The exacerbation of Ebola outbreaks by conflict in the Democratic Republic of the Congo

PNAS – Proceedings of the National Academy of Sciences of the United States
of America

http://www.pnas.org/content/early/
[Accessed 26 Oct 2019]

The exacerbation of Ebola outbreaks by conflict in the Democratic Republic of the Congo
Chad R. Wells, Abhishek Pandey, Martial L. Ndeffo Mbah, Bernard-A. Gaüzère, Denis Malvy, Burton H. Singer, and Alison P. Galvani

PNAS first published October 21, 2019. https://doi.org/10.1073/pnas.1913980116
Significance
There is limited understanding of what ramifications conflict events have on disease transmission and control in regions plagued by civil unrest and violence. Furthermore, the multifaceted nature of the conflict events during an epidemic is yet to be characterized. Using conflict data, ethnographic appraisal, and a mathematical model, we provide a descriptive timeline of the events during the ongoing Ebola outbreak in the Democratic Republic of the Congo. We quantified the unrest preceding a conflict event and its subsequent impact on control activities to demonstrate how conflict events are contributing to the persistence of the epidemic. Our model framework can be extended to other infectious diseases in areas that have experienced chronic conflict and violence.
Abstract
The interplay between civil unrest and disease transmission is not well understood. Violence targeting healthcare workers and Ebola treatment centers in the Democratic Republic of the Congo (DRC) has been thwarting the case isolation, treatment, and vaccination efforts. The extent to which conflict impedes public health response and contributes to incidence has not previously been evaluated. We construct a timeline of conflict events throughout the course of the epidemic and provide an ethnographic appraisal of the local conditions that preceded and followed conflict events. Informed by temporal incidence and conflict data as well as the ethnographic evidence, we developed a model of Ebola transmission and control to assess the impact of conflict on the epidemic in the eastern DRC from April 30, 2018, to June 23, 2019. We found that both the rapidity of case isolation and the population-level effectiveness of vaccination varied notably as a result of preceding unrest and subsequent impact of conflict events. Furthermore, conflict events were found to reverse an otherwise declining phase of the epidemic trajectory. Our model framework can be extended to other infectious diseases in the same and other regions of the world experiencing conflict and violence.