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The nearly one-year Ebola outbreak in the Democratic Republic of the Congo – and the international community needs to strengthen support.
This is the message of an emergency meeting organized by the World Health Organization in Geneva on Friday. A group of independent experts met to determine whether the outbreak was serious enough to constitute a "public health emergency of international concern", a rare designation that the WHO assigns to diseases which constitute a global threat.
For the third time since October, the committee decided again that this was not the case. "Although the epidemic is an extraordinary event and there is a risk of international spread, we believe that the current response would not be strengthened," said Preben Aavitsland, Acting Chair of the WHO Committee.
However, the director general of the agency, Tedros Adhanom Ghebreyesus, said that "this epidemic is really an emergency" for the DRC and the region. He drew particular attention to a $ 54 million funding gap required for the response.
The DRC has faced more than 2,100 cases of Ebola since last August and more than 1,400 deaths. This is the second Ebola outbreak, after the unprecedented 2014-2016 epidemic in West Africa, affecting 28,000 people. It is also the first known outbreak of Ebola in an active war zone (north-eastern provinces of North Kivu and Ituri).
Political instability in the region and outbreaks of violence have frequently interrupted Ebola interveners' efforts, resulting in more cases. It has also done the basic job of controlling an outbreak – looking for contacts of infected people, following them, vaccinating people at risk – which is particularly difficult.
Earlier this week, the epidemic spread for the first time internationally, from the DRC to Uganda. Shortly after crossing the eastern border of the DRC, a five-year-old boy and his grandmother – who have been confirmed as carriers of the Ebola virus – have died. Currently, 27 potentially infected family contacts are being monitored and the total number of cases in Uganda may soon increase.
This prompted WHO leader Tedros to convene the meeting on Friday. "The case export to Uganda is a reminder that as long as this epidemic continues in DR Congo, there will be a risk of spread to neighboring countries," said Aavitsland. "The international community needs to increase funding and support to strengthen preparedness and response in developing countries. [the DRC] and in neighboring countries. "
The WHO declaring a public health emergency is rare
WHO has declared a public health emergency only four times since the promulgation of the International Health Regulations, which governs global health emergencies, in 2007. And these decisions are not taken lightly.
Formally, a PHEIC – pronounced "false" – is defined as "an extraordinary event that is considered to constitute a risk to the public health of other states because of the international spread of the disease and potentially requiring a coordinated international response".
In fact, it is a policy tool that WHO uses to sound the alarm about a serious disease that has surprised the world and endangered people's health. The aim is to immediately draw countries' attention to the need to mobilize resources and prevent the disease from spreading across borders.
However, a key element in a USPIE's statement is to determine whether the threat of the disease is serious enough for countries to be forced to adopt travel and trade restrictions. Declarations can be devastating for local economies and are often associated with economic losses. (You can read more about USPPIs here.)
The emergency committee must agree that an epidemic meets this official definition: it is an extraordinary situation, which presents a high risk for other countries and which requires an immediate and coordinated global response.
In describing why the emergency committee decided not to declare a PHEIC, Aavitsland said the outbreak of the DRC did not yet meet these criteria. And the inconveniences associated with this statement would not be offset by the extra attention of a PHEIC. "The response continues to be hampered by lack of adequate funding and limited human resources," added Aavitsland. Yet, "declare [a PHEIC] in an effort to try to raise funds would be a misuse of the instrument. "
Some experts disagree with WHO decision
Some global health experts have disagreed with the committee's decision. "Declaring this as a PHEIC would have increased the level of international political support that was lacking to date, strengthened diplomatic, public health, security and logistical efforts, as well as freed up more financial resources to support incredibly courageous teams and engaged [DRC]Said Jeremy Farrar, director of the Wellcome Trust.
"It was time to declare [an emergency] There are about 1,000 cases, so I think it's time to declare now, "said Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University.
The Emergency Statement "is an unambiguous global statement that the situation is catastrophic," said Tom Inglesby, director of the Center for Public Health Safety Johns Hopkins Bloomberg School of Public Health. "A PHEIC would have informed high-income countries and donors that the WHO needed much more help and that there were real risks of spreading the epidemic."
For now, we should be concentrating collectively on the DRC, said Ron Klain, former "Ebola Tsar" in the United States. The fact that this epidemic "is spreading relentlessly" should have been an international concern, he said, regardless of the designation of the state of emergency. "What has been missing for some time is not a label, but rather the intensification of concern by the international community, which has been indispensable and long overdue.
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