 Good morning and welcome to this morning's issue briefing fighting Ebola My name is Ryan Morehart and I lead the forum's work on global health security and in today's briefing will hear from three distinguished panelists Each representing organizations on the front lines of efforts to strengthen health security in Africa Across Africa an acute public health event is reported every four days and globally the frequency of disease outbreaks has been rising at At the same time we know that in infectious disease threat anywhere could be a threat everywhere and These outbreaks and epidemics have considerable impacts on lives and livelihoods in fact our collective vulnerability to the societal and economic impacts of infectious disease crises is increasing and today in the Democratic Republic of the Congo Responders are again battling Ebola And now the second largest Ebola epidemic in history The first being the one in West Africa several years ago that cost 11,000 lives over 11,000 lives and over 53 billion dollars those three affected economies The outbreak in DRC has been called one of the most complex outbreaks ever and Meanwhile we heard from Secretary General Guterres earlier this week That the United Nations only has 15 percent of what it needs to fight the Ebola epidemic for the remainder of the year in DRC To tell us more about the situation in DRC as well as overall efforts to protect lives and livelihoods in Africa from infectious disease threats It is a privilege to welcome our three panelists Brian Chirombo acting representative here in South Africa for WHO Nema Kaseje From the medicine San Francie doctors without borders and Dr. John Kenesong Director from Africa Centers for Disease Control and Prevention We'll hear from each of our panelists and then in a remaining time. We'll take questions here from the floor To get us started Brian Could you provide some insight into the ongoing response and what what are our priorities now, but also going forward? Thank you very much for this opportunity The outbreak in the DRC as you have given the background is actually the 10th in the DRC itself and DRC has had outbreaks of Ebola since 1972 and largely they've been able to control them because they've largely been in the Outlying areas not in the big cities the current outbreak started in August 2018 and It has up to date. We have just over 3,000 people who have been confirmed or we have had Ebola both confirmed and Probable cases and we have just gone over 2,000 deaths. So it has been quite a massive outbreak There have been almost 200,000 people who have been contact trace now in terms of Whether we are making progress with the response We actually are even though of course the numbers are quite big The response itself has been very good. We do have we have had some political issues But in general the leadership the president has led from the front, which has been very critical The different pillars of the response have been put in place The partners have really come together compared to the West Africa epidemic where we did have some challenges with partnership In this in this outbreak the partnership has been very strong and the other different pillars of the response have been very good public health response the Partnerships the resource mobilization and other aspects have actually been quite good So we are making good progress in terms of moving forward some of the aspects that have come in place is vaccination which is helping new Interventions drugs that are being used they are investigational but have actually been also used there's been very good cross-border collaboration which has been critical and But what I wanted to highlight is the root causes Of the outbreak is actually the weak health systems and that's where the focus really needs to to to be put in For example, you've mentioned the cost of the response. It's actually astronomical and if you give example the World Health Organization in its response almost 80% of our resources have actually gone to the response for the country over the last two years Instead of strengthening health system. So but what do I mean by is the health systems now when we look at the DRC? the DRC is number 176 out of 189 countries in terms of the human development index the coverage of immunization is Only 35% so which shows that the systems are extremely weak They are frequent outbreaks of measles and other other diseases the And I think I've highlighted the cost of it and I think you have also highlighted that so I think three messages that I would like to emphasize One unless we invest in the health systems We are always going to be chasing out out of these outbreaks We really have to address the capacities of countries in terms of International health regulations as defined by the international health regulations Secondly diseases don't apply for borders for visas across border. So the cross border Interaction needs to really take place and that's what will strengthen the response and finally the whole international community private public and all partners civil society have to really hold hands together and it is good that in this response That is happening, but that's critical for us to be able to address the Thank You Brian Thank You Brian John. Let's go to turn to you John We've just heard from from from Brian some of the progress and priorities moving forward Sitting at Africa CDC. What are you seeing there in DRC, but also as you look forward? Thank you Ryan for including me as part of the Africa Center. So disease control and prevention on this panel we There are several lessons that we learned from the West Africa disease outbreak which was devastating which clearly position in node On certain terms the importance of disease threats for the economy and for the security of the region So I reflect from where I sit mean this is saying that you are standing any issue is where you sit From the African Union perspective we There's a lot of things that get done. I've spent two and a half years at the African Union and I'm trying to stand up a new center for disease control and prevention and I think them the turn to Not highlight the work that the Union or the Commission is doing in the most appropriate way When the West Africa Ebola outbreak occurred the head of states took a decision to establish a Centers for Disease Control and Prevention Similar to what the United States did after the malaria outbreak after the second-wave war Establish the US CDC China establish the China CDC in 2005 after the South outbreak