2019

"Many specific challenges in the DRC compound the already difficult task of vaccine delivery. Years of internal conflict have displaced millions from their homes, limiting their access to preventive health services. The country has an estimated population of 87 million, of which more than half are children. About two thirds live in rural areas and 40% of mothers report distance to health facilities as a challenge when getting health care. In addition, inherent mistrust of government-run programmes prevents some from seeking care. Those who do are met by health-care workers who want to help, but are hampered by stock outages or unstable refrigeration necessary to store vaccines in the prescribed temperature range. Many are understaffed or simply don’t have sufficient vaccines available due to the fragility of cold-storage and supply chain in remote areas."

"Last year, the DRC’s Ministry of Health led an effort to vaccinate 18 million children against the measles across the country, using $22m of donor funding – excluding MSF’s contribution. In comparison, USAID alone has spent $569m since the start of the Ebola outbreak, according to the US State Department, while the total funding for the Ebola response is unclear."

"Close to a quarter of a million people have been infected this year alone. The World Health Organization (WHO) says this is the world's largest and fastest-moving epidemic. Measles in DR Congo has now killed more than twice the number who have died of Ebola there in the last 15 months. The Congolese government and the WHO launched an emergency vaccination programme in September that aimed to inoculate more than 800,000 children. But poor infrastructure, attacks on health centres and a lack of access to routine healthcare have all hindered efforts to stop the spread of the disease. Four million children have been vaccinated, but experts warn that this amounts to less than half of the total in the country - and not enough vaccines are available."

"“We’re facing this alarming situation because millions of Congolese children miss out on routine immunization and lack access to health care when they fall sick,” said Beigbeder. “On top of that, a weak health system, insecurity, community mistrust of vaccines and vaccinators and logistical challenges all contribute to a huge number of unvaccinated children at risk of contracting the disease.”"

"Channelling attention and resources to the Ebola outbreak, donors and government officials were blindsided by the developing measles catastrophe, while the nation’s ailing infrastructure and healthcare system stymied an effective response. And now, the coronavirus pandemic has been unleashed on the world, complicating an already challenging situation. “It’s obvious the priority will be given to COVID-19 in the coming weeks and months,” said Vincent Sodjinou, the head of the World Health Organization’s (WHO) measles response. “The priority [before] was on Ebola, and it wasn’t easy to mobilise funds,” he added. “For measles, it was difficult for us to fight. It was a daily fight.”"

"DAKAR (Reuters) - Democratic Republic of Congo’s government has declared an epidemic of mea-sles, which the latest health ministry figures show has now killed at least 1,500 people, more than a hundred more than have died of Ebola. While health officials have focused on the hemorrhagic Ebola virus in Congo’s east, about 87,000 suspected measles cases have been reported across the coun-try so far this year, more than the 65,000 recorded in the whole of last year. Congo’s health minis-try announced the measles figure when it declared the epidemic on Monday."

"The DRC has difficulties on a number of levels. The country has such a high birth rate — 3.5 million children are born each year — that it needs to conduct mass vaccination campaigns every two years. Those campaigns, in which tens of thousands of health workers fan out across this vast country, are a logistical nightmare. First, the government has to get the vaccine from the capital, Kinshasa, to remote villages that can be reached only by helicopter — or through bloody conflict zones in the eastern part of the country. The vaccine must be kept between 2 °C and 8 °C from the time it leaves the warehouse until it is administered — a challenge in a tropical environment where power outages are frequent. Health workers must be trained to inject it safely, a much more difficult task than dropping liquid polio vaccine on a child’s tongue. The vaccine comes as a powder, which must be reconstituted with an accompanying solution of sterile diluent and then used within 6 hours. It also comes in ten-dose vials; worried about wastage, vaccinators are sometimes hesitant to open one when just a few children show up to a session, so the children go unimmunized."

