There’s a nearly year-long Ebola outbreak simmering in the Democratic Republic of Congo — and the international community needs to step up its support.
That’s the message from an emergency meeting at the World Health Organization in Geneva on Friday. A panel of independent experts met to discuss whether the outbreak is dire enough to constitute a “public health emergency of international concern,” a rare designation the WHO gives to diseases that pose a global threat.
For the third time since October, the committee decided once again that it’s not. “While the outbreak is an extraordinary event, and there’s risk of international spread, we believe that the ongoing response would not be enhanced” by a formal emergency declaration, said Preben Aavitsland, acting chair of the WHO’s committee.
Still, the agency’s director general, Tedros Adhanom Ghebreyesus, said “this outbreak is very much an emergency” for DRC and the region. He drew particular attention to a $54 million gap in funding required for the response.
The DRC has faced more than 2,100 cases of Ebola since last August and more than 1,400 deaths. That makes this the second-worst Ebola outbreak ever, after the unprecedented 2014-’16 West Africa epidemic, which affected 28,000 people. It’s also the first known Ebola outbreak to happen in an active war zone (the country’s northeastern provinces, North Kivu and Ituri).
The political instability in the region and flare-ups in violence have frequently interrupted the efforts of Ebola responders, leading to more cases. It’s also made the basic work of controlling an outbreak — tracing the contacts of the infected, following up with them, vaccinating people at risk — particularly challenging.
Earlier this week, the outbreak spread internationally for the first time, from the DRC into Uganda. Shortly after crossing DRC’s eastern border, a 5-year-old boy and his grandmother — who both were confirmed to have the Ebola virus — died. Now, 27 contacts of their family who might be infected are being followed up with, and Uganda’s case total may soon mount.
That prompted the WHO’s leader, Tedros, to call Friday’s meeting. “The exportation of cases into Uganda is a reminder that as long as this outbreak continues in DR Congo, there will be a risk of spread to neighboring countries,” Aavitsland said. “The international community must step up funding and support for the strengthening of preparedness and response in [the DRC] and in neighboring countries.”
The WHO declaring a public health emergency is rare
The WHO has only declared a public health emergency four times since the International Health Regulations, which govern global health emergency responses, were enacted in 2007. And these decisions are not taken lightly.
Formally, a PHEIC — pronounced “fake” — is defined as “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response.”
In reality, it’s a political tool that the WHO uses to sound the alarm about a serious disease that has caught the world off guard and put people’s health in danger. It’s meant to draw countries’ immediate attention to galvanize resources and stop the disease from spreading further across borders.
But a key consideration in declaring a PHEIC is whether the disease threat is dire enough for countries to be forced into enacting travel and trade restrictions. Declarations can be devastating to local economies, and are often associated with economic losses. (You can read more about PHEICs here.)
The emergency committee has to agree that an outbreak meets that formal definition: that it is extraordinary, poses a high risk for other countries, and requires an immediate, coordinated global response.
In describing the emergency committee’s rationale for not declaring a PHEIC, Aavitsland said that the DRC’s outbreak didn’t yet meet those criteria. And the harms of declaring one wouldn’t be offset by the additional attention a PHEIC would bring. “The response continues to be hampered by a lack of adequate funding and strained human resources,” Aavitsland added. Still, “to declare [a PHEIC] in an effort to try and raise funds would be a misuse of the instrument.”
Some experts disagree with the WHO’s decision
Some global health experts disagreed with the committee’s decision. “Declaring this a PHEIC would have raised the levels of international political support which has been lacking to date, enhanced diplomatic, public health, security and logistic efforts as well as released more financial resources to support the incredibly brave and committed teams working in [DRC],” said Dr. Jeremy Farrar, director of the Wellcome Trust.
“It was time to declare [an emergency] about 1,000 cases ago, so I certainly believe it is time to declare now,” said Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University.
The emergency declaration “is an unambiguous global statement that the situation is dire,” said Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health. “A PHEIC would have communicated to high-income countries and donors that WHO needs much more help and that there are real dangers of the outbreak spreading further.”
For now, our collective focus should be on DRC, said former US “Ebola czar” Ron Klain. The fact this outbreak has been “spreading, unabated” should have already been an international concern, he said, regardless of any official emergency designation. “What has been missing for some time is not a label, but rather, intensified international concern which is much needed and long overdue.”