The statement outlines a series of unofficial reports of suspected Ebola cases in the country and the government’s repeated refusal to provide information that WHO requested to better understand the situation.
“The limited available official information from Tanzanian authorities represents a challenge for assessing the risk posed by this event,” the statement says.
This move shows “how seriously WHO sees the role of full transparency and disclosure about Ebola cases in this outbreak,” said Thomas Inglesby, director of Johns Hopkins Center for Health Security. “It's obviously quite unusual for WHO to make a statement like this, so they clearly have concerns.”
If Ebola cases were found in Tanzania, it would be the second time an Ebola case crossed international borders during this outbreak, which has ragged on for over a year and resulted in over 3,100 cases and over 2,100 deaths, as of Sept. 24. Tanzania has never had a case of Ebola.
Cross-border transmission is a high-level concern, with countries across the region putting in place measures to prevent transmission. Tanzania began its preparations in May 2018, but an assessment last month found “areas for improvement.”
Unofficial reports, incomplete info
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WHO, in its statement, said it was first made aware on Sept. 10 of unofficial reports of the death of an Ebola case in Dar es Salaam, the nation’s largest city, and the subsequent quarantine of that person’s contacts. The following day, WHO received further, unofficial reports that the person tested positive for Ebola and another suspected case was identified in Mwanza, in northern Tanzania. It also received unofficial reports of another case in Dar es Salaam.
The government then reported to WHO that there were no confirmed cases of Ebola in the country, but failed to provide alternative diagnoses for the illnesses or clinical data, according to the statement.
WHO recommends to countries that have not previously had Ebola outbreaks that the first 50 suspected negative samples be cross tested by a “reference” laboratory. Tanzania, for example, could consider having samples tested at the Uganda Virus Research Institute, Tarik Jašarević, a spokesperson for WHO, told Devex.
But the government is not considering a secondary confirmation testing, according to the statement.
On Sept. 19, WHO received additional unofficial reports that a contact of one of the earlier cases was sick.
“However, to date, clinical data, results of the investigations, possible contacts and potential laboratory tests performed for differential diagnosis of those patients have not been communicated to WHO,” according to the statement. It notes these developments put the risk at a “very high” at both the national and regional levels.
In response, WHO deployed a “multidisciplinary rapid response team” to Tanzania to bolster response capacity at the agency’s country office, which can provide technical assistance with the Tanzanian government’s investigation of the suspected cases, “should this be requested” by the government.
“WHO and partners continue to engage with national authorities and stand at the ready to offer technical expertise and other support to Tanzania in responding to any type of health emergency they may be facing,” Jasarevic told Devex.
“We would not want to speculate. The important thing to do is to continue to keep those affected informed, and to take the right public health actions,” he said.
The importance of transparency
There are many risks for Tanzania moving forward if the government chooses to continue withholding information, Johns Hopkins’ Inglesby said.
First, it means that any efforts to contain an actual outbreak could be stunted, he said. The containment of Ebola requires functional systems of containment, the protection of health care workers, communication to the health care system to watch for new cases, the education of communities, and the implementation of safe burial practices.
“It's difficult to put those things in place without being very clear that there are cases of diagnosed Ebola,” he said. “This needs to be communicated quite candidly, not just internationally, but within those local communities and to the larger public.”
A lack of transparency could also lead to a loss of confidence among other countries in the region that could lead to actions including trade restrictions, he said. This is something WHO has worked hard to prevent over the past year in the Democratic Republic of the Congo.
"Whether it's a case or not, at this point, it's extremely important for the Tanzanian government to communicate that in as much scientific detail as is available," Inglesby said.
Governments could also withhold information for the same economic reasons. The Ebola outbreak in West Africa, the largest in history, cost affected countries’ economies billions of dollars, with the World Bank estimated the economic losses at $2.8 billion — $600 million for Guinea, $300 million for Liberia, and $1.9 billion for Sierra Leone.
China’s delay in sharing information about SARS to the public and WHO was also driven in part by economic reasons. It took months before the government allowed WHO epidemiologists to enter Guangdong province where it first emerged in November 2002. It wasn’t until April 2003 that WHO epidemiologists reached the province. The SARS outbreak underlined the importance for countries to report any unusual disease outbreaks despite potential economic impacts, according to an article in The Lancet in 2013.
Engagement between governments and WHO “at the highest level” is crucial in containing diseases such as Ebola, Inglesby said, because the agency has deep technical expertise on Ebola and it has the ability to galvanize international resources, organize NGOs, and assist in the deployment of vaccines.
“Tanzania’s refusal to share information & virus samples with WHO is a violation of fundamental ethical & legal norms of global solidarity. I applaud WHO for calling out the government. Knowledge & transparency are the key first steps to rapid assessment & containment,” tweeted Lawrence Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law.