"A viral outbreak has killed more than 6,500 children in the Democratic Republic of the Congo (DRC) and is still spreading through the country. The foe isn’t the feared coronavirus, which has only just reached the DRC. It’s an old, familiar and underestimated adversary: measles. Cases began to spike here in October 2018. Children became weak, feverish and congested, with red eyes and painful sores in their mouths, all with the telltale rash of measles. “We have been running after the virus ever since,” says Balcha Masresha, an epidemiologist with the World Health Organization (WHO) regional Africa office in Brazzaville in the neighbouring Republic of Congo. The situation has mushroomed into what WHO experts say might be the largest documented measles outbreak in one country since the world gained a measles vaccine in 1963 (see ‘Measles cases on the rise’). The highly contagious measles virus continues to spread around the globe. In 2018, cases surged to an estimated 10 million worldwide, with 140,000 deaths, a 58% increase since 2016. In rich countries, scattered measles outbreaks are fuelled by people refusing to vaccinate their children. But in poor countries, the problems are health systems so broken and underfunded that it is nigh-on impossible to deliver the vaccine to people who need it. The DRC’s flood of cases shows why measles will keep flaring up despite efforts to control it. And the situation will only worsen with the COVID-19 pandemic: more than 20 countries have already suspended measles vaccination campaigns as healthcare workers scramble to deal with coronavirus."

"In countries with advanced healthcare, the measles vaccine works upwards of 85 percent of the time, according to Patricia Tanifum, a measles expert at the WHO. But in remote corners of the DRC, where the health system and road network have suffered decades of conflict, underfunding and neglect, the virus thrives. Some five million children in the DRC are acutely malnourished, which means the effectiveness of the vaccine is reduced. When vaccinated, malnourished children are less able to devel-op the immunoglobulin against measles, leaving them vulnerable, Sodjinou said. Meanwhile, about 1 percent of rural areas have access to electricity from the national grid, making it hard to deliver and store temperature-sensitive vaccines such as measles that need to be kept between 2 and 8 degrees Celsius (35.6 and 46.4 Fahrenheit). “If not kept in the right range of temperature … it would be correct to compare it to a water injection given to children,” said Philippe Mpabenda, MSF’s head of measles response in Boso Manzi."

"An outbreak of measles that began in early 2019 in the southeast corner of the Democratic Republic of the Congo (DRC) has now spread to all 26 provinces. Over 180,000 cases and more than 3,000 deaths have been reported. The outbreak has disproportionately affected young children under five years of age. Similar outbreaks occurred previously in the DRC in 2011 and again in 2015. This is the largest and most fatal of the large measles outbreaks across the world this year. These have occurred in the Ukraine, Philippines, Brazil, US, New Zealand, Madagascar and Nigeria. While the details of each individual outbreak vary, the root cause of measles outbreaks is always the same: too few children receive timely and effective vaccination."

"“We’re fighting the measles epidemic on two fronts - preventing infections and preventing deaths,” said UNICEF Representative in the DRC, Edouard Beigbeder. “Along with the government and key partners, UNICEF has been racing to vaccinate children against measles, and at the same time, supplying clinics with medicines that treat symptoms and improve the chance of survival for those already infected.”"

"Since the start of 2019, the DRC’s measles epidemic has infected more than 341,000 people and killed some 6,400, taking almost three times as many lives as Ebola over the same period. “The actual mortality rate might be much higher, up to four or five times higher than what we see in official numbers because there are a lot of health structures that are not functioning properly,” said Karel Janssens, Doctors Without Borders’ (MSF) head of mission in the DRC. “So, there’s a lot of community deaths that are not reflected in some of the official reports.”"

"The challenge of transporting an effective vaccine from a factory to a village like Macau is a logistical nightmare. The DRC is about seven times the size of Germany but has less than 0.5 percent of the paved roads compared to Germany. “Sometimes you can find a village which is 100km (62 miles) from the health centre, and they don’t have a motorbike or cold-chain,” said Sodjinou."

