The World Health Organization said Wednesday the growing Ebola outbreak in the eastern part of the Democratic Republic of the Congo does not currently constitute a global health emergency.
The decision was made on the advice of a panel of international experts, called an emergency committee, that was convened to advise WHO Director-General Tedros Adhanom Ghebreyesus on the issue.
It’s the second time this year that a so-called emergency committee has decided that an Ebola outbreak did not meet the criteria to declare a public health emergency of international concern — a PHEIC in WHO parlance. The earlier time was during a previous Ebola outbreak in western DRC that started in April and was contained by July.
Committee chair Dr. Robert Steffen said the 11-member panel concluded that the international community’s response to the outbreak was adequate at this point. There was nothing to be gained from declaring a PHEIC, and potentially some problems triggered by doing so, Steffen said.
“We thought there was really no added value,” said Steffen, a professor of epidemiology and infectious diseases prevention at the University of Zurich.
He suggested some countries might use the declaration of a PHEIC as an excuse to bar travel from DRC or the region.
In fact, one of the rationales for deploying a PHEIC, a tool of the International Health Regulations, is to tell countries they should not impose trade or travel restrictions during outbreaks because they discourage countries with outbreaks from reporting them and can hinder response operations.
Professor Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown, said he believed the committee made the wrong call. Declaring a PHEIC would have led to the mobilization of more resources, he said.
In particular, Gostin said the response teams in this outbreak need additional protection, functioning as the response teams are in a conflict zone.
The outbreak is occurring in North Kivu, a province in northeastern DRC that is effectively a war zone. Scores of rebel groups operate in North Kivu, complicating the work of the Ebola response teams and putting their personal security at risk.
“The WHO has neither the mandate nor the expertise to deal with security threats,” Gostin said. “The United Nations needs to train and deploy peacekeepers in support of a public health mission. Without security protection, conflicts and public distrust will propel this Ebola outbreak, and threaten public health responses in the future.”
Ron Klain, a Washington lawyer who served as President Barack Obama’s “Ebola czar” during the unprecedented West African outbreak in 2014-2015, also suggested more help is needed. Klain said the decision not to declare the outbreak a PHEIC should not be read as an encouraging signal.
“It is time for the global community — especially the United States — to step up their efforts in this outbreak,” Klain said.
Currently U.S. government employees — including highly experienced Ebola experts from the Centers for Disease Control and Prevention — are being barred from traveling to the outbreak zone. The State Department has deemed the conditions on the ground too dangerous for U.S. employees.
As of Wednesday, there were 220 confirmed and probable cases in this outbreak, the seventh largest on record. Of those people,142 have died.
The WHO has warned that the risk of the virus spreading to DRC’s eastern neighbors is “very high” but that the risk of spread outside the region remains low. The CDC and others have been working with DRC’s eastern neighbors to prepare them to be able to respond quickly if transborder spread occurs.
The outbreak, which may have started in July and was first recognized at the end of that month, appeared to be coming under control in September. But in late September the security situation worsened, limiting the surveillance and containment work the response teams could conduct. That and other problems have led to a recent sharp increase in cases.
There have been more cases in October so far — 59 as of Tuesday — than in the entire month of September. In fact, about one-quarter of the cases in this outbreak to date have been reported in October.