In this USAID Podcast episode, Acting Assistant Administrator for the Bureau for Democracy, Conflict, and Humanitarian Assistance Admiral Tim Ziemer and Hurricane Dorian Response Director James Fleming sit down with the Administrator to discuss “Strengthening Our Capabilities for Relief and Response” through the lens of USAID’s efforts in two major crises: Hurricane Dorian in the Caribbean and the Ebola response in the Democratic Republic of the Congo.
Carol Han: Administrator Green, the Democratic Republic of the Congo declared an Ebola outbreak on August 1st of last year. As of November 24th, there have been approximately 3,300 confirmed and probable cases and nearly 2,200 related deaths. How do you see this situation from your vantage point?
Mark Green: Well, certainly the situation is getting better in the sense that the infection rate is down from where it was some months ago. That’s all good news, but there are still underlying challenges. Remember what made the outbreak here so difficult to tackle and contain, is where it occurred. It occurred in an area in which every bad thing and every bad challenge in development terms had struck this poor area and the people of this area for decades; poor governance, limited access to water, electricity. So you put on top of that people who are already distrustful of outsiders and institutions. So a challenging situation, but the team led by the Disaster Assistance Response Team, or DART made up of professionals from USAID, CDC, and others, I think has done a remarkable job. A ways to go, but great progress.
Carol Han: Admiral Ziemer, you recently traveled to DRC. In fact, you’ve made three trips so far. Could you paint a picture of what you saw happening on the ground, and what are the challenges that we as an agency face in containing this outbreak?
Tim Ziemer: Each of those trips showcase something different to me. It’s really important for everybody to understand, we’re dealing with three dynamic factors. We know the virus, we have vaccines now that are experimental, and also other interventions that have actually been a positive point. So even though we have vaccinated 300,000 plus people, even though we have interventions, that if you show up at an Ebola treatment center early enough, there’s a good probability of being cured.
There are other vectors, the insecurity of the two provinces of the 25 where this Ebola outbreak is manifesting itself, is one of the most insecure places in the world. There were two attacks in Beni Town, which is the epicenter of the outbreak. An Ebola treatment center was burned, seven people were killed, and nine were injured. There was a protest to advocate for getting rid of the UN Security Forces. So that is not a surge, that is a characteristic that has manifested itself and made this so complex over the last 18 months.
Then thirdly, the community distrust is at a high point. Each village population city center is its own community in itself. And we’re finding that they have their hands up, the roadblocks are up, and it’s been a challenge to get all three of those vectors, the virus, the insecurity and the community to come together so that we can start seeing an improvement.
The good news is, over the last couple months, we’ve seen the number of cases reported drop from over 200 a week down to the last report to 27. And we’ve seen the footprint shrink from 19 to 20 health centers down to 4. We are able to understand and focus the interventions more effectively, but the jury is still out whether or not we’re going to be able to get in there with our partners, working with the government, working with WHO, to bring this to an end as quickly as we possibly can.
Carol Han: Administrator Green, please correct me if I’m wrong, but I believe you also spent some time in the DRC. What were some of the impressions that you got when you were on the ground, sir?
Mark Green: Well, I did two trips. One to Eastern DRC, the area most afflicted. I was struck by how scattered people were. There really wasn’t a sense of community structure that would pull people in, that quite frankly, would make our interventions more effective. Instead, people were being chased away because they were distrustful of their community leaders. The very people they should be turning to are people they don’t entirely trust.
I think there’s been progress made. We’ve been able to make some investments that we think will slowly begin to rebuild that trust. But it’s a real reminder of how important, not just democracy writ large, but responsive governance is, to taking on a challenge like this. We know what to do, we have better tools than we had during the last outbreak, and we have the lessons learned from the last outbreak. What makes this different is that you have community institutions that don’t have the same level of trust that they did in other parts of the continent; areas that with these challenges that make it difficult to bring those interventions to bear, to apply those lessons, and to be able to bring those new tools.
The other trip I took was to the capitol itself, and what I saw there was again, how governing institutions have an important role to play, and if not played well, they can actually exacerbate the challenges. One of the reasons that we were seeing insecurity in Eastern DRC is that truck drivers, surveillance officers weren’t always getting paid in a timely fashion, and that was creating agitation and strife. That strife created insecurity in places that we couldn’t get to; some of the places where we knew in fact the interventions were warranted. So again, a complex situation, getting better, but still some ways to go.
Carol Han: Administrator Green, you just brought up the previous Ebola outbreak. There was a big one back in West Africa in 2014. A question to you and both Admiral Ziemer, who had worked on the response while you were at the White House. How do you feel that this current outbreak compares with what happened back in 2014?
Mark Green: Well, again, to me it’s the complexity of the underlying situation. Things are better in the sense that we have the experience of the past; lessons learned and new tools. But the complexity of the situation in Eastern DRC. And I should also mention we not only had the problems of kleptocracy and corruption, but you also had an election taking place at the very time that we are trying to get into some of these areas with some of the tools that we know can make a difference; very, very complicated situation. That to me, is the big difference from my perspective, but really Admiral Ziemer is the one who would know best given the perches that he had now and then.
Tim Ziemer: Clearly, the West Africa outbreak in terms of cases and deaths superseded this one. This one in DRC is now number two, but in terms of just total cases, it’s really, much smaller. But I would make a case, this is much more challenging. Lots of lessons learned from West Africa. We’ve applied those lessons. We have the new vaccine. We have new interventions.
This Administration is committed to responding and containing to infectious outbreaks where they occur. It is a priority not only for Administrator Green as the lead foreign assistant Agent, but it also is a priority for Secretary Pompeo, and Secretary Azar. The collective State, USAID, HHS, and our CDC colleagues coming together represents that responding to not only the previous outbreak, but this one, and the next one is a significant challenge. I might add, our congressional partners have been all in and making sure they understand the dynamics; they continually ask USAID, what more can we do to bring this outbreak to an end?
Mark Green: To me what we need is, after the outbreak is fully contained, is to make sure that we never let our guard down; that we continue the vigilance because we’ll need to continue to make investments, particularly in surveillance systems and making sure that we have adequate stockpiles of interventions. The good news is Congress on a bipartisan basis really made key investments that have positioned us well for the current outbreak, but we need to make sure that we remain vigilant, sadly, because there will be another outbreak.
Carol Han: You penned an op-ed in which you explained that when it came to fighting the outbreak, there were quote ‘long difficult months ahead’. How do you stand now with that statement?
Mark Green: It’s still true. I think the trajectory is a positive one. I think real progress is being made. The numbers are clearly improving. Understand that people are still dying every week, and this is continues to be an ongoing tragedy. The trajectory is a good one, but again, what I would say is that we can’t let our guard down, so when this is quote unquote ‘finished’, it won’t be finished. It’ll be instead time to shift to a different phase in which we make sure that we’re well prepared for what is unfortunately likely to happen again in the future.
Edited by S. Lizotte