Ebola outbreak in DR Congo: WHO declares global health emergency

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WHO Director-General Dr. Tedros Adhanom Ghebreyesus has declared the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) a Public Health Emergency of International Concern (PHEIC), said a WHO news release. The declaration was made in Geneva on July 17, 2019. This is the fifth such declaration in history.

The “Ebola outbreak in the Democratic Republic of the Congo declared a Public Health Emergency of International Concern” headlined news release cited Dr. Tedros Adhanom Ghebreyesus: “It is time for the world to take notice and redouble our efforts. We need to work together in solidarity with the DRC to end this outbreak and build a better health system. Extraordinary work has been done for almost a year under the most difficult circumstances. We all owe it to these responders – coming from not just WHO but also government, partners and communities – to shoulder more of the burden.”

More than 1,600 people have died since August in the second-deadliest Ebola outbreak in history, which is unfolding in a region described as a war zone.

The WHO declaration followed a meeting of the International Health Regulations Emergency Committee for EVD in the DRC. The Committee cited recent developments in the outbreak in making its recommendation, including the first confirmed case in Goma, a city of almost two million people on the border with Rwanda, and the gateway to the rest of DRC and the world.

This was the fourth meeting of the Emergency Committee since the outbreak was declared on 1 August 2018.

Funding delays 

The Committee expressed disappointment about delays in funding which have constrained the response.

They also reinforced the need to protect livelihoods of the people most affected by the outbreak by keeping transport routes and borders open.

It is essential to avoid the punitive economic consequences of travel and trade restrictions on affected communities.

“It is important that the world follows these recommendations. It is also crucial that states do not use the PHEIC as an excuse to impose trade or travel restrictions, which would have a negative impact on the response and on the lives and livelihoods of people in the region,” said Professor Robert Steffen, chair of the Emergency Committee.

Since it was declared almost a year ago the outbreak has been classified as a level 3 emergency – the most serious – by WHO, triggering the highest level of mobilization from WHO. The UN has also recognized the seriousness of the emergency by activating the Humanitarian System-wide Scale-Up to support the Ebola response.

In recommending a PHEIC the committee made specific recommendations related to this outbreak.

“This is about mothers, fathers and children – too often entire families are stricken. At the heart of this are communities and individual tragedies,” said Dr. Tedros. “The PHEIC should not be used to stigmatize or penalize the very people who are most in need of our help.”

Media reports said:

A WHO expert committee declined on three previous occasions to advise the UN health agency to make the declaration for this outbreak, even though other experts say it has long met the required conditions.

A declaration of a global health emergency often brings greater international attention and aid, along with concerns that nervous governments might overreact with border closures.

Goma is a major regional crossroads in northeastern Congo on the Rwandan border, with an international airport. A sick Congolese fish trader also traveled to Uganda and back while symptomatic — and later died of Ebola.

While the risk of regional spread remains high, the risk outside the region remains low, WHO chief said.

Tedros insisted that the declaration was not made to raise more money — even though WHO estimated “hundreds of millions” of dollars would be needed to stop the epidemic.

Dr. Joanne Liu, president of the Doctors Without Borders, said she hoped the emergency designation would prompt a radical reset of Ebola response efforts.

“The reality check is that a year into the epidemic, it’s still not under control, and we are not where we should be,” she said. “We cannot keep doing the same thing and expect different results.”

Liu said vaccination strategies should be broadened and that more efforts should be made to build trust within communities.

Fifth such declaration in history

Prior to the present declaration of global emergency, emergencies were declared for the devastating 2014-16 Ebola outbreak in West Africa that killed more than 11,000 people, the emergence of Zika in the Americas, the swine flu pandemic and polio.

WHO defines a global emergency as an “extraordinary event” that constitutes a risk to other countries and requires a coordinated international response.

Last month, the outbreak spilled across the border for the first time when a family brought the virus into Uganda after attending the burial in Congo of an infected relative. Even then, the expert committee advised against a declaration.

Alexandra Phelan, a global health expert at Georgetown University Law Center, said Wednesday’s declaration was long overdue.

“This essentially serves as a call to the international community that they have to step up appropriate financial and technical support,” she said but warned that countries should be wary of imposing travel or trade restrictions.

Such restrictions “would actually restrict the flow of goods and health care workers into affected countries so they are counterproductive,” she said. Future emergency declarations might be perceived as punishment and “might result in other countries not reporting outbreaks in the future, which puts us all at greater risk.”

WHO had been heavily criticized for its sluggish response to the West Africa outbreak, which it repeatedly declined to declare a global emergency until the virus was spreading explosively in three countries and nearly 1,000 people were dead. Internal documents later showed WHO held off partly out of fear a declaration would anger the countries involved and hurt their economies.

The organization’s emergency committee will meet again within three months to assess the situation. Committee members will review whether the outbreak is still a global emergency and whether other measures are needed.

Wednesday’s announcement prompted fear in eastern Congo, where many carry on business across borders and travel overseas.

“I am vaccinated and I protect myself against Ebola,” said Zoe Kibwana, 46, a shoe salesman who does business in Uganda, just 70 kilometers (40 miles) from Beni. “Closing the borders would handicap our economy. The health ministry and WHO need to end this epidemic as soon as possible.”

The current outbreak is spreading in a turbulent Congo border region where dozens of rebel groups are active and where Ebola had not been experienced before. Efforts to contain the virus have been hurt by mistrust among wary locals that has prompted deadly attacks on health workers. Some infected people have deliberately evaded health authorities.

The pastor who brought Ebola to Goma used several fake names to conceal his identity on his way to the city, Congolese officials said. WHO on Tuesday said the man had died and health workers were scrambling to trace dozens of his contacts, including those who had traveled on the same bus.

Congo’s minister of health resisted the characterization of the outbreak as a health emergency.

“We accept the decision of the committee of experts but one hopes that it’s a decision that wasn’t made under pressure of certain groups that want to use this as a way to raise funds for certain humanitarian actors,” said Dr. Oly Ilunga.

Those working in the field say the outbreak is clearly taking a turn for the worse despite advances that include the widespread use of an experimental but effective Ebola vaccine.

Dr. Maurice Kakule was one of the first people to survive the current outbreak after he fell ill while treating a woman last July before the outbreak had even been declared.

“What is clear is that Ebola is an emergency because the epidemic persists despite every possible effort to educate people,” he told the Geneva meeting.


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