Questions arise again over need to declare Ebola public health emergency

GENEVA — As the Ebola outbreak rages on in the Democratic Republic of Congo, and the World Health Organization and other organizations face increasing challenges to respond, questions swirl again over whether it’s time to declare a public health emergency of international concern.

The WHO has convened the emergency committee twice since the outbreak was announced in August — first in October 2018 then again in April 2019. But despite the enormous challenges, and concerns around the potential risk of the Ebola virus spreading to neighboring countries, the committee has stopped short from advising the director-general to declare it as a global public health emergency.

But the number of cases have surpassed 1,800, and WHO and other organizations are dealing not just with the high volume of cases but also mistrust, financing challenges, and insecurity. Just a week after the April emergency committee meeting, a WHO staff member, Richard Valery Mouzoko Kiboung, an epidemiologist from Cameroon, was killed during an attack at the Butembo University Hospital.

In his opening address at the 72nd World Health Assembly, WHO Director-General Tedros Adhanom Ghebreyesus highlighted the numerous challenges on the ground.

“We are not just fighting a virus. We’re fighting insecurity. We’re fighting violence. We’re fighting misinformation. We’re fighting mistrust. And we’re fighting the politicization of an outbreak,” he said.

“Ebola does not take sides. It’s the enemy of everybody. Unless we unite to end this outbreak, we run the very real risk that it will become more widespread, more expensive, and more aggressive,” he added.

Despite the challenges, however, the declaration of a public health emergency of international concern, or PHEIC, seems far from the agenda.

“The last emergency committee, they didn't declare PHEIC based on a strong analysis of the situation,” Dr. Jaouad Mahjour, assistant director-general on emergency preparedness and the international health regulations, told Devex. “But they asked, as a recommendation to the director-general, to continue to monitor the situation and if something happens, to convene [again]. And so far, the situation since the last emergency committee didn't drastically [change], at least not any new thing to call for an emergency meeting.”

In one of its recent situational updates, WHO said there was no guarantee the virus would not cross to neighboring countries. WHO officials said stronger national and international efforts were needed at the technical and financial level to respond and eventually stop the outbreak.

Frontline responders such as the Alliance for International Medical Action, or ALIMA, underscored the current uncertainties in the response. The outbreak is currently centered in Beni and Katwa, near the borders of Rwanda and Burundi, where there’s a risk of crossing borders.

But Benjamin Gelly, fundraising officer for ALIMA, told Devex that despite being the second largest Ebola outbreak in history, the current outbreak hasn’t reached the “threatening level” of the Ebola outbreak in West Africa in 2014.

However, “if it begins to have more cases on the frontal areas, on the borders, and if it starts to get regional, maybe it will be time [to declare a public health emergency of international concern],” he said.

Implications of a PHEIC

Declaring a public health emergency of international concern could have several implications. One of the most common perceptions is it will help galvanize international support to contain a crisis. But the implications are dependent on the recommendations by the emergency committee, said WHO’s Mahjour.

“Nobody can expect what the PHEIC do, or doesn't do, unless we look at the recommendation. The recommendations are tailored to the situation. If the committee feels that it's lack of funding, then they will recommend to have more funding,” he said.

Organizations such as ALIMA acknowledge they are limited in their response by the funding they get from international organizations, including WHO and the European Commission. In France, ALIMA is also experiencing challenges in fundraising after the French government scrapped a law that gives individuals tax incentives to give to charity.

The declaration of PHEIC, however, could lead countries to take extreme measures that are not necessarily part of the committee’s recommendations.

“From our previous experience when a PHEIC is declared, many countries attempted to take some public health measures and, sometimes they overreact to the event. We saw it in 2014 where some borders were closed, some flights were canceled. This may happen, and this is over reaction to the PHEIC,” Mahjour said.

He said, however, he understands there are different point of views on the issue.

“All public health experts, they don't have the same advice. And this is a very healthy situation. This debate is by itself very important,” he said.

Breaking down silo mentality

Speaking before member states on Tuesday, Oly Ilunga Kalenga, minister of health of the Democratic Republic of Congo, shared successes, despite the complexity of the response. The epidemic has not spread out to neighboring countries, and they have vaccinated over 100,000 people.

“Without an effective response, without the teams on the ground, without all these vaccinations, doubtless today [we would] be talking not about around 2,000 cases, we would be talking about tens of thousands of case,” he said.

But he underscored the need to rethink the strategy, by looking at both the successes and shortcomings of the response, which he said had several weaknesses including response fragmentation. All actors in the response need to continually communicate to each other, he said.

“We believe that the donors can also help to put an end to this lack of communication by promoting an approach in which financing is well and truly linked to action plans and specific measures,” he added.

The health minister also talked about community engagement, and said there are no links between community engagement and violence.

“To say that there is a link between community engagement and violence is very dangerous narrative to embark on. It's a narrative that is based on the assumption that communities are intrinsically violent and when they express their disagreement they do it through violence. This narrative cannot be accepted,” he said.