and the European CDC I think that much is not really talked enough I think that's one of those big things that happen after that outbreak so since then we have a center up and running We currently have about 60 people in the field a theater of respond for such a young organization and entirely supported by the member states funding, okay entirely 100% of that What we have used in responding to this outbreak has been from the member states I think that much needs to be mean for such a political organization That is learning to transition from being a political entities strictly to and becoming a Establishing agencies that go into implementation. I think that much has to be said. So let me Say that each outbreak has its own characteristics We thought we knew everything about the West Africa Outbreak and that next time we occur we took it would take the formulas apply it in the IRC and then we would get it Over after all, we know the five things that you can do without even vaccines or treatment to control Ebola We know them very well contact tracing test the people do Community engagement and psychological support. It's not the case in the IRC because of what they call it from the WHO Said we are now in a zone Where this conflict went on for forever? They mean the traditional tools that we know are falling apart this community Distrust so that has pushed our ability to respond outwards I mean and it's draining resources considerably into the the theater of Respond in all of that the government's leadership is important in in all of this we have all Aligning behind the leadership of the government of the DRC to respond because it is the responsibility of That country to ensure the security the health security of its citizens Not not not partners so partners come in to support them So I'm also agreeing with a they call it from WHO that capacity building both national level and regional level And global level is very very important We have to structure the discussion in such a way that there's some governance as to what we do and And begin to take ownership back to the country so that and responsibility so that they can actually move forward with their own health system strengthening and As infrastructure, let me just give you one one one share one reflection during the nine-hour break We wrote a commentary in the Lancet where we said We've learned all these lessons from West Africa and the nine-hour break, but the most important lesson is that we should have DRC so support the RCS to establish is national public health institutes that can conduct surveillance all the time and Pick these things early before they happen where we're not given the chance to even finish that commentary then the 10 hour break occurs So that commentary became irrelevant because we were all again into a respond mode if we had if DRC had had their own national public health institute that Conducted community surveillance event based on we would have picked up this outbreak very early on because If you trace the timing of this outbreak When we were in Bandaka in the western part of DRC, this outbreak was already going on But because of we had no systems in place there. We didn't know okay Nobody knew that that outbreak and if you recall the outbreak the nine-hour break was declared over Like a week early and then a week later this outbreak was only and it was not in the war zone at that time It migrated into the war zone So I'm a totally in agreement with our WHO colleague that is supporting the country to establish a functional national respawn Unit or a public health institute like what China did what the Europeans did what the United States is Fundamental in that it would have costed us half or even one tenth of what we are currently putting into the theater of responders So at the African Union that is the position we are taking we are supporting them DRC to respond to it and put off the fire But dialogues are already ongoing with the DRC with respect to how can we build a coalition and Partnership to strengthen them to have their own national public health institute that can truly have In the network manner in the country the population of DRC when the first Ebola outbreak was was reported in 1976 was a little bit over 20 million about 23 to be very specific that was 1976 today We are doing in a country that has a population about 90 million people It means the same mass area We've been almost quadrupled the number of people living there. They are encroaching into different areas to for their protein needs disrupting the ecology in a way that I mean was is unprecedented and Besides the weak system we have to pay attention to the re-emergence of these diseases that the Ebola strains we are dealing with in This current outbreak are new transmissions from from zoonotic transmissions from the reservoir Okay, there are two new subtypes not even genotype subtypes that have been introduced into the population So again, that suggests that we need a more holistic approach to this and Work with the government of DRC and put them at the forefront of this response Thank you, John and John one of the things you mentioned was was applying formulas You know, we've gone through this now the the tenth outbreak and and as you said We're applying the formula from the from the ninth and we're hitting a wall And one of the reasons NEMA that we've been hitting a wall is and John mentioned it is community mistrust Could you say a little bit more about what it takes to to build trust in Communities like this during such a crisis First of all, thank you for the opportunity to be here and to participate in this panel and I'll start out by saying that trust is absolutely it's fundamental to any kind of health intervention and Right from when someone decides to even come to your to your facility to get care So if they don't trust your facility or what you're providing us a solution They will not come and once they get there if they don't trust you they won't tell you about their symptoms So there's no way you can actually find out that something is wrong and once you give them the diagnosis If there's no trust they won't agree with the treatment. They would agree with being quarantined So trust is is fundamental and in addition to the mistrust there is also ongoing misinformation about about the outbreak about what What partners are coming to do what the humanitarian is coming to do So that is also an issue in addition to the mistrust And I believe that the the solution to to the mistrust and the misinformation