"Money is a major problem. Vaccination campaigns cost around US$1.80 per child in the DRC, says Masresha; international donors foot some of the bill, but the country is expected to pay a share. In 2010, the DRC couldn’t muster the funds and cancelled a scheduled campaign. An outbreak that hit at the end of the year raged for more than 30 months. Further campaigns in 2013–14 and 2016–17 didn’t reach enough children. In June 2019, after cases soared to more than 3,500 a week at the start of the year, the DRC government declared an epidemic, opening the door to further international aid. By the end of the year, 18.5 million children had been vaccinated. The WHO estimates that there have been more than 348,000 cases and 6,500 deaths, but Francisco Luquero, an epidemiologist at Epicentre, the research arm of Médecins Sans Frontières (MSF, also called Doctors Without Borders) in Paris, thinks the outbreak is much worse. The case count reflects only people who go to health centres, he says; many don’t in the DRC. As for the mortality estimates, “they count deaths that happen right after a measles case. They should look out for the next five years,” he says, because of immune amnesia. “The outbreak will have a profound impact on public health.”"

"Even when cases of measles are detected in clinics, limited diagnostic and communication infrastructure can cause significant lags in triggering the outbreak response. The DRC currently has only one reference laboratory that can run the blood tests necessary to confirm a measles outbreak. Transporting and processing samples can take weeks. Add to this the competing demands of a health system combating two Ebola outbreaks in the past two years, and these lags can become larger."

"It’s problematic. It is fundamentally problematic to have that level of weaponry in a civilian environment, unregulated. It is problematic. It was modified in essence to function as a rifle, and to avoid any legal prohibitions."

"The ...("Trump Campaign" or "Campaign") showed interest in WikiLeaks's releases of documents and welcomed their potential to damage candidate Clinton."

"[T]he Russian government employed a second form of interference: cyber intrusions (hacking) and releases of hacked materials damaging to the Clinton Campaign. ...the Main Intelligence Directorate of the General Staff of the Russian Army (GRU) carried out these operations. ...The GRU stole hundreds of thousands of documents from the compromised email accounts and networks. ...disseminating stolen materials through the fictitious online personas " " and "." The GRU later released additional materials through the organization WikiLeaks."

"A statement that the investigation did not establish particular facts does not mean there was no evidence of those facts."

"The IRA later used social media accounts and interest groups to sow discord... through... "." The campaign evolved from a generalized program designed... to undermine the U.S. electoral system... The IRA' s operation also included the purchase of political advertisements on social media in the names of U.S. persons and entities, as well as the staging of political rallies... To organize those rallies, IRA employees posed as U.S. grassroots entities and persons and made contact with Trump supporters and Trump Campaign officials... Section II... details... the Russian social media campaign."

"In July 2016, Campaign foreign policy advisor traveled... to Moscow and gave the keynote address at the . Page had lived and worked in Russia between 2003 and 2007. After returning... Page became acquainted with at least two Russian intelligence officers... Page's July 2016 trip to Moscow and his advocacy for pro-Russian foreign policy drew media attention. The Campaign then distanced itself from Page and, by late September 2016, removed him from the Campaign."

"In mid-2014, the IRA sent employees to the United States on an intelligence-gathering mission..."

"The investigation... identified numerous links between the Russian government and the Trump Campaign. Although the investigation established that the Russian government perceived it would benefit from a Trump presidency... and that the Campaign expected it would benefit electorally from information stolen and released through Russian efforts, the investigation did not establish that members of the Trump Campaign conspired or coordinated with the Russian government in its election interference activities."

"On July 22, 2016, WikiLeaks posted thousands of internal DNC documents revealing information about the Clinton Campaign. ...[W]ithin a week of the release, a foreign government informed the FBI about its May 2016 interaction with Papadopoulos and his statement that the Russian government could assist the Trump Campaign. On July 31, 2016... the FBI opened an investigation into potential coordination between the Russian government and individuals associated with the Trump Campaign."

