A new commentary published on 4 February in The Lancet has called upon World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus to reconvene the emergency committee and to reconsider whether to declare the Ebola outbreak in the Democratic Republic of the Congo (DRC) a “public health emergency of international concern (PHEIC)” (1).
The recent outbreak in the DRC is the second largest in history, after the West Africa epidemic of 2014, and is complicated by ongoing armed conflict and political instability in the African country. The current Ebola epidemic, therefore, presents a highly complex humanitarian crisis. In October, the WHO concluded that while a PHEIC should not be declared at this time, the emergency committee remains “deeply concerned” and highlighted the critical need for “ongoing vigilance” and “intensified” “response activities, fearing “significant deterioration” in the DRC. However, according to a report published on 23 January, the number of Ebola cases has tripled since October and the disease has expanded into 18 health zones in the provinces of North Kivu and Ituri.
A PHEIC is defined by the International Health Regulations (2005) as “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. The authors ― an international group of public health experts ― highlight the current risk of “a long-term epidemic with regional, perhaps global, impacts” and argue that the legal criteria for a PHEIC have been met, and have been for some time. Moreover, the risk of Ebola spreading across borders into Uganda, Rwanda, and South Sudan is increasingly high, particularly owing to conflict-driven migration ― 300 000 DRC refugees have crossed into Uganda in the past 6 months, adding to an existing refugee population of around 1 million.
From the beginning of the outbreak in August 2018 until 21 January 2019, there have been a total of 699 cases ― 650 confirmed and 49 probable ― reflecting a continuation of the outbreak across a wide geographical area. Despite remarkable efforts being made by the WHO, the DRC Government, and non-governmental organisation (NGO) partners, the outbreak has continued to spread and resources are being stretched. As a result, cases are not being identified early enough ― fewer than 20% of new Ebola cases were on known contact lists ― and vaccinations supplies are limited.
Declaring a PHEIC would “galvanize high-level political, financial, and technical support.” But the authors also warn of potentially devastating impacts on the DRC as a result of trade or travel barriers. Furthermore, the PHEIC could also incentivise armed groups to target Ebola workers in an attempt to gain leverage. As such, along with UN support, the WHO should take “active steps to prevent unlawful and harmful restrictions” but will need to tread carefully, remain culturally sensitive, and practice smart diplomacy.
(1) Gostin L., et al. Ebola in the Democratic Republic of the Congo: time to sound a global alert? The Lancet (2019). DOI: 10.1016/S0140-6736(19)30243-0
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