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The WHO finally declared a public health emergency over Ebola

The outbreak in the Democratic Republic of Congo has been ongoing since last August.

A woman gets her temperature measured at an Ebola screening station as she enters the Democratic Republic of the Congo from Rwanda on July 16, 2019.
Photo credit should read JOHN WESSELS/AFP/Getty Images

A nearly year-long Ebola outbreak is simmering in the Democratic Republic of Congo — and despite the rollout of a vaccination campaign, the virus has continued to spread.

Now it’s time for the world to start paying attention.

That’s the message from an emergency meeting at the World Health Organization in Geneva on Wednesday. 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. It was the fourth such meeting since October.

Unlike the last three meetings, a formal emergency was declared this time because of the “concerning geographic spread of the virus,” said WHO Director General Tedros Adhanom Ghebreyesus, who is known as Dr. Tedros.

“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” said Dr. Tedros. “We all owe it to these responders — coming from not just WHO but also government, partners and communities — to shoulder more of the burden.”

Dr. Tedros also called on countries to avoid imposing “punitive and counterproductive” travel and trade restrictions. They “serve no useful purpose,” he said, and could instead drive people with Ebola underground, hampering the outbreak response.

While the risk of Ebola in the DRC and neighboring countries remains high, the risk outside the region is low, he added.

The same was true for 2014-’16 West Africa epidemic. (That didn’t stop Chris Christie, Donald Trump, and others from fear-mongering about Ebola, and using the outbreak to call for borders to be closed down.)

This is the second-largest Ebola outbreak in history — and the first in a war zone

The DRC has counted more than 2,500 total cases of Ebola since last August and more than 1,600 deaths. That makes this the second-worst Ebola outbreak ever, after the unprecedented 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.

A new case in Goma, a city of 1 million and one of the DRC’s largest urban centers, prompted the latest emergency meeting.

Goma is a major transportation hub, with roads and highways that lead to Rwanda. Ebola there has often been described as a “nightmare scenario,” and one WHO and DRC’s health ministry have been scrambling to prevent.

On July 14, the WHO learned that a priest picked up the virus in Butembo, one of the current hot spots in this outbreak, and traveled on a bus to Goma. Health officials identified dozens of people that the priest, who later died, had come into contact with.

The political instability in the region and flare-ups in violence have frequently interrupted the efforts of Ebola responders and led 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.

In June, the outbreak spread internationally for the first time, from the DRC into Uganda. Shortly after crossing DRC’s eastern border, 3- and 5-year-old brothers and their grandmother died from the virus.

Uganda’s toll may rise soon: The WHO and the Ugandan health ministry are currently tracking down the contacts of a DRC woman who visited Uganda on July 11 to sell fish in a market. The woman reportedly vomited four times, potentially spreading the virus, and later died of Ebola.

It’s rare for WHO to declare a public health emergency

Before today, 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.

The first time was in 2009, with the outbreak of the H1N1 swine flu pandemic. The second time was in May 2014, when polio seemed to surge again, threatening the eradication effort. The third time, in August 2014, came as the Ebola outbreak in West Africa was growing out of control. And the fourth was related to Zika in 2016.

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 to risk countries 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.

Global health experts have been calling for an emergency designation for months

Many global health experts have for months been saying this outbreak constitutes a PHEIC.

“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, in June.

An emergency declaration “is an unambiguous global statement that the situation is dire,” Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health, previously told Vox. It communicates “to high-income countries and donors that WHO needs much more help and that there are real dangers of the outbreak spreading further.”

But as Dr. Tedros signaled, it’s also possible the PHEIC may inspire damaging travel bans and trade restrictions on DRC and the region, doing more harm than good.

For now, our collective focus should be on the DRC, said former US “Ebola czar” Ron Klain. The fact that this outbreak has been “spreading, unabated” already should have been an international concern, he said in June, regardless of the 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.”