"August 2, 2016, Trump campaign chairman Paul Manafort met in New York City with his long-time business associate , who the FBI assesses to have ties to Russian intelligence. Kilimnik requested the meeting to deliver... a peace plan for Ukraine that Manafort acknowledged... was a "backdoor" way for Russia to control part of eastern Ukraine; both men believed the plan would require candidate Trump's assent to succeed (were he to be elected President). They also discussed the status of the Trump Campaign and Manafort's strategy for winning Democratic votes in Midwestern states. Months before that meeting, Manafort had caused internal polling data to be shared with Kilimnik, and the sharing continued for some period... after..."

"Fall 2016. On October 7, 2016, the media released video of candidate Trump speaking in graphic terms about women years earlier... considered damaging to his candidacy. Less than an hour later, WikiLeaks made its second release: thousands of John Podesta' s emails that had been stolen... in late March 2016. The FBI and... U.S. government institutions were... continuing their investigation of suspected Russian government efforts to interfere... That same day, October 7, the Department of Homeland Security and the Office of the Director of National Intelligence issued a joint public statement "that the Russian Government directed the recent compromises of e-mails..." Those "thefts" and the "disclosures"... the statement continued, "are intended to interfere with the US election process.""

"Post-2016 Election. Immediately after the... election, Russian government officials and prominent Russian businessmen began trying to make inroads into the new administration. ...The Russian Embassy made contact hours after the election to congratulate the President-Elect and to arrange a call with President Putin. Several Russian businessmen picked up the effort from there."

", the chief executive officer of Russia's sovereign wealth fund, was among the Russians who tried to make contact... In early December, a business associate steered Dmitriev to , a supporter of the Trump Campaign and an associate of senior Trump advisor Steve Bannon. Dmitriev and Prince later met face-to-face in January 2017 in the and discussed U.S.-Russia relations. ...another business associate introduced Dmitriev to a friend of ... Dmitriev and Kushner's friend collaborated on a short written reconciliation plan for the United States and Russia, which Dmitriev implied had been cleared through Putin. The friend gave that proposal to Kushner before the inauguration, and Kushner later gave copies to Bannon and incoming Secretary of State Rex Tillerson."

"On December 29, 2016, then-President Obama imposed sanctions on Russia for having interfered in the election. Incoming National Security Advisor Michael Flynn called Russian Ambassador and asked Russia not to escalate the situation in response to the sanctions. The following day, Putin announced that Russia would not take retaliatory measures in response to the sanctions at that time. Hours later, President-Elect Trump tweeted, "Great move on delay (by V. Putin)." The next day, on December 31, 2016, Kislyak called Flynn and told him the request had been received at the highest levels and Russia had chosen not to retaliate as a result of Flynn's request."

"On January 6, 2017, members of the intelligence community briefed President-Elect Trump on a joint assessment-drafted and coordinated among the Central Intelligence Agency, FBI, and National Security Agency-that concluded with high confidence that Russia had intervened in the election through a variety of means to assist Trump's candidacy and harm Clinton's. A declassified version of the assessment was publicly released that same day."

"That fall, two federal agencies jointly announced that the Russian government "directed recent compromises of e-mails... intended to interfere with the US election process." After the election... the United States imposed sanctions... By early 2017, several congressional committees were examining Russia's interference..."

"Summer 2016. Russian outreach to the Trump Campaign continued... as... Trump was becoming the presumptive Republican nominee.... On June 9, 2016, for example, a Russian lawyer met with senior Trump Campaign officials Donald Trump Jr., , and campaign chairman Paul Manafort to deliver... "official documents and information that would incriminate Hillary." The materials were offered to Trump Jr. as "part of Russia and its government's support for Mr. Trump." ...the Campaign anticipated receiving information from Russia that could assist candidate Trump's electoral prospects, but the Russian lawyer's presentation did not provide such information. Days after the June 9 meeting... a cybersecurity firm and the DNC announced that Russian government hackers had infiltrated the DNC and obtained access to opposition research on candidate Trump, among other documents."

