Ebola's Effect on Elections in the Congo: Public Health Watch

These days, elections in Africa garner a certain amount of global attention—and rightfully so.

Recent changes in the political landscape in countries such as Zimbabwe, Kenya, Burundi, and even relatively stable South Africa have implications not just for the local citizenry but for the region and continent as well, impacting everything from trade to the flow of migrants to worldwide health. On December 30, 2018, the Democratic Republic of the Congo (DRC) held its first formal national elections since it gained independence from Belgium in 1960—and, not surprisingly, the world was watching.

As in many countries in Africa, polling was marred by threats of violence and irregularities in the voting rolls. However, the DRC also faced a rather unique challenge: The central African country is currently experiencing the second largest Ebola outbreak in history, with 577 confirmed cases as of January 8, 2019, according to World Health Organization (WHO) figures.

“The good news is that this time around—unlike in west Africa in 2014—we have an effective Ebola vaccine, which has so far been delivered to an estimated 30,000 people,” Peter Hotez, MD, PhD, dean of the National School of Tropical Medicine and Health Policy Scholar, Baylor College of Medicine, and former US science envoy during the Obama administration, told Contagion®. “Were it not for the vaccine, we could be seeing a repeat of 2014, when 11,000 perished [from the disease]. The bad news is that conflict in the eastern DRC is preventing full deployment of the vaccine so that people will still needlessly die.”

Indeed, unfortunately, the DRC is only the latest example of political instability and infectious diseases creating a vicious cycle in resource-poor societies. In fact, the west African Ebola outbreak in 2014-2016 was undoubtedly worsened by the fact that several of the affected countries—Guinea, Liberia, and Sierra Leone—were in the midst of, or only just emerging from, long civil wars.

According to Dr. Hotez, the relationship between politics and disease is also currently playing out in Syria and Yemen (among other countries in the Middle East), where civil war has led to concerns over outbreaks of cholera and Leishmaniasis, and Venezuela, where a breakdown of the government has helped foster outbreaks of malaria and measles, among other diseases.

“We’ve identified conflict and political instability as one of the most important new, 21^st-century drivers of neglected tropical diseases,” Dr. Hotez told Contagion®. He and his colleagues chronicled the effects conflict can have on disease control efforts in a paper published in April 2018 in PLOS Neglected Tropical Diseases.

In the DRC, fears regarding the spread of Ebola influenced not only the voting but the election campaigns preceding the balloting, with reports indicating that candidates were reluctant to shake voters’ hands due to the risk of transmission. In its coverage of the election, The New York Times suggested that the country’s longtime president Joseph Kabila used the ongoing Ebola crisis as an excuse to restrict residents in certain areas of the country from voting.

Although Kabila has reportedly agreed to step down, pending the election results, observers are still questioning whether or not there will be a peaceful transfer of power in the DRC. As of this writing, votes were still being counted. Given the uncertainty of the situation there, and the growing concerns regarding Ebola, Dr. Hotez and others have called on the international community to get involved. He would like to see the United Nations Security Council and WHO, among others, institute formal policies regarding disease control in conflict areas to ensure treatment is accessible and, where applicable, vaccines are adequately distributed.

“The connection between global security and public health is still not well delineated,” Dr. Hotez explained. “However, we have to recognize that in areas where there is widespread political instability or outright hostilities, we’ll inevitably see the emergence or re-emergence of catastrophic neglected diseases. This needs to be addressed.”

Before it’s too late—for the people of the DRC and elsewhere.