MANILA — The World Health Organization declared the Ebola outbreak in the Democratic Republic of the Congo a public health emergency of international concern on Wednesday, two days after hosting a high-level event on Ebola aimed at raising the profile of the crisis and gathering increased international support for the response.
Robert Steffen, chair of the emergency committee, cited several reasons for the decision, including the recent spread of the disease in the city of Goma, the recurrence of “intense transmission” of the disease in Beni, and the assassination of the two Ebola workers over the weekend, which Steffen said demonstrates the continued risks responders face on the ground.
“Today’s declaration should spring the international community into action and wake up the world to the severity of the situation.”— Bob Kitchen, vice president for emergencies, International Rescue Committee
The fact that the Ebola outbreak, first declared in North Kivu and Ituri provinces on Aug. 1, 2018, has lasted nearly a year also caused concern, as did the limited staff and financial resources available for the response.
Steffen said the decision was not meant as a reflection of “suboptimal performance” of actors working in the response. He emphasized the committee’s call for countries not to place travel and trade restrictions as a result of the declaration. Any border closures will have a “terrible impact” on the economy of the affected region, he said.
WHO Director-General Tedros Adhanom Ghebreyesus seconded the call for measured reaction.
“Closing borders could have disastrous consequences for the lives and livelihoods of the people who cross the border every day for trade, education, or to visit relatives. Such restrictions force people to use informal and unmonitored border crossings, increasing the potential for the spread of disease,” he said.
“We call on all countries, companies, and individuals to support DRC by respecting these recommendations,” Tedros added.
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Organizations have been calling for months for WHO to declare the outbreak a global health emergency, in part to help raise financial resources for the response. But the WHO chief emphasized that the declaration was not meant for fundraising, but for preventing the international spread of the disease.
“WHO is not aware of any donor that has withheld funding because a PHEIC had not been declared. But if that was the excuse, it can no longer be used,” said Tedros, who noted that WHO would be briefing the U.N. Security Council on July 31, the third briefing since the outbreak last August.
A long-awaited declaration
The declaration took place at the fourth reconvening of the emergency committee since the start of the outbreak. It came after signs of spread of the disease: a pastor who traveled from Butembo to Goma was diagnosed with Ebola and died there, and a woman who visited Uganda last week to buy fish in Mpondwe market died on Monday after returning to DRC and being admitted to an Ebola treatment facility.
Tedros said that while there’s no evidence so far of local transmission in both Uganda and Goma, they represent a “concerning geographical expansion of the virus.”
“This declaration is an urgent call to countries around the world that their financial support is desperately needed to prevent the spread of Ebola and save lives.”— Alexandra Phelan, global health security expert, Georgetown’s Center for Global Health Science and Security
Many in the global health community welcomed the declaration, especially those who think it’s long overdue.
“Today’s decision is the right call: the conditions for declaring a PHEIC under international law have been satisfied for many months. This declaration is an urgent call to countries around the world that their financial support is desperately needed to prevent the spread of Ebola and save lives,” said Alexandra Phelan, a global health security expert at Georgetown’s Center for Global Health Science and Security.
Julie Fischer, director of Georgetown’s Elizabeth R. Griffin Program, said the declaration should encourage countries to mobilize resources, including more personal protective equipment and rapid diagnostic testing to protect health workers and the affected communities from further infections.
Rory Stewart, U.K. secretary of state for international development, highlighted the importance of ensuring donor governments get “the basics right” on the ground during a speech at Monday’s high-level event on Ebola.
“Our real priority has to still be surveillance, contact tracing, vaccination, and above all just getting the basics right … like [having] the protective equipment in the clinics, making sure that people are not reusing their syringes and gloves, which I saw even on my most recent visit in DRC,” he said.
Gayle Smith, who helped lead the U.S. Ebola response in West Africa and is now CEO and president of the ONE Campaign, underscored the urgency to invest resources in the response.
“The time to start caring about Ebola isn’t when it reached the shores of the United States or Europe, it’s right now,” she said in a statement.
Many reiterated the calls made by the emergency committee and by Tedros for countries not to impose trade and travel restrictions in the affected countries, a concern raised multiple times in previous emergency committee meetings.
“We strenuously advocate for a scaled-up response that saves lives as well as livelihoods by keeping borders open, while bolstering informal and formal surveillance of cases at crossing points,” Laura Miller, Mercy Corps' acting country director for DRC, said in a statement.
Others noted that failure to act could have drastic consequences.
“Today’s declaration should spring the international community into action and wake up the world to the severity of the situation. This is a public health emergency in a complex humanitarian emergency — failure to respond accordingly will lead to a failure to contain the disease,” said Bob Kitchen, International Rescue Committee’s vice president for emergencies, emphasizing the importance of increasing community engagement in DRC and neighboring countries.
Several NGOs have expressed frustration that there does not appear to be enough emphasis on community engagement and ownership in the response. But others have underscored the complex socio-political environment in the affected areas of North Kivu, where decades of conflict and insecurity have led communities to be highly suspicious of outsiders, even of Congolese from other parts of the country.
Update, July 17, 2019: This story has been updated with additional quotes and analysis.