SYDNEY – The decision by a World Health Organization-convened emergency committee Friday not to recognize the current Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern — a PHEIC — may contribute to an erosion of the multilateral agency’s legitimacy and authority over the long term, experts said here today. They argued that emergency committees tasked with advising the WHO Director General on declaring PHEICs have stepped away from criteria set out in international agreements.
The outbreak met the criteria of a PHEIC when the first WHO emergency committee on the outbreak met back in October of 2018, Dr. Mark Eccleston-Turner of Keele University said, yet the committee failed to declare a PHEIC then and has failed to declare a PHEIC twice since – most recently on Friday when the committee was reconvened following the news of cases detected in Uganda.
According to criteria set in the International Health Regulations – an instrument of international law all 196 United Nations member states are legally bound to – a PHEIC should be declared when a health event is sudden and serious, has the potential to impact public health beyond an affected country’s border, and requires immediate international action. When the emergency committee failed to declare a PHEIC the second time they met in April 2019, Eccleston-Turner said, the committee said the criteria was not met because there had not been international spread, yet the criteria, Eccleston said, “requires the potential for international spread, not actual international spread.”
“It appears there is a change in the way in which the criteria is being understood and interpreted,” he said. This change was apparent again Friday when the committee decided not to declare a PHEIC, despite actual international spread, Eccleston-Turner said. This time the emergency committee justified their decision by claiming the spread of the virus into Uganda is not expected to pose global risks.
The decisions not to declare PHEICs not only impacts the response to the outbreak, as the declaration of PHEICs often act as a “clarion call” to the international community, mobilizes funding and helps accelerate responses, Eccleston-Turner said, but also carry long-term implications for international law. “If the WHO can add or change criteria to the International Health Regulations, why can’t states?” he said.
“We already know that states are ignoring the IHR by not reporting outbreaks,” Eccleston-Turner said. “This is a fragile international agreement predicated on trust. The chances of states ignoring their IHR obligations only increases as the WHO ignores PHEIC criteria,” he added.
Rabita Aziz is senior global health policy specialist at the Infectious Diseases Society of America, which produces this blog.