is that it's not not just Community engagement because engagement sometimes means you go in you talk to the leaders It's it's it's giving them leadership is putting them in the driver's seat Giving them the opportunity to frame the issue And so that you also understand well, how do they perceive this? do they actually even see Ebola as a problem and what do they feel is the solution and Do their priorities align with what you believe is it? so that's absolutely important at this stage because what we're doing with though we're making progress the situation is still not under control and and and The only way I think is to not only engage with the communities But put them in the leadership role so that they're framing and developing the solutions together with all the partners and the government And I think that they'll be like the only The only way forward the other The other thing I'd like to highlight in addition to what my co-panelists have Discussed is the fact that women are children and children are more affected by this outbreak than others So 70% of the deaths of the cases are in women and in children and Women because they're the caretakers. They're the one when someone is sick in the home It's the woman who will take care of that person. So they're more exposed to it and They're more cases in women. So that's something that we need to be aware of and we should be inclusive of women So women should also be in the room at the table Framing the issue and coming up with solutions for this outbreak Thank you. Now my you know on the point on on women and children I think it's also the case and the panelists can agree I hope that that Not only are women and children more affected by the the current Respond the the current epidemic but actually because of a lack of capacity that one of the first Areas of a health system that money is pulled from to support that the crisis in the response is from maternal and child health And so this is a challenge that is You know has cascading consequence in addition to sort of being devastating in its own right We'd like to turn to the floor now. Thank you to our panelists for those interventions I'd like to turn to the floor take some questions If there are any we can take them in rounds And then if there are none we can we also I have a couple more of my own So are there questions from the floor would be great if there were So please we have a microphone coming your way Thanks, could you say more about the cross-border effort say for example between DRC and Rwanda how that Is that done on the bilateral base or was that broken by the AU or how does that have his mechanisms? But it affected and so could you introduce yourself would you mind? I'm sorry Andrew Jones at link places in London And are there others again? I would like to take them in rounds if we could Sure, please ma'am Hi Apologies, I came a couple minutes late. So if my question is already been addressed you just ignore it I guess I was wondering All the recent news about vaccines that seem to be working and treatment that seems to be working I guess My cynical view had expected that it would take longer for the global pharmaceutical Industry to actually come up with solutions for Ebola since it There often be a bias against diseases in places like Africa and so I'm curious What what you all think drove the response from the medical industry to actually work on treatments and vaccines And if you think that has gone well and and what we could learn from it Could you introduce yourself to as well? I'm sorry Katie Hill with liquid telecom. Thank you And we could take one more before we turn to the panelists if there's another one great so To the panelists here is we have a question on cross-border and cooperation at the border and a question on the The role of the of the vaccine that we're seeing in the current response and maybe what it has taken to get there And what's that what's next? So maybe I could respond first to the cross-border and then the others could end so it's it's actually all the above Basically, there has been cross-border work. That's happening between the countries themselves bilaterally. So Is I I think I didn't mention so The DRC is right in the middle of nine countries. So that's one of the challenges Secondly the borders are extremely extremely porous in their four particular countries Where this is this is worse and they are not the five where it's not as bad But it's still a problem. So the cross-border work has been very critical at bilateral But in addition to that and I think John may talk about the EU But in addition to that the World Health Organization has also worked with the East African community and the West African community To actually do some simulations and assist the communities themselves to begin to address some of the cross-border issues So basically it's actually at both levels because it's critical and part of the big problem is between each country. There's so much movement Between them each each day actually, so I think Let me just pick out on that I think there's been a concerted effort I think first of all by WHO in Goma. They had a meeting I think last month where I think at a technical level, but Those are called in front line states together and to discuss technical collaboration But together with WHO and the African Union Commission and Africa CDC We will be convening the meeting ministerial level meeting on the 21st of October In Goma where you bring in all Countries and DRC together to agree on a framework of coordination I think that meeting invitations have been sent out together with them the Commissioner of Social Affairs and Dr. Moeti Discuss in Yokohoma when we were there last week and that that is going to I mean Be addressing that issue that we we thought that bringing everybody together so that you have a framework of understanding How to do this will be very very important. I think It will be the first service kind that I mean all countries not just the front line countries are coming together to agree on a way to share information share data and Address cross border issues. I think one of the things that Which speaks to the importance of the question you just raised is the collaboration between DRC and Uganda When the case that was dictated in Uganda in Cassacy happened It was because of the good information sharing not necessarily data and that trust that existed I mean when I went to Uganda was there almost if not almost on the same day that Dr. Moeti was there We're in the EOC with a minister