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WHO says Ebola outbreak still not an international health emergency
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For the second time, an emergency committee convened by WHO voted against declaring the Ebola virus outbreak in the Democratic Republic of the Congo, or DRC, an international public health emergency.
Committee chairman Robert Steffen, MD, said members voted almost unanimously not to declare a public health emergency of international concern (PHEIC) despite worry about the duration of the outbreak, which began last summer, and a recent spike in the number of cases.
As he did in October when the committee also voted against declaring a PHEIC, Steffen indicated that the No. 1 reason for not doing so is that the outbreak has not spread beyond the DRC.
“If it stays within a country, by definition it’s not of international concern because it has not spread,” Steffen said.
WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, accepted the decision, but warned that the outbreak response remained underfunded by more than $100 million and asked that the international community step up its commitments.
“Stopping this outbreak is our collective responsibility,” he said.
Tedros has said that ongoing violence being perpetrated by armed militia groups threatens to reverse any gains that have been made in the outbreak. The number of confirmed and probable cases rose steadily during the first months of the year, climbing past 1,200 in mid-April, making it the second-largest Ebola outbreak on record after the West African epidemic. More than 800 people have died.
The violence has included attacks on Ebola treatment facilities, including one in March at a facility that was visited just hours later by Tedros and CDC Director Robert Redfield, MD.
Fearing cross-border spread, other countries have begun vaccinating health care and front-line workers with Merck’s experimental V920 vaccine — first Uganda, then South Sudan and Rwanda.
In the DRC, more than 100,000 people have received the vaccine. For the first time, WHO released data on the vaccine’s effectiveness, showing that it has been protective in 97.5% of the people who have received it.
Ebola outbreak expert Mike Ryan, MD, MPH, who heads WHO’s health emergency program, said the vaccine “is demonstrating remarkable efficacy against infection.”
The vaccine is being administered on a voluntary basis to contacts — and contacts of contacts — of confirmed Ebola patients as part of a ring trial. Around 10% of contacts have not accepted vaccination, which also has hindered control efforts, Ryan said. – by Gerard Gallagher and Caitlyn Stulpin
Disclosures: Ryan, Steffen and Tedros report no relevant financial disclosures.
Perspective
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Ronald Klain
Whether the Ebola outbreak in the DRC technically is or is not a PHEIC is beside the point. The response is failing to get the disease under control. This is particularly worrisome given that — unlike the Ebola response in 2014-2015 — this effort has the benefit of a highly effective vaccine that can prevent the disease’s spread.
In my view, four things need to happen. First, WHO needs to withdraw earlier statements that implied that the outbreak was coming under control, and make it clear that vastly increased, urgent action is needed because of the risk for spread of the disease to new and vulnerable populations. Second, the United States needs to step up its contribution and on-the-ground involvement in the response, with diplomatic engagement to make it safer for U.S. responders to operate in the key areas; increased deployment of U.S. personnel; and action to increase supplies of the vaccines, therapeutics and diagnostics. Third, with U.S. leadership, other nations too must step up their financial contributions and security and diplomatic assistance to WHO and to the nongovernmental organizations that need backing and support for their operations. And fourth, global health leaders should prepare a plan for mass vaccination — going beyond the current ring vaccination effort — to prevent the disease’s spread to new areas.
WHO has decided this is not a PHEIC. But that does not change the grim reality that it is an emergency, and the international community — led by the U.S. — needs to get a lot more concerned, right away.
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