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The Ebola epidemic in the Democratic Republic of the Congo, where health workers are attacked, is testing the ability of the planet to cope with the situation. He is also questioning whether the use of a major weapon to deal with such health crises could be in vain in this case.
Despite the seriousness of the situation, the epidemic in North Kivu has not been declared a public health emergency of international concern – a PHEIC in the broad sense of the term health. This fact has frustrated some health experts, who insist that it is time to proclaim an international emergency.
Other experts, however, say that labeling this epidemic as a global health crisis would not help stop the spread of the Ebola virus in the region. They fear that this will aggravate an already dangerous situation.
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"I do not see what a PHEIC will add," said Ilona Kickbusch, director of the World Health Center at the Graduate Institute of International Development Studies in Geneva.
"If you say that this is supposed to trigger a call to action and the attention of the international community, it is already happening. If this is supposed to trigger coordination, this is already happening. If this is supposed to trigger a response and international funds, this is already happening, "said Kickbusch. "There is not enough money … but that will not solve the problem itself. You do not stop a war with money. "
The outbreak, which probably began in late April 2018, was recognized as an Ebola virus at the end of July. On August 1, the World Health Organization declared that an epidemic was under way in North Kivu.
In the following months, the Congolese Ministry of Health, WHO and various NGO partners struggled to stop the spread of the virus. Their efforts have been hindered by the fact that this epidemic is occurring in a highly populated part of the country which has been a conflict zone for decades.
On Sunday, there were 1,705 cases and more than 1,124 deaths, making it the second-largest epidemic of Ebola ever recorded.
In the fall, the intervention teams found themselves caught in the middle when insurgents attacked government forces or United Nations peacekeepers in the area. But in recent months, workers in the Ebola response have been the target of repeated violent attacks. at least three health workers were killed.
The answer is the subject of dangerous rumors circulating on social media, that Ebola does not exist or that the agents of the answer brought it to the region. In recent days, pamphlets have been distributed, giving the agents of the response an ultimatum: Stop the epidemic and leave the region in a few days, if not.
Twice Tedros Adhanom Ghebreyesus, Director-General of WHO, convened a meeting of external experts to help determine whether or not the outbreak should be declared PHEIC. On two occasions, in October and again in April, the so – called emergency committee concluded that the epidemic, although very worrying, was not a global health emergency. This decision was based on the fact that, until now, the disease had not spread beyond Congo's borders to allow transmission in neighboring countries.
Tedros, as called the Director General of the WHO, took into account the statement against the emergency declaration.
Dr. Robert Steffen, chair of the emergency committee meeting in April, acknowledged at a press conference that WHO was struggling to raise funds to fund the response to the outbreak. outbreak, and said that a PHEIC could open additional pockets.
But Steffen said that was not enough reason to declare an emergency. "It would not be appropriate to declare a PHEIC only to generate funds," he said.
More funds and more stakeholders could actually increase the danger, said Dr. Jeremy Farrar, director of the Wellcome Trust. Part of the violence has already been motivated by money, with some people complaining that the WHO is actually benefiting from the epidemic.
"To have many nationalities other than those of North Kivu and the DRC – for the moment, I think that could easily worsen the situation and that the situation could become completely uncontrollable from the point of view of the violence", declared Farrar .
The region is full of armed militias, some of which finance their operations by kidnapping humanitarian workers for ransom. "The more money we have, the more opportunities for kidnapping," he said. "You could make the situation worse."
Farrar acknowledged that if the choice had been his, he would probably have declared this epidemic of public health emergency, but he did not think it would make a material difference on the ground.
"I think it's a bit of a puzzle in a way," he said.
Another problem with the statement of a USPIE was found in other cases where the tool was used. The International Health Regulations – a treaty to combat health threats – stipulates that countries must not penalize countries that declare to have a dangerous disease epidemic by imposing travel or trade restrictions on the affected country. In reality, many have used the PHEIC statement to do just that.
Many countries have cut visas for nationals of Liberia, Guinea and Sierra Leone during the Ebola crisis in West Africa 2014-2016. A number of international airlines have stopped flights to these countries, which makes it much more difficult for flight attendants and crucial supplies to enter the region. This could happen again.
"The main challenges on the ground are the insecurity and reluctance of the community, fueled by conspiracy theories. A PHEIC statement will not change that. This is not a magic wand, "said Dr. Preben Aavitsland, a former Norwegian epidemiologist, who helped draft the International Health Regulations Review in 2005 that created the PHEIC instrument.
"We are all too familiar with the likely side effects of a PHEIC statement: unfair travel and trade restrictions. This could both hinder response work and severely affect the local economy, thereby increasing community resistance, "said Aavitsland. He was a member of the WHO Emergency Committee on Ebola, which met in April, but said the views he shared with STAT were his.
David Fidler, director of Indiana University's Center for American and Global Security, said it was inappropriate to wait for a statement to be reported as a PHEIC because of fears that it might prove useless or against -productive.
"These concepts are very subjective and are not clearly anchored in public health principles and scientific data – the core elements of what an analysis of PHEIC under the [International Health Regulations] must be, "said Fidler.
He too suspects that declaring this epidemic global health crisis would not solve the problem. But he is concerned that the debate over the opportunity to declare a PHEIC in this case undermines the credibility of the tool.
"During this outbreak, we found this gap between experts who reject its relevance and other experts who insist that it is essential to use a USPI to manage this epidemic," Fidler said. "This controversy has the potential to discredit the power of the PHEIC and the RSI more generally."
Kickbusch agreed that the International Health Regulations needed to be clarified and that the PHEIC tool was needed, but that the time did not come to undertake this work.
"In the current political situation, I do not think anyone should reopen an international document," she said. "It's a lot, way too risky."
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