaccination coverage among vulnerable communities, malnutrition, weak public health systems, outbreaks of other epidemic-prone diseases, difficult access by vulnerable populations to healthcare and insecurity that has hampered response in some areas” allowed the disease to spread like wildfire in the DRC and kill thousands.
Despite the devastating death toll, the international community paid little attention to the outbreak. While a few media outlets reported on the rapidly growing epidemic and the dire lack of funds to confront it, the resulting devastation remains largely uncovered – not even remotely matching the panic and concern over the ongoing coronavirus outbreak.
The highly mobile viral disease, officially known as COVID-19, has been dominating global headlines since the beginning of the year. The virus’s capacity to diffuse quickly and easily across the borders, coupled with the relative lack of knowledge about its severity, made COVID-19 the international community’s number one concern, with the WHO declaring it a global pandemic on Wednesday.
The ensuing panic rapidly overshadowed other massive, yet locally contained, epidemics, like the measles outbreak in the DRC, both in attention and resources. The equation, once more, appears to be the more distance – physical or imagined – the less interest, compassion and engagement.
Moreover, the fact that measles is a widely known, less mysterious disease that can be prevented with a simple vaccine, caused the international community and media to pay less attention to the outbreak. The Ebola epidemic, for example, which killed about 2,000 people in the DRC since 2018, received much more attention and resources. Nineteen months after the start of the outbreak, the last Ebola patient was recently discharged from a hospital in Beni, a city in the North Kivu province of eastern DRC.
As the international community failed to respond to the crisis efficiently, the DRC government also found itself unable to contain the outbreak, for a host of reasons, not all of which are linked to war or corruption.
Political context and response
The measles outbreak has been ravaging the DRC since 2018, but the formal declaration of an epidemic came only in mid-2019. This dangerous delay was partly the result of a post-election political power vacuum in the country. When the first measles cases were reported, a government had not been formed yet and ministries were operating through interim staffing. This political-institutional deadlock exacerbated existing challenges in handling public health emergencies, making a prompt response – including prevention, surveillance and treatment – more difficult.
Since new President Felix Tshisekedi assumed office in early 2019 after a much-disputed election, he began outlining political reform and governance innovations in various sectors and provinces, including eastern DRC, where more than 100 armed groups continue to vie for local power.
With the support of aid agencies, the DRC government is reported to have vaccinated more than 18 million children below five in 2019. However, in certain areas, routine vaccination coverage remains low and 25 percent of the reported measles cases are children over the age of five. In addition to low immunisation and vaccine rates, widespread malnutrition is reported for at least 48 health zones across the country.
Moreover, the weakness of the public health system and its inability to cover – geographically and economically – basic healthcare needs has cleared the way for a quicker spread of the measles outbreak. Humanitarian agencies estimate a countrywide vaccine coverage of at least 95 percent to be necessary if the DRC was to have a shot at combating this outbreak.
To contain this epidemic, the DRC government needs to improve health services and vaccination coverage, including in rural, hard-to-access areas. This would also bolster access to more consistent healthcare for vulnerable populations and thus help prevent future outbreaks.
But the government is unlikely to be able to achieve this alone.
Regional health emergency vacuum
The DRC government undoubtedly needs support to contain the epidemic, but the much-needed help does not seem to be on offer, even on the continent.
Just like the international community, regional African powers also failed to respond to the epidemic in the DRC efficiently.
In recent years, many countries on the continent proved their ability to defeat epidemics. For example, in response to a 2019 measles outbreak in neighbouring Uganda, the government embarked on a swift, five-day immunisation campaign in which approximately 19 million children below the age of 15 received the combined measles-rubella vaccine. This makes 43 percent of Uganda’s population.
Efficient response to an epidemic in one country, however, rarely translates into a regional response. From Ebola to measles, the ability of African countries to work together in containing regional health threats remains shaky. Even the countries who have the capacity to help fight epidemics beyond their borders often fail to do so as a result of existing political tensions and suspicions. Consequently, regional solutions to epidemics never materialise, making countries in need solely dependent on international powers.
This, however, does not need to be the case.
The Africa Centres for Disease Control and Prevention (Africa CDC) is responsible for ensuring African nations exchange knowledge and share expertise in the face of major health emergencies. It should thus work to get regional powers together to respond to the measles outbreak in the DRC. African countries are better placed and equipped than foreign NGOs and institutions to tackle the public health crises in their backyards.