A shift from reactionary towards more proactive and sustainable approaches is required for effective Ebola virus disease preparedness in Africa: A case study of key lessons learned from the Democratic Republic of Congo
Authors: Ryan Caroline S. , Belizaire Marie-Roseline D. , Nanyunja Miriam , Olu Olushayo Oluseun , Ahmed Yahaya Ali , Latt Anderson , Yiek Matthew Tut Kol , Bamuleke Bertrand , Tusiime Jayne , Nsabimbona Nadia , Conteh Ishata , Nyashanu Shamiso , Ramadan Patrick Otim , Woldetsadik Solomon Fisseha , Nkata Jean-Pierre Mulunda , Ntwari Jim T. , Nzeyimana Senya D. , Ouedraogo Leopold , Batona Georges , Ndahindwa Vedaste , Mgamb Elizabeth A. , Armah Magdalene , Wamala Joseph Francis , Guyo Argata Guracha , Freeman Alex Yao Sokemawu , Chimbaru Alexander , Komakech Innocent , Kuku Muhau , Firmino Walter M. , Saguti Grace E. , Msemwa Faraja , O-Tipo Shikanga , Kalubula Precious C. , Nsenga Ngoy , Otau Ambrose Talisuna 
Published: July 2022

Abstract
Background
From May 2018 to the end of June 2022, the Democratic Republic of Congo (DRC) experienced six Ebola virus disease outbreaks within its borders. During the 10th EVD outbreak, the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. Burundi, Rwanda, South Sudan and Uganda were classified as priority one countries while Angola, Central African Republic, Congo, Tanzania and Zambia as priority two. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events.
Main text
Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent COVID-19 pandemic. Shortfalls such as lost opportunities in vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in the areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during Ebola virus disease outbreak preparedness and response rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations and the Sustainable Development Goals.
Conclusions
Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable approaches to emergency preparedness towards achieving global health security is now.