Spread of Ebola not a surprise, not a PHEIC, committee finds in third meeting

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Following a third emergency meeting since the outbreak of Ebola in a conflict-riven region of the Democratic Republic of Congo, and the first since the outbreak was found to have spread to neighboring Uganda, a committee appointed by the World Health Organization has once again concluded that the still uncontrolled crisis does not constitute a Public Health Emergency of International Concern — a PHEIC.

The committee did, however, “express its deep concern” about the outbreak, and about challenges to a response which in its 11th month remain “hampered by adequate funding and strained human resources.” acting committee chair Dr. Preben Aavitsland said.

Dr. Aavitsland and Who Director General Dr. Tedros Adhanom Ghebreyesus agreed that the outbreak is an emergency — for the Democratic Republic of Congo and the region — and that the spread of disease to one of the nine countries bordering the DCR was expected. The impacts of the spread are not expected to pose global risks, however, Dr. Aavitsland said, adding that for that reason it still does not meet the criteria of a PHEIC. The committee is, however, “deeply disappointed” in a continued shortfall of international donor funding that has slowed preparedness efforts in the region, Dr. Aavitsland said.

The definition of a PHEIC, according to the 2005 International Health Regulation that established the designation is “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”. This definition, according to WHO “implies a situation that is: serious, sudden, unusual or unexpected, carries implications for public health beyond the affected State’s national border and may require immediate international action.”

Even before the confirmation of Ebola illnesses and deaths among a family in Uganda this week, the outbreak has carried implications for public health beyond DRC national borders that have led neighboring nations to train and vaccinate health workers and equip Ebola treatment units. Those implications are increased by the displacement of hundreds of thousands of people in the area, due to ongoing armed conflict and political unrest. That situation, across the outbreak-affected area is recognized to have allowed the outbreak to remain uncontrolled after 11 months, in a country that has controlled nine previous outbreaks — the most recent within three months — and to be both “serious,” and “unusual.” In addition Dr. Aavitsland counted among the committee’s recommendations that “donor countries should step up,” and that an overall funding gap of $54 million is limiting resources for both preparation and response.

Still, he said, in response to a reporter’s question, declaring a PHEIC to raise needed funding “would be a misuse of the instrument.” Dr. Aavitsland also said, however that the decision not to declare a PHEIC was influenced at least in part by potential consequences of the perception that the outbreak poses a “global emergency.” These, he said includes the imposition of travel and trade restrictions — which the committee has following each of its meetings recommended against, as well as the possibilities of airlines cancelling flights to the region and of border closures, that, he said, could harm the DRC economy.

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