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For the third time, the World Health Organization on Friday refused to declare the Ebola outbreak in the Democratic Republic of Congo a public health emergency, although the epidemic has spread this week in neighboring Uganda and is class as the second deadliest in history.
A group of experts advising W.H.O. discouraged because the risk of spreading the disease beyond the region remained low and the declaration of an emergency could have turned against it. Other countries may have reacted by stopping flights in the region, closing borders or limiting movement, measures that could have harmed Congo's economy.
Dr. Preben Aavitsland, Norwegian expert on public health and acting chairman of the emergency committee to advise WHO, said there was "not much to gain but potentially a lot to lose. "
At the same time, the committee of 10 infectious disease experts said in a statement that it was "deeply disappointed" that donor countries have not given as much money as the W.H.O. and the affected countries must fight the epidemic.
But some world health experts have said in recent months that the W.H.O. should declare an urgency to bring the world's attention to the Ebola crisis. Dr. Jeremy Farrar, director of the Wellcome Trust, a foundation for London-based health, said Friday that such a statement would have boosted efforts to control the epidemic.
"This would have increased international political support and strengthened diplomatic, public health, security and logistics efforts," he said.
Dr. Tedros Adhanom Gebreyesus, W.H.O. Director-General, accepted the committee's recommendation, saying that even if the epidemic did not meet the criteria for a declaration of urgency, "for the families affected, it is indeed an emergency situation" .
W.H.O. asked for $ 98 million for its response and received only $ 44 million. In an interview before the announcement, Tedros said he had recently received pledges from Britain, the United States and Germany.
"We have never seen such an epidemic," he said. "It happened in a chronic war zone and coincided with an election that politicized the situation as a whole. Militia attacks have continued to interrupt operations, and when this happens, the virus is a free virus. "
Ebola vaccine supplies are running out, said Dr. Tedros, but Merck agreed Thursday to reopen its plant and make more. To stretch the stocks up to the finish, the doses are split up and a new Johnson & Johnson vaccine will be deployed soon, he said.
The epidemic began in August and challenged early expectations that it would be quickly controlled.
In March, Doctors Without Borders evacuated its staff from the epicenter after its Katwa and Butembo clinics were burned or overwhelmed by the dispersal of their patients. In April, a Cameroonian doctor working for W.H.O. was targeted and killed.
The state department ordered all US staff – including doctors from the Centers for Disease Control and Prevention – to leave shortly after their arrival last August, following a swap exchange. fire on the road between their place of work and their place of residence.
Sure Tuesday, the first case outside Congo was detected in Uganda – a 5-year-old boy from a town near the border.
The children looked sick and, when they were stopped at a border post, their temperature was taken. They were isolated and invited to wait for their transfer to an Ebola treatment center. Instead, six family members escaped and took an unguarded path to the shallow place. Lubiriha River, which forms the border but is easily ford.
It was only after the pastor's funeral, attended by more than 80 people, that he was confirmed dead from the Ebola virus. The Congolese authorities are trying to find everyone present.
The Ebola virus spreads in body fluids, including blood and diarrhea, and dead bodies can be contaminated with a live virus. Congolese health authorities have alerted Ugandan counterparts, but the 5-year-old was already in a hospital in Uganda, about 15 miles from the border. Since, both boys and grandmother are dead.
Experts do not expect the Ugandan epidemic to become uncontrollable.
Uganda has a strong central government and an organized health system, but lacks liquidity. He suffered and beat three previous Ebola outbreaks, in 2000, 2007, and 2012.
On Thursday, Ugandan health officials announced that they had agreed with their Congolese counterparts to create more health posts at "unofficial entry points" such as those used by the affected family.
In addition, with outside help, Uganda has been intensively preparing for the Ebola virus to invade the Congo.
"We expected it," said Dr. Tedros. "It was when, not so."
Approximately 4,700 health workers and others who may come into contact with infected persons have been vaccinated.
Unicef has organized more than 14,000 meetings in schools, churches, mosques, markets, taxi stands, bus stops and even funerals to discuss the prevention of Ebola and the need to seek care as soon as the symptoms appear.
By contrast, in eastern Congo, the epidemic has become uncontrollable because the region is so unpredictable.
The region is so isolated from the capital, Kinshasa, that 20 people were already dead at the time of confirmation of the presence of the virus in their blood samples.
Mistrust of the national government is intense and dozens of local militias and self-proclaimed rebel armies are spreading. Health workers have been arrested at informal roadblocks where bandits are asking for money.
In recent months, experts have been alarmed by an acceleration of infections as more than 130,000 people have been vaccinated. Although it took about eight months to reach the first 1,000 cases, it only took a few more to exceed 2,000.
Officials estimate that many deaths occur in villages where families refuse to bring sick relatives for testing.
In Congo, just over half of new cases involve people with known links to previous cases, indicating that contact tracing, considered essential to overcoming an epidemic, has collapsed.
The case fatality rate among known cases is about 66%, but the number of unknown cases makes the actual number impossible to calculate.
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