of health and he said she said this is a really a good example That should be highlighted where immediately that family got into a bus and was driving to Are you beyond that? She was called up and they kept they put everything you check and tracks you because our system even though We have we may have the best surveillance systems in place and it's only as good as the information that you get So that particular piece of just trust and sharing that information Avoided a disaster that could have happened possibly happened in Uganda despite the extensive Preparations that Uganda had put in place. So imagine if they didn't go to Cassacy went through and on control border into Maybe can trust I will be a disaster So that is so important that they need to coordinate efforts to build a trust among member states and share information and data It's another area where trust is coming up We've talked about Nema Nema was talking about trust in the response But now we're talking about trust across borders and in sort of mutual capacities Whether it's for information sharing or just in the health system itself to support a response and we have seen that in twice now To the there's a Any comments on the question here we have on on the role of the vaccine what it has meant that a vaccine is there and Implications of the vaccine Yeah, let me take they take on that. I think we have more better tools In the 10th outbreak than we had in the 9th outbreak and then we've had in the West Africa outbreak Collective I mean in West Africa our break was not controlled because of vaccines or Treatment I mean the vaccines came if you recall towards the end of it was controlled because of the traditional tools that we had We know in dealing with Ebola. I think that is very very clear now We have even better tools the challenge you have now is the application of those tools. I mean and the Ebola situation we all know is it all Centres around finding the individual and the contacts and making early especially for the treatment as we just read a few weeks ago Find it early Treat them with those monoclonal antibodies. You have a 90% chance of success Think the key word is finding them Many vaccines will only work if you find the contacts and then you vaccinate them now with the issues that We just raised about community cooperation. I don't want to use the word resistant the corporation It is it becomes a problematic But somehow I've still see the thanks to this the vaccine that has been used We truly don't know where we would have been with this outbreak if we didn't have the vaccines I mean it could have it would have been probably it might estimate Non-informed by a cent is that if we didn't have a vaccine Yeah, this outbuild have been completely out of out of control So I think we bring it and if you clock them every morning at 9 30 I mean I coordinate the emergency operations center from From a disarmament I connect with Goma Benin Kinshasa then the place is south Sudan Uganda places that that I have people station in and you clearly see that the week that you have violence The new cases go up and the week that may you settle in and there's calm there the cases go down So it's I mean I agree with that Brian that you Well, the response is good. We're doing all we can do but without stopping the violence the medical interventions will be Who take us a while to get to read the benefits Maybe I could add that I think again coming back. It's it's the holistic response. That's going to be critical So definitely a vaccine have had a big impact In the new new drugs, but I think as Johnny said You still have to find the people even when you vaccinate the most effective way is what we call ring vaccination so you actually have to find somebody who is The case and then you vaccinate those around so it's too critical that the system is working So and I think you give the example of Uganda obviously the cross-border interaction was critical, but also the Response in Uganda in I think it took about two weeks from the time of the death of the pastor The crossing of the family to go to the funeral coming back and then the cases and then Investigating them within two weeks the response was in full gear and they were able to ensure That they actually address all the issues the contact tracing etc So for me the critical thing still is that respond the systems have to be in place And these additions will obviously make it much easier if you've got vaccines and the new Investigational drugs would also and just to build on that We won't find the cases unless there is trust unless the community believes in what we're doing believes in our interventions and I agree with you that you're deploying these The vaccines the new medication in a weak health system is very very challenging And so I think something as what that we need to think about In addition to to the emergency response is as you mentioned earlier Building the health system and strengthening the health system and making sure that we are from the humanitarian Sectors, especially we're not creating a parallel system because a lot of the cases are still dying in centers That are not Ebola centers And so we need to make sure that whatever response is ongoing is Integrated within the health system that is there and it's used as an opportunity to to strengthen the health system That's right. I could just add one example of the system which unfortunately I wouldn't show the pictures Yes, but in Uganda when this happened they you could show actually They've dashboards that we have helped them to develop in one of the aspects for example was just looking at each Facility are the frontline workers clear about what Ebola is and how to respond We could show in a dashboard and Uganda has done that by facility which facilities have Frontline workers who actually know what to do and which ones don't have and it's shown Graphically, it's then very easy to know where the gaps are and actually address them So the whole issue of the health system is so key and regardless of what else we throw in the system is not working it's going to be very expensive and We may still not make as much and it won't be sustainable over time So for walking within what's in place where reinforcing it and we are ensuring sustainability Thank you panelists. We're at the end of our time today So thank you to each of you for providing remarks and for continuing your work to strengthen health security in Africa And thank you to our guests here and enjoy the rest of our forum on Africa. Thank you