he World Health Organization has convened a special committee of experts to help guide its response to the expanding Ebola outbreak in the Democratic Republic of the Congo. During its first meeting on Friday, the group will be asked if the outbreak should be declared an international health emergency.
The announcement that an emergency committee will assess the latest Ebola outbreak comes a day after the national laboratory in the DRC confirmed a case had been discovered in Mbandaka, a city of over 1 million people.
Director-General Tedros Adhanom Ghebreyesus told STAT he established the emergency committee — the first of his tenure — because of the seriousness of the threat posed by the outbreak.
“While DRC has previously confronted 8 outbreaks the proximity of the current outbreak to neighboring countries, the dispersed pattern of cases, infection of health workers and confirmation in an urban center, connection of this major urban center (Mbandaka) with other major urban centers within DRC and neighboring countries via the Congo river are a cause for concern,” said Tedros, who traveled to the DRC last weekend to assess the situation and the response.
The director-general, who goes by his first name, said the WHO also needs guidance on how to help surrounding countries prepare for the possibility the outbreak may spill over DRC’s borders. The WHO has put DRC’s nine neighbors on high alert.
“It is also important we get the best independent expert advice on preparedness in surrounding countries,” Tedros said.
The WHO’s latest update, published Thursday, revealed the agency is sending more Ebola vaccine to DRC. On Wednesday, 4,300 doses of an experimental Merck vaccine arrived in Kinshasa. The WHO said it plans to send another 3,240 doses.
The agency revealed that it now believes there are at least four cases at Mbandaka, which is the capital of the province of Equateur in western DRC. Previous updates had put the count there at two. Of the four, one tested positive using a rapid and a confirmatory laboratory test; the other three are considered suspect cases.
Two of the Mbandaka cases have known links to a probable case that occurred at the outbreak’s epicenter, Bikoro, in April. An earlier report said they attended the funeral of someone who has been deemed to have probably died of Ebola before the outbreak was recognized. Funerals often fuel the spread of Ebola, if local customs involve washing and touching the deceased.
The specter of the virus once again transmitting in an urban setting is a chilling one, hearkening to painful memories of the massive West African Ebola outbreak that began at the end of 2013. Then the WHO was slow to recognize the threat. This time, it has warned of the risk of urbanized Ebola from the start and is working hard to forestall it.
“Confirmation of urban Ebola in DRC is a game changer in this outbreak — the challenge just got much much tougher,” Dr. Peter Salama, the WHO’s deputy director-general for emergency preparedness and response, said on Twitter on Thursday.
Salama also provided a new case count, saying that there are already 44 confirmed, probable, and suspect cases in this outbreak and 23 of those people have died.
The emergency committee will be asked if this outbreak should be deemed a public health emergency of international concern — a PHEIC (pronounced “fake”) in health law.
Dr. Ashish Jha thinks the committee may not declare a PHEIC just yet. But if it holds off, it will undoubtedly say it needs to continue to meet to reassess the situation and could declare an emergency later if the outbreak escalates.
“It’s still localized to a single country and a single region within that country,” said Jha, director of the Harvard Global Health Institute. “Obviously, if there is evidence that the disease is spreading further — down the Congo river to other cities along the river, for instance, I could imagine them coming back and declaring a PHEIC.”
Regardless of whether the declaration comes Friday, establishing an emergency committee at this point sends a loud message about how concerning this outbreak is, said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.
“This is not going to bring any new resources on the front lines today that they didn’t have yesterday. They’ve basically already sent in the A Team to begin trying to stop this,” Osterholm said. “But I think what it does is it lets the rest of the world know how important this is and why the support for this A Team effort is so critical. And whether it be other country donors, other organizations stepping up if additional resources are needed, this is really important.”
The DRC government announced on May 8 that it had confirmed two cases of Ebola in Equateur province, which borders the Republic of the Congo. The countries are separated by the Congo River, a large waterway that serves raises the risk exponentially that cases could move from the outbreak zone to the large centers of Kinshasa (population 11.6 million) and Brazzaville (population 2 million) south of Equateur.
Bikoro, where the majority of the cases have been identified, is a port town on a lake that feeds into the Congo. But there are cases in at least three locations at this point: Mbandaka, Bikoro, and a village inland from Bikoro called Ikoko Impenge, where the outbreak may have begun. The latter is only accessible by motorbike.
Confirmation that the virus made its way to Mbandaka has led to a further deployment of resources. The WHO said it sent 30 people to the city to do surveillance.
This story has been updated.