DRC Ebola outbreak now a PHEIC, WHO committee says following fourth meeting

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WHO leaders speaking at the meeting today in which they announced that the DRC outbreak, now a year on, is a Public Health Emergency of International Concern.

Citing recent cases that highlighted risks of international Ebola spread, and the killing earlier this week of two more responders working to control the ongoing outbreak of  the disease in the Democratic Republic of Congo, a World Health Organization-convened committee today recommended that the agency declare the now year-long crisis in that country a Public Health Emergency of International Concern — a PHEIC.

The declaration will be the fifth since the mechanism of declaring public health emergencies of “international concern,” intended to build cooperation in controlling outbreaks with international ramifications, was introduced in 2005. Declared previously in response to outbreaks of H1N1 flu, polio, Zika, and the West Africa Ebola outbreak  — after patients were confirmed in the United States and Nigeria’s most populous city —  this declaration marks the just second time a PHEIC has been declared in response to Ebola outbreak and the first time in the Democratic Republic of Congo, where the virus was first identified, and where nine previous outbreaks have occurred. The meeting today marked the fourth time the committee has met to weigh whether to recommend a PHEIC, since the outbreak in a politically unstable and violence-riven region of the country with near borders to nine neighboring countries was recognized in August 2018. The first meeting led to a finding that the situation was “extraordinary,” but not a PHEIC, the second to a call only for “redoubled efforts,” and the third, just a month ago, amid a funding gap of more than $54 million, to a call for donor countries to “step up.”

Earlier this week, WHO Director General Dr. Tedros Adhanom Ghebreyesus asked the committee to meet again following confirmation that a patient in Goma, a city of two million people close to the Rwanda border with an international airport, had traveled across the region while sick with Ebola. Today, as the committee met, the Uganda Ministry of Health announced that a fish trader from Beni — a city where at least 475 people have fallen ill with confirmed Ebola — had traveled to a Uganda market where she vomited four times before returning to Beni where her Ebola was confirmed where she died Monday.

The pastor traveling from Butembo went through three health checkpoints before his illness was confirmed in Goma where he sought care, and the fish trader “did not use the formal border entry point” in her travels according to the Uganda health ministry.

Those incidents, the assassination of two Ebola responders in their Beni home, the geographical expansion of the disease, and the now year-long continuation of disease spread with control efforts disrupted by violence were factors in today’s decision, committee Chair Dr. Robert Steffen said. With all of these factors anticipated even as the outbreak began, why the committee did not declare a PHEIC sooner remains unclear. Following earlier meetings, committee members have cited concern that declaration of a PHEIC could lead to trade and travel bans, and closed borders, and Dr. Steffen as well as Dr. Tedros emphasized again today that those measures would be “punitive and counter-productive.” Committee representatives also have said that declaration of a PHEIC should not be used to spur increased funding.

Today, however, Dr. Steffen noted that “resources have become a limiting factor in technical assistance,” adding, “there must be more involvement by the international community.”

Dr. Tedros, in turn, said he was aware of no instance of a nation withholding funding because a PHEIC had not been declared, adding, however, “if that was the excuse, it can no longer be used.”

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