The World Health Organization declared the Ebola outbreak in the Democratic Republic of the Congo a global health emergency on Wednesday, a move that is likely to escalate international attention on a crisis that has flared for a year despite aggressive efforts to stamp it out.
The declaration, which critics have contended is long overdue, could increase the amount of funding and assistance other countries are willing to provide to the response effort.
But if the experience of the West African Ebola outbreak of 2014-2016 is any indication, it could also lead to border closings, trade restrictions, cancellations of flights, and the suspension of visas to people from the DRC.
WHO Director-General Tedros Adhanom Ghebreyesus, who declared the public health emergency of international concern — known as a PHEIC — on the recommendation of a panel of outside experts, stressed that any type of travel or trade restriction would impede the effort to extinguish the outbreak and hurt the economies of the countries in the region.
“The government of DRC is doing everything they can,” said Tedros, as he is known. “They need the support of the international community. … That includes its financial support.”
The WHO and its partners in the containment effort have struggled to stop this outbreak, the second largest on record. There have been more than 2,500 cases and close to 1,700 deaths.
They have also struggled to raise the funding needed to finance the operation, and have warned recently that the lack of funds is actually limiting what can be done on the ground.
“WHO is not aware of any donor that has withheld funding because a PHEIC had not been declared,” the director general said. “But if that was the excuse, it can no longer be used.”
The various partners in the outbreak response are currently finalizing a strategic plan — the fourth of this outbreak. Final figures haven’t been set but Tedros warned it will run to the hundreds of millions of dollars. Dr. Mike Ryan, executive director of the WHO’s emergencies program, said the cost of the public health portion of the operation alone will likely be in excess of $233 million.
Mercy Corps, one of the NGOs working on the outbreak response, said it hoped the declaration of a PHEIC would translate into more support for the work that needs to be done in DRC.
“Every day, women, men, and children are dying of the Ebola virus and it is becoming too easy to forget that the ever-climbing case numbers are people,” said Laura Miller, Mercy Corps’ acting country director for the DRC.
The decision was applauded by some global health experts who have been frustrated by the fact it wasn’t taken earlier.
“Almost all international legal and policy experts agree that the conditions for declaring a PHEIC were met long ago, so we are delighted to see that the emergency committee and the director-general have finally come to this decision,” said Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University. “Not only do we believe that the decision will help bring additional needed attention to this ongoing crisis, but also move nations in the regions to take all necessary steps to address the potential spread of the disease.”
Though calls for the declaration of a PHEIC have become deafening as the length of this outbreak has dragged on, it was not entirely clear Wednesday when the advisory panel — called an emergency committee — finally relented and recommended the declaration. The committee had eschewed that path on three earlier occasions, including most recently in June, after three infected people from DRC crossed the border into Uganda.
All three were isolated quickly; all three died from their illness. There were no secondary infections from those cases.
Professor Robert Steffen, chair of the emergency committee, said the decision to conclude that a PHEIC is now warranted was based on several factors — the resurgence of transmission in Beni, a city that had been a hotspot early in the outbreak; the continued risk to Ebola response workers (two were recently murdered); the fact that nearly a year into the outbreak transmission is occurring over a wide swath of territory; and the discovery of a case in Goma.
Most of those factors were also true in June when the committee voted not to recommend a PHEIC. But Margaret Harris, the WHO’s communications manager for the Ebola response in DRC, said the committee felt the outbreak had reached a tipping point, with transmission occurring over an increasing large geographic area.
It remains to be seen if that will include Goma, a city of 2 million people south of the outbreak zone. Goma is on the border with Rwanda and is a regional travel hub; it’s long been feared it could serve as a launching pad for a much larger outbreak.
A pastor who was infected recently traveled by bus from Butembo to Goma, encountering a large number of people on his way. The pastor has since died.
Ryan said so far 257 people who either were in contact with the man, or in contact with his contacts, have been vaccinated in Goma. To date no other infections have been diagnosed there, but there would be no surprise if this case triggered other infections in the city.
There is also the possibility of additional cases in Uganda. On Wednesday, the country’s health minister announced an infected woman from DRC crossed into Uganda to trade for fish; she later returned to DRC, where she died. Authorities are looking for people who were in contact with her while she was in Uganda so they can be vaccinated.
Since the start of the outbreak last August, nearly 164,000 people have been vaccinated with an experimental Ebola vaccine being developed by Merck. While the WHO credits the vaccine for preventing a larger disaster, the outbreak response has struggled to find a way to bring this outbreak to an end.
The outbreak is occurring in a part of DRC that has been a conflict zone for decades. A United Nation peacekeeping force operates in the area and has had to provide security for outbreak responders who have come under attack from people in the region, some of whom believe Ebola was brought to the region by the outsiders.
Seven people working on the response have been killed, teams trying to conduct safe burials to prevent transmission have been attacked, and Ebola treatment centers have been fire bombed. The violence and the distrust has sharply impeded the outbreak responders’ ability to bring the outbreak under control and it’s not clear at this point what will swing the trajectory toward a conclusion of the outbreak.
This marks only the fifth time the WHO has declared a public health emergency of international concern. The previous PHEICs were the 2009 H1N1 flu pandemic, the 2014-2016 Ebola outbreak in West Africa, and the Zika outbreak in Latin America in 2016. Setbacks in the polio eradication effort in 2014 led WHO to declare the spread of wild poliovirus a public health emergency; that PHEIC remains in place today.