Contrasting the impact and cost-effectiveness of successive intervention strategies in response to Ebola in the Democratic Republic of the Congo, 2018-2020
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Introduction The 10th outbreak of Ebola Virus Disease (EVD) in the Democratic Republic of the Congo (DRC) in 2018–2020 was the largest in DRC’s history and the second largest worldwide. Different strategic response plans (SRPs) were implemented, and the outbreak was eventually stopped after a large scale-up of operations with the SRP 4, which benefited from all public health measures deployed during SRPs 1-3, upon which it developed a more holistic approach including community engagement, logistics and security.
Methods We used modelling to characterise EVD transmission and assess the epidemiological impact of the two main response strategies (SRPs 1–3 vs SRP 4). We simulated potential future epidemics with different intervention scenarios, combined with a costing model to evaluate the incremental cost-effectiveness of different strategies.
Results We estimated a mean effective reproduction number R of 1.19 (credible interval (95% CrI) = (1.13 ; 1.25)). The spatial spread was moderate with an average 4.4% (95% CrI = (3.5%; 5.4%)) of transmissions moving to different health zones. The scale-up of operations in SRP 4 coincided with a threefold reduction in transmission, and 30% faster control of EVD waves. In simulations, SRP 4 appears cost-saving, although most simulated outbreaks remain small even with SRPs 1–3.
Conclusion Most EVD outbreaks are expected to be small and can be contained with SRPs 1–3. In outbreaks with increased transmissibility or in the presence of insecurity, rapid scale-up to SRP 4 is likely to save lives and be cost-effective.
Methods We used modelling to characterise EVD transmission and assess the epidemiological impact of the two main response strategies (SRPs 1–3 vs SRP 4). We simulated potential future epidemics with different intervention scenarios, combined with a costing model to evaluate the incremental cost-effectiveness of different strategies.
Results We estimated a mean effective reproduction number R of 1.19 (credible interval (95% CrI) = (1.13 ; 1.25)). The spatial spread was moderate with an average 4.4% (95% CrI = (3.5%; 5.4%)) of transmissions moving to different health zones. The scale-up of operations in SRP 4 coincided with a threefold reduction in transmission, and 30% faster control of EVD waves. In simulations, SRP 4 appears cost-saving, although most simulated outbreaks remain small even with SRPs 1–3.
Conclusion Most EVD outbreaks are expected to be small and can be contained with SRPs 1–3. In outbreaks with increased transmissibility or in the presence of insecurity, rapid scale-up to SRP 4 is likely to save lives and be cost-effective.
Date Issued
2025-04-15
Date Acceptance
2025-02-28
Citation
BMJ Global Health, 2025, 10 (4)
ISSN
2059-7908
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Global Health
Volume
10
Issue
4
Copyright Statement
© World Health Organization 2025. Licensee BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Intergovernmental Organization (CC BY 3.0 IGO) license (https://creativecommons.org/licenses/by/3.0/igo/)
License URL
Identifier
10.1136/bmjgh-2024-015822
Publication Status
Published
Article Number
ARTN e015822