The Ebola outbreak in the Democratic Republic of the Congo (DRC) is now an international public health emergency, an International Health Regulations (IHR) emergency committee that convened at the World Health Organization (WHO) decided Wednesday.
When discussing the decision to declare this outbreak a Public Health Emergency of International Concern (PHEIC), WHO officials cited concerns about geographical expansion of transmission within the country, as well as the sustained length of the outbreak, which started last August.
They gave several examples of cause for potential alarm, not only the new case this week in Goma, which is on the border of Rwanda, but the recurrence of intense transmission in the large city of Beni, months after Ebola spread was thought to be stopped there. Officials also cited the recent case of a woman with Ebola symptoms who crossed into Uganda.
Security was another key issue, with WHO officials mentioning the recent assassination of two Ebola health workers.
“When the response is disrupted, the virus gets the advantage and we lose all the progress we made,” WHO director-general Tedros Adhanom Ghebreyesus, MBBS, PhD, said on a conference call with the media.
As of July 15, there were 2,512 Ebola cases in this current outbreak, with 1,676 deaths. The director-general formally declared the PHEIC following Wednesday’s meeting. The WHO Emergency Committee had opted at three prior meetings not to recommend PHEIC status for the outbreak, when it still appeared contained within the DRC.
A Public Health Emergency of International Concern is notable because under the International Health Regulations, the 196 countries in the IHR have a “binding international legal agreement” to “respond promptly” when a PHEIC is declared. This declaration expires after three months, and is reviewed at least that often to determine whether changes need to be made to these recommendations.
The last time an outbreak of Ebola was declared a PHEIC was in 2014 during the outbreak in West Africa, which eventually had cases around the world, including in the U.S. However, WHO officials emphasized that was not the case here, with Robert Steffen, MD, chair of the WHO International Health Regulations Emergency Committee characterizing this outbreak as “a regional emergency, but not a global threat.”
“Our strategy [does not need] to be changed, we need to intensify our actions and become more proactive,” Steffen said.
In fact, WHO officials emphasized that declaring a PHEIC does not mean recommending restrictions on travel and trade. They urged neighboring countries not to close their borders, as this actually hampers the fight against Ebola. Currently, there have been more than 75 million screenings for Ebola at border crossings, WHO officials said. Closing the borders is not recommended because it could simply lead people to use unmonitored border crossings, increasing the potential for the spread of disease.
Still, they acknowledged continuing challenges to the response efforts. Michael Ryan, MD, executive director of WHO’s health emergencies program, noted that there is a gap in the supply of rVSV-ZEBOV-GP — the licensed Ebola vaccine, which has forced responders to adjust dosing down by half. But, he added, “accelerating vaccine production is a priority.”
Ryan also noted that the WHO supports the introduction of a second Ebola vaccine, the adenovirus 26 vectored glycoprotein/MVA-BN (Ad26.ZEBOV/MVA-BN) vaccine developed by Johnson & Johnson. But he said that DRC officials had “expressed concerns about introducing a second vaccine.” The WHO’s Strategic Advisory Group of Experts (SAGE) already recommended this second vaccine as part of the interim recommendations for Ebola vaccination, released in May.
“The efficacy of the vaccine has proven itself in the field. In the last 5-6 weeks, we’ve had the highest number of rings [for vaccination] started in the shortest time since the start of the outbreak,” Ryan said, noting the “huge amount of work” that has gone into improving community surveillance and acceptance of the vaccination program.
But these efforts still need funding, WHO officials said, though Adhanom Ghebreyesus was clear in stating that declaring a PHEIC should not be linked to fundraising efforts.
“[I hope] renewed commitment to finance … will continue, whether it’s a PHEIC or not,” he said. “Financing should be available to prevent outbreaks … [and] for preparedness. Financing should be to fix the roof before the rain comes.”