"One week later, in the first week of May 2016, Papadopoulos suggested to a representative of a foreign government that the Trump Campaign had received indications from the Russian government that it could assist the Campaign through the anonymous release of information damaging to candidate Clinton. Throughout... and for several months thereafter, Papadopoulos worked with Mifsud and two Russian nationals to arrange a meeting between the Campaign and the Russian government. No meeting took place."

"The (IRA) carried out the earliest Russian interference operations identified...—a social media campaign designed to provoke and amplify political and social discord in the United States. The IRA... received funding from Russian oligarch and companies he controlled. Prigozhin is widely reported to have ties to... Putin."

"Spring 2016. Campaign foreign policy advisor made early contact with , a London-based professor who had connections to Russia and traveled to Moscow in April 2016. Immediately upon his return to London from that trip, Mifsud told Papadopoulos that the Russian government had "dirt" on Hillary Clinton..."

"[I]nteractions between Russian Ambassador Kislyak and Trump Campaign officials both at the candidate's April 2016 foreign policy speech in Washington, D.C., and during the week of the Republican National Convention were brief, public, and non-substantive. ...[T]he investigation did not establish that one Campaign official's efforts to dilute a portion of the Republican Party platform on providing assistance to Ukraine were undertaken at the behest of candidate Trump or Russia. The investigation also did not establish that a meeting between Kislyak and Sessions in September 2016... included any more than a passing mention of the presidential campaign."

"2015. Some of the earliest contacts were made in connection with a Trump Organization... project... . Candidate Trump signed a Letter of intent for Trump Tower Moscow by November 2015, and in January 2016... Michael Cohen emailed and spoke about the project with the office of Russian government press secretary . The Trump Organization pursued the project through at least June 2016, including by considering travel to Russia by Cohen and candidate Trump."

"Volume II addresses the President's actions towards the FBI's investigation into Russia's interference in the 2016 presidential election and related matters, and his actions towards the Special Counsel's investigation. Volume II separately states its framework and the considerations that guided that investigation."

"Russia interfered in the 2016 presidential election principally through two operations. First... a social media campaign... favored... Trump and disparaged... Clinton. Second, ...computer-intrusion operations against... the Clinton Campaign and... then released stolen documents."

"The investigation did not always yield admissible information or testimony, or a complete picture of the activities undertaken... Some individuals invoked their Fifth Amendment right... and were not, in the Office' s judgment, appropriate candidates for grants of immunity. The Office limited its pursuit of other witnesses and information—such as information known to attorneys or individuals claiming to be members of the media—in light of internal Department of Justice policies... Some of the information obtained via court process... was presumptively covered by legal privilege and was screened from investigators by a filter (or "taint") team. Even when individuals testified or agreed to be interviewed, they sometimes provided information that was false or incomplete, leading to some of the false—statements charges described above. And the Office faced practical limits on its ability to access relevant evidence as well—numerous witnesses and subjects lived abroad, and documents were held outside the United States."

"[S]ome of the individuals we interviewed or whose conduct we investigated—including some associated with the Trump Campaign—deleted relevant communications... using applications that feature encryption or that do not provide for long-term retention of data or communications records. In such cases, the Office was not able to corroborate witness statements through comparison to contemporaneous communications or fully question witnesses about statements that appeared inconsistent with other known facts."

"Accordingly, while this report embodies factual and legal determinations that the Office believes to be accurate and complete to the greatest extent possible, given these identified gaps, the Office cannot rule out the possibility that the unavailable information would shed additional light on (or cast in a new light) the events described in the report."

"On May 17, 2017, Deputy Attorney General Rod J. Rosenstein... appointed the Special Counsel "to investigate Russian interference with the 2016 presidential election and related matters." ...[and was] "...authorized to conduct the investigation including: (i) any links and/or coordination between the Russian government and individuals associated with the campaign of President Donald Trump; and (ii) any matters that arose or may arise directly from the investigation; and (iii) any other matters within the scope of 28 C.F.R. § 600.4(a). ...Section 600.4 affords the Special Counsel "the authority to investigate and prosecute federal crimes committed in the course of, and with intent to interfere with, the Special Counsel's investigation, such as perjury, obstruction of justice, destruction of evidence, and intimidation of witnesses." ...The authority to investigate "any matters that arose... directly from the investigation,"... covers similar crimes that may have occurred during the course of the FBI's confirmed investigation before the Special Counsel's appointment. "If the Special Counsel believes it is necessary and appropriate," the Order further provided, "the Special Counsel is authorized to prosecute federal crimes arising from the investigation of these matters.""

