The meeting of the Emergency Committee convened by the Director-General of WHO under the International Health Regulations (IHR) (2005) concerning Ebola Virus Disease in the Democratic Republic of the Congo (DRC) took place on Friday, June 14, 2019, from 12:00 pm to 5:00 pm Geneva time (CEST).
Context and discussion
The Committee was deeply concerned about the current epidemic which, despite some positive epidemiological trends, particularly in the epicentres of Butembo and Katwa, shows that the extension and / or reinfection of the disease in other regions such as Mabalako present new challenges. around the acceptance and security of the community. In addition, the lack of adequate funding and lack of human resources further hampered the response.
The case group in Uganda is not unexpected. rapid response and initial containment testify to the importance of preparedness in neighboring countries. The Committee welcomes the communication and collaboration between the DRC and Uganda.
At the same time, the case export in Uganda recalls that, as long as this epidemic continues in the DRC, there is a risk of spread to neighboring countries, although the risk of spread to countries outside the region remains weak.
The Committee wishes to commend the heroic work of all stakeholders, who continue to work under extremely difficult and stressful conditions.
The committee debated at length the impact of a PHEIC statement on the response, possible unintended consequences and how these could be managed. Divergent views were expressed, the Committee having recognized that recent cases in Uganda constituted an international spread of the disease.
Conclusions and advice
The Committee was of the view that the epidemic was a health emergency in the DRC and in the region, but did not meet the three PHEIC insurance criteria under the IHR. Although the epidemic is an extraordinary event, with a risk of international spread, the current response would not be reinforced by formal temporary recommendations under the IHR (2005).
The Committee gave the following public health advice, which it urged the countries and partners who took note of it:
- Countries at risk should improve their preparedness for the detection and management of exported cases, as Uganda has done.
- Cross-border filtering in the DRC should be continued and its quality improved and sustainable.
- Continue to map population movements and sociological models to predict the risk of spreading the disease.
- All priority countries should put in place approvals for experimental drugs and vaccines as an immediate priority for preparation.
- Optimal vaccine strategies with maximum impact on the reduction of the epidemic recommended by the WHO Strategic Expert Advisory Group (SAGE) should be implemented rapidly.
- The Committee is deeply disappointed that WHO and affected countries have not received the necessary funding and resources for this epidemic. The international community must increase funding and support the strengthening of preparedness and response in the DRC and in neighboring countries.
- Continue to build community awareness, engagement and participation. There has been a lot of progress in community engagement activities. However, in border communities, where mobility is particularly likely, community engagement needs to be more specifically targeted to identify the most-at-risk populations.
The Committee welcomes and encourages the implementation by the United Nations and its partners of more coordinated measures to reduce security threats, mitigate security risks and create an enabling environment for public health operations , as an essential platform for accelerating disease control efforts.
- The Committee places strong emphasis on its previous recommendations against the application of any restrictions on international travel or trade.
- The Committee does not consider it necessary to control admissions at airports or other points of entry.
The Committee advised the Director-General of WHO to continue to monitor the situation closely and to reconvene the Emergency Committee as necessary.
Minutes of the meeting
The members and councilors of the emergency committee were called by teleconference.
Dr. Robert Steffen, President, having been able to attend the meeting in person, Dr. Preben Aavitsland chaired the discussions.
The Director-General welcomed the Committee by telephone from the Democratic Republic of the Congo.
Representatives from the WHO Legal Service and the Compliance, Risk Management and Ethics Department briefed Committee members on their roles and responsibilities, as well as the requirements of the IHR and the IHR. criteria that define a PHEIC: an extraordinary event that poses a risk to public health. the international spread of risk for other countries, which requires a coordinated international response. The role of the committee is to advise the Executive Director, who makes the final decision as to the determination of a PHEIC. The committee also provides temporary advice or recommendations, as the case may be.
Committee members were reminded of their duty of confidentiality and their responsibility to disclose their personal, financial or professional relationships that could be considered to constitute a conflict of interest. Each member was interviewed and no conflict of interest was identified.
The Chair then reviewed the agenda of the meeting and introduced the presenters. Presentations were made by representatives of the Ministry of Health of the Democratic Republic of the Congo and the National Communicable Disease Control Commission of Uganda.
The situation in the Democratic Republic of the Congo has been reviewed, including the current epidemiological situation and response strategies, including the changes put in place to improve community engagement. Serious and persistent incidents, which resulted in injuries and deaths among the interventions, seriously impeded the response. The epidemic has had four waves since August 2018, but the number of cases has decreased in the last month. Active screening for missing contacts is underway. Factors contributing to the on-going epidemic are population movements, health care seeking behaviors directed against traditional healers, poor infection prevention and control measures in health facilities, security and safety issues. the lack of involvement of political leaders.
Representatives of the Uganda National Communicable Disease Control Commission reviewed recent cases, contacts and contact tracing. They informed the Committee of their actions, including notification to WHO and political commitment, and preparedness activities undertaken since August 2018. A national coordinating working group was activated and a team rapid intervention deployed. Clinical management is available in an Ebola treatment unit in Bwera. Control takes place at official points of entry. Vaccination at the stadium will start on June 15th.
A representative of the WHO Regional Office for Africa presented the status of regional preparedness activities, particularly in Burundi, Rwanda, South Sudan and Uganda. . Persistent problems have been noted, particularly at the district and sub-country levels, as well as insufficient cross-border collaboration and lack of funding to support preparedness activities.
A representative of the International Organization for Migration informed the Committee about prevention, detection and control measures at entry points for cross-border preparation.
The United Nations Emergency Response Coordinator for Ebola presented an update on the security situation and on efforts to create a dynamic and responsive environment for the response to epidemics. Interventions were frequently disrupted, which had an impact on the increase in the number of cases. UN-wide support is needed to strengthen public health action and coordinate international assistance. Access and community acceptance are increasing, with decreases in some areas. Increases in attacks in some areas are being processed.
The WHO Secretariat provided an update on the current situation and the response to the Ebola epidemic and ongoing preparedness activities in neighboring countries. The risk assessment for the DRC remains very high at the national and regional levels but low at the global level. The risk in Uganda remains moderate at the national level and low, as well as at the regional and global levels. However, the high risks of the Ugandan event have been mitigated by rapid communication and coordination between authorities in all jurisdictions. detection at points of entry and subsequent response activities; and operational preparedness and preparedness in Uganda. A high level of cooperation and transparency between the DRC and Uganda has been noted with satisfaction. The incidence of cases has generally decreased over the last five weeks, but the rate of transmission remains high, especially in some hot spots. IPC measures, safe burials and mobility of the population were examined, as well as details on the search for contacts. The operational extension has been reviewed and a significant need for funding, both for response and preparation, has been highlighted. Less than a third of the necessary resources are available; there is currently $ 54 million in funding, compared to $ 98 million needed for response until July 2019.
On the basis of this opinion, reports prepared by affected States Parties and information currently available, the Director-General accepted the Committee's assessment that the Ebola epidemic in the Democratic Republic of the Congo did not constitute a public health emergency of international concern. . In the light of the advice of the Emergency Committee, WHO advises against the application of restrictions on movement or travel. The Director-General thanked the members of the Committee and the advisers for their advice.