COVID Era Echoes at Nairobi Airport Amid Ebola Threat

Upon landing at Nairobi’s Jomo Kenyatta International Airport in June, I felt like I was stepping back into the COVID-19 pandemic period. Officials, donned in blue gowns, masks, and goggles, guided the exhausted travelers past a thermal sensor to check for fevers. Additionally, we were required to scan a QR code for contact tracing. Just two days prior, Kenya’s high court had suspended a plan to send Ebola-exposed Americans from nearby nations to quarantine in the country. Yet, the government proceeded with the plan, which sparked violent protests resulting in the deaths of two Kenyans. Fortunately, Kenya has reported no Ebola cases thus far, and the citizens are keen to keep it that way. In contrast, neighboring Uganda has confirmed 16 cases and one death, while the Democratic Republic of Congo, the outbreak’s origin, has seen 363 cases and 63 deaths. Most experts believe these numbers may be an undercount. The situation appears to be deteriorating.

This Ebola outbreak poses a significant threat, potentially becoming the worst in history. Case numbers have escalated at an alarming rate. This particular strain, known as the Bundibugyo virus, is challenging to detect and, notably, lacks an available vaccine. It’s affecting one of the most unstable regions in one of the globe’s most vulnerable states. At a time when prosperous nations, especially the U.S., appear to be withdrawing from supporting these vulnerable areas, the impact is concerning.

While the reduction of USAID did not initiate this Ebola outbreak, it certainly emboldens the virus. It likely led to delayed detection and compromised efforts to deliver testing and treatment. Furthermore, it dismantled carefully built networks of trust and slowed the overall response to the crisis.

“There are resources we usually rely on that aren’t available anymore,” a former USAID health official based in Nairobi shared, requesting to remain anonymous due to potential backlash. Cuts have reduced surveillance systems, early warning mechanisms, and the number of healthcare workers on the ground.

A cohesive response could have turned this epidemic into a manageable situation. Instead, what we face is an unpredictable emergency that has the capacity to cause substantial deaths and further destabilization in a region that is already precarious and critical to various U.S. interests.

The current Ebola crisis began in Mongbwalu, a mining town in the Ituri province of Congo. This area has been marred by conflict, with armed groups vying for control over its resources, particularly gold. Here, entire economies revolve around mining: workers, some of whom are children, labor for long hours, and women often find work in domestic tasks or selling sex. These towns are challenging places to live, characterized by transience and a general distrust of outsiders. Sexual violence is unfortunately prevalent. Around 7 million people are displaced within Congo, primarily in the eastern provinces, including Ituri. Many others have sought refuge in Uganda and Burundi. Within weeks of the initial Ebola case confirmation, cases have also appeared in Goma, a rebel-controlled city close to Rwanda, and in Kampala, the Ugandan capital—both over 350 miles from Mongbwalu.

Mongbwalu is quite remote; however, prior to last year, USAID workers were present in Goma and Kampala.

The reach of USAID was immense. Before its cuts, the agency employed over 10,000 individuals globally and had a hand in more than 5,000 projects, including those focused on pandemic preparedness and infectious disease control. Unfortunately, its disease surveillance mechanism was largely dismantled with the agency. With no support from USAID, the transportation of Ebola samples from suspected outbreak zones to Kinshasa for testing faced significant delays, compromising the response. While the World Health Organization became aware of potential issues in early May, it too has suffered funding cuts, losing U.S. support. Reports indicate that American officials did not learn of the outbreak until over a week after the World Health Organization’s initial notification.

It’s clear that while systemic breakdowns contributed to the situation, the sheer scale of the outbreak quickly strained available medical resources, including tests and PPE. “We’ve never witnessed an Ebola outbreak beginning at such a scale,” noted Trish Newport, an emergency program manager for Doctors Without Borders, who led efforts during prior outbreaks in Congo. “Typically, supplies are stocked for a manageable number of cases, not something this vast and far-reaching.”

But the initial shock only tells part of the story. “You need infrastructure to ramp up response efforts,” she emphasized. “That’s where the challenge arises.”

The U.S. withdrawal from international health organizations and the dismantling of USAID’s resources have both played roles in allowing Ebola to spread unchecked, according to various experts. “Transport networks for samples that would have been established for other viruses could have been utilized,” stated the former USAID official. “It’s not merely that we eliminated global health programs; we also cut vital malaria and HIV programs that had built-in infrastructures that could mobilize quickly when a health crisis emerged.”

Drawing from an earlier mpox outbreak in Kenya, which predominantly affected marginalized populations, the former official remarked on how, even without a direct USAID presence, partnerships and pre-established networks enabled quicker responses. It was easier to train familiar health workers about emerging diseases when USAID’s structure was in place.

However, now, according to her, “all of that is gone.” The agency’s cuts not only reduced its workforce but also dismantled connections with local groups and contractors who employed community members. These relationships were critical for swiftly mobilizing healthcare efforts.

Community health workers, a group supported by USAID, play vital roles in delivering health improvements across sub-Saharan Africa. I’ve observed them working efficiently in various countries, including Kenya and Congo. Typically, these workers conduct health screenings, promote preventative care, manage chronic illnesses, and advise individuals on hospital visits. They act as the first line of defense during disease outbreaks, helping to identify and guide those with concerning symptoms. Yet with USAID’s absence, the influence and information that these workers could provide have waned.

Communities are often wary of aid workers, and misconceptions complicate responses. In Mongbwalu, local residents, accustomed to other treatable illnesses, grew suspicious when individuals with similar symptoms didn’t return from hospitals. Furthermore, traditional burial practices created barriers when communities resisted health workers trying to implement preventative measures.

Interestingly, while people are aware of Ebola, previous outbreaks offered quicker test results. The current variant is trickier to detect, and the absence of testing facilities outside Kinshasa has left many unsure of their conditions for days, exacerbating distrust toward external healthcare.

Ituri, the outbreak’s heart, is fraught with conflict, and community trust is crucial. As Newport explained, “we must discuss trust, which ties back to lab capabilities. If we can’t provide definitive answers regarding Ebola, we risk losing community confidence.” Aid initiatives can sometimes feel misappropriated, as locals question the influx of resources when basic needs remain unmet. Newport highlighted that during past crises, building infrastructure like wells was critical in establishing trust before addressing more pressing health issues.

Once clean water was established in affected areas, communities expressed a desire for medical support. Newport recalls their request for an Ebola isolation unit, indicating how addressing foundational needs can, over time, pave the way for necessary health interventions.

Urgent challenges facing health responses include enhancing laboratory capabilities and swiftly executing humanitarian responses that consider community needs. Newport pointed out that without proper systems, unintended consequences could arise. Effective responses must protect vulnerable populations from potential exploitation by aid workers, as seen during prior crises.

Experts agree, timely responses aren’t just about saving lives—they also help limit potential spread, a global concern. “There’s evident anxiety among other countries about the contagion reaching them,” Newport remarked. Without effective measures to identify who has Ebola or identifying close contacts, the risk of further spread remains a significant worry.

On a brighter note, Ebola isn’t airborne and isn’t nearly as contagious as other viruses, such as COVID-19, making a global pandemic unlikely. There are experienced individuals and organizations ready to respond based on previous lessons learned.

However, the troubling news remains the loss of one of the key organizations addressing such outbreaks—USAID. Experts have warned that dismantling public health frameworks could eventually have negative repercussions for U.S. citizens as well. Time will tell just how substantial those effects might be.