In previous Outbreak Thursday posts, we have discussed various contexts of the ongoing Ebola outbreak in the Democratic Republic of Congo (DRC), including response operations in conflict areas, enhancing response efforts, and the importance of contract tracing and monitoring. This week, we revisit the outbreak with a specific focus on funding the response efforts.

Previous Response Funding

Controlling outbreaks and preventing further disease spread can be costly. According to the US CDC, response funding for the 2013-16 West Africa Ebola epidemic reached more than $3.6 billion by December 2015, of which more than $2.3 billion was donated by the US. The overall funding provided by the US was given to numerous implementing partners, including the WHO, International Rescue Committee, Red Cross, Mercy Corps, and World Food Programme as well as the US CDC and other national governments to support the many activities encompassing response operations. Of the $3.6 billion that went toward the West Africa Ebola response, the WHO reported receiving more than $459 million from governments and multilateral organizations to manage the health-related response activities. During the previous Ebola outbreak in DRC—which lasted from May 8 to July 24, 2018—response funding totaled $63 million, of which approximately $36 million contributed directly to WHO and its activities.

Current Situation

The current outbreak in DRC is the second largest recorded Ebola outbreak in history. As of March 5, the DRC Ministry of Health reported a total of 907 confirmed and suspected cases with 569 deaths. Last week, the WHO Director-General Dr. Tedros Adhanom Ghebreyesus called on the international community to mobilize funding for the outbreak to avoid the risk of slowing response efforts. The WHO stated that the strategic response plan for the current period, February to July 2019, requires $148 million, and funding is urgently needed for partners to continue their on-the-ground response operations. As the outbreak continues to grow, the strategic response plan for the current 6-month period is predicting a larger budget than that of the two previous response plans for this Ebola outbreak. The first strategic response plan, which lasted from August to October 2018, budgeted approximately $43 million, and the second strategic response plan, covering October 2018 to January 2019, estimated $63 million for response operations.

While the WHO utilizes its Contingency Fund for Emergencies to respond to outbreaks and supplement funding gaps when needed, this fund is primarily used to allow for immediate response and assistance when outbreaks begin, before other funding is mobilized. The plea for donors to fund the current strategic response plan allows the WHO and its partners to continue their response efforts without placing further strain on the Contingency Fund for Emergencies.

Shortly after the WHO’s request for donors, the World Bank issued a press release detailing its funding pledges for the current 6-month accelerated response plan. The Pandemic Emergency Financing Facility (or “pandemic insurance”) approved the release of up to $20 million within 3 days of the request by the DRC government. Half of these funds were released immediately, with the remaining funds released within a month. The World Bank also made available $60 million in grants and credits through the International Development Association. Most recently, Wellcome Trust announced a pledge of $2.6 million to support vaccine research, a component of the Ebola response. With more than half of the requested $148 million to support the DRC Ebola response efforts already pledged, we hope the remaining funds can be provided by governments and multilateral or non-governmental organizations as expediently as possible.

Security Concerns Hindering Response Efforts

The combination of ongoing armed conflict, inadequate public health and healthcare infrastructure, and highly mobile populations is hampering response efforts, and additional funding is needed to escalate the response. With active conflict in the area hindering surveillance, contract tracing, ring vaccination, and other response activities, this Ebola outbreak has continued to grow and present a public health threat. The existing security threats have resulted in various responding organizations scaling back their presence from DRC or leaving altogether in an effort to protect the safety of their healthcare workers. Notably, the US government announced its decision to withdraw CDC and other government officials in the early stages of the outbreak over security concerns. Most recently, following the attack of 2 Ebola treatment centers, Médecins Sans Frontières (MSF) suspended their activities in Butembo and Katwa, both hotspots in this Ebola outbreak. The loss of organizations with experience in Ebola response operations places further strain on the DRC Ministry of Health, WHO, UNICEF, and other remaining responders and increases the risk of continued disease spread in affected areas with limited access to care. With the many challenges facing the current Ebola outbreak, and in some instances fueling the outbreak, ensuring that adequate funds are readily available to escalate the operational response activities is all the more important.

Conclusion

This is not the first time Outbreak Observatory has discussed the importance of increasing financial support for outbreak response operations in our weekly posts. Additionally, in a recent Perspective piece for The New England Journal of Medicine, Dr. Tom Inglesby, Director of the Johns Hopkins Center for Health Security, and Dr. Jennifer Nuzzo, Senior Scholar at the Center and Principal Investigator for the Outbreak Observatory, stressed the need to ramp up the Ebola response including increasing financing efforts before the outbreak became “far harder and more expensive to stop,” a concern that is becoming increasingly relevant. Ensuring adequate funding for the next six months of activities detailed in the strategic response plan will be vital for the internal efforts to control this outbreak.



Photo: Epidemiologist in full PPE performs a rapid diagnostic test for Ebola while in the field. Photo courtesy of CDC.

Outbreak Observatory aims to collect information on challenges and solutions associated with outbreak response and share it broadly to allow others to learn from these experiences in order to improve global outbreak response capabilities.