"The Acting Attorney General further clarified the scope... A memorandum dated August 2, 2017, explained that the Appointment Order... "...permit[s] its public release without confirming specific investigations involving specific individuals." ...the Special Counsel had been authorized... to investigate allegations that three Trump campaign officials—, Paul Manafort, and —"committed a crime or crimes by colluding with Russian government officials with respect to the Russian government's efforts to interfere with the 2016 presidential election." The memorandum also confirmed the Special Counsel's authority to investigate...other matters, including... allegations involving Manafort (crimes arising from payments he received from the Ukrainian government and crimes arising from his receipt of loans from a bank whose CEO was then seeking a position in the Trump Administration); allegations that Papadopoulos committed a crime or crimes by acting as an unregistered agent of the Israeli government; and four sets of allegations involving Michael Flynn..."

"On October 20, 2017, the Acting Attorney General confirmed... the Special Counsel's investigative authority as to... First, ...to investigate "the pertinent activities of Michael Cohen, Richard Gates, [redacted name], Roger Stone, and [redacted name]" ...Second, with respect to Michael Cohen... to investigate " leads relate[d] to Cohen' s establishment and use of Essential Consultants LLC to, inter alia, receive funds from Russian-backed entities." Third, ...authority to investigate individuals and entities who were possibly engaged in "jointly undertaken activity" with existing subjects of the investigation, including Paul Manafort. Finally, ...into "allegations that [then-Attorney General Jeff Sessions] made false statements to the... Senate[,]" ..."

"There was substantial evidence immediately available to the Special Counsel at the inception of the investigation in May 2017 because the FBI had, by that time, already investigated Russian election interference for nearly 10 months."

"Certain proceedings associated with the Office's work remain ongoing. [T]he Office has transferred responsibility for... remaining issues to other components of the Department of Justice and FBI. Appendix D lists those transfers."

"Two district courts confirmed the breadth of the Special Counsel's authority to investigate Russia election interference and links and/or coordination with the Trump Campaign. ...[T]he Office periodically identified evidence of potential criminal activity that was outside the scope of the Special Counsel's authority... [T]he Office referred that evidence to appropriate law enforcement authorities, principally other components of the Department of Justice and to the FBI. Appendix D summarizes those referrals."

"[T]he Office issued more than 2,800 subpoenas under the auspices of a grand jury sitting in the District of Columbia; executed nearly 500 search-and-seizure warrants; obtained more than 230 orders for communications records... obtained almost 50 orders authorizing use of s; made 13 requests to foreign governments pursuant to Mutual Legal Assistance Treaties; and interviewed approximately 500 witnesses, including almost 80 before a grand jury."

"Third, the investigation established that several individuals affiliated with the Trump Campaign lied to the Office, and to Congress, about their interactions with Russian-affiliated individuals and related matters. Those lies materially impaired the investigation... The Office charged some of those lies as violations of the federal false­ statements statute. ...Michael Flynn pleaded guilty to lying about his interactions with... Kislyak during the transition period. ... pleaded guilty to lying to investigators about, inter alia, the nature and timing of his interactions with , the professor who told Papadopoulos that the Russians had dirt on candidate Clinton in the form of thousands of emails. Former Trump Organization attorney Michael Cohen pleaded guilty to making false statements to Congress about the Trump Moscow project. ...And ...the U.S. District Court found that Manafort lied to the Office and the grand jury concerning his interactions and communications with about Trump Campaign polling data and a peace plan for Ukraine."