DRC Ebola outbreak not a PHEIC, but challenges, risks remain daunting, requiring investments

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A World Health Organization-convened committee examining the Ebola outbreak in the Democratic Republic of Congo concluded today that the current conditions of the outbreak do not constitute an international health emergency, but do continue to pose significant challenges that could warrant revisiting the question. WHO Director General Tedros Ghebreyesus called for the committee to weigh whether the outbreak, which was first reported in a remote rural area, should be declared a Public Health Emergency of International Concern, after four cases were reported in Mbandanka, a city with a population of 1.2 million, greatly accelerating its potential to spread.

The outbreak was announced May 8, with the confirmation of two cases in Bikoro, a lakeside market town in the northwestern region of the DRC. Since then 45 cases have been reported, dating back to April 4, and have so far been reported to have taken 25 lives, including those of three health workers. The infections among health workers also raise concerns of accelerated spread. Of the cases, 14 have been confirmed, an indication that mobile labs and personnel are up and working in the affected areas. WHO, Médecins Sans Frontières, UNICEF and the World Food Program all sent personnel and supplies to Bikoro within two days of the first case confirmations. Use of a vaccination developed during the West Africa outbreak, but never applied during an active outbreak, will begin Sunday, WHO officials said. This effort will differ too, Dr. Peter Salama, an epidemiologist with WHO’s Health Emergencies division, with “a paradigm shift” to offer effective prevention and treatment.

Dr. Peter Salama, at the WHO press conference this morning.

“In the past,” he said, “our main objective was containment.” Still, he noted, administering ZMapp, an experimental treatment used mainly on infected international health workers during the previous outbreak, requiring intravenous infusion, will be “hard to imagine” amidst Bikoro’s resource limitations.

The remoteness of the region where the first cases were reported, requiring hours of travel by motorbike on nominal roads greatly challenges tracing the contacts of those confirmed to have the virus — and tracing people who have been in contact with them — for testing, isolation, and vaccination. In addition bringing in sufficient personnel and supplies to diagnose, isolate and care for patients, educate community members, and protect health workers will require clearing land for an airstrip where planes can land. The committee is recommending screening — and infusions of resources to support screening — for the virus at the DRC airport and at river ports. They are not recommending screening at international airports or any restrictions to trade or travel.

While the remoteness of the area adds obstacles to responses, the area’s proximity and access to the Congo River open the possibility of the outbreak spreading to large urban areas, including in other countries, with ports on the river. The DRC borders nine other countries, of which the Central African Republic and Congo-Brazzaville are considered to be at particular risk of spread. The confirmation of cases in Mbandaka, near the river, added to concerns.

For all of those obstacles and risks, WHO officials today expressed optimism that efforts will quickly limit the outbreak’s spread, citing strong efforts and coordination by DRC government offices, WHO staff, and partners. The efforts provide a stark contrast to responses to the West Africa outbreak which spread across Guinea, Liberia, and Sierra Leone, devastating cities and communities, as well as health work forces and capacities and was carried into Lagos, Nigeria, the most populous city in Africa before WHO convened the committee that determined that outbreak had become a matter of international concern. Containing this outbreak, WHO officials said today, will cost about $26 million, of which $9 million has been pledged so far. It is a small investment, they emphasized, in both the lives and the money it will save. The West Africa outbreak, by the time it ended had cost from $2 billion to $3 billion in direct costs, and taken the lives of more than 11,000 people.

The contrast, Tedros (who goes by his first name) pointed out, highlights “how important solidarity is at an early stage.”

 

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