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Congo’s Ebola Outbreak Bad, but Not Global Emergency, WHO Says

The World Health Organization (WHO) today announced that the worsening Ebola crisis in the Democratic Republic of Congo (DRC) does not meet the criteria for declaring an international public health emergency, though concern for the region is high.

WHO Director-General Tedros Adhanom Ghebreyesus, PhD, convened an emergency committee today by teleconference from Geneva, Switzerland, to discuss the outbreak. The committee decided against declaring a global emergency.

Tedros told reporters today in an international press conference that, according to the most recent information, 216 people have been infected in the DRC and 179 have died. Fifty-seven people have been treated and have recovered, and more than 18,000 have been vaccinated, including 4000 children. Of the DRC’s 10 provinces, eight have been affected. The WHO has more than 250 workers deployed in the country.

“The [DRC] government’s leadership is still strong,” Tedros said.

He said the committee’s decision “does not mean WHO is not taking the outbreak seriously. Although the risk of global spread is low, it remains very high for neighboring countries, and we will be vigilant and strengthen our response and we will not rest until the outbreak is finished.”

Tedros noted that the country faces three main barriers: security in the midst of active conflicts, mistrust of healthcare workers, and geographic complications, including a highly mobile population and high population density.

Robert Steffen, MD, chair of the emergency committee and professor with the Department of Epidemiology and Prevention of Infectious Diseases at the University of Zurich, in Switzerland, told reporters the committee had to weigh several criteria in deciding whether to declare an international public health emergency.

The first is whether the situation is extraordinary. Although there have been many Ebola oubreaks in the DRC, Steffen said, “this one is extraordinary because there is a particular challenge with respect to security, with armed groups attacking particularly also in the area of the outbreak.”

The second is risk for cross-border spread. He said that although there is a risk, particularly to the closest country, Uganda, “so far not a single case has been exported.”

The third is whether an international response may be required. Steffen noted that an international response is already underway.

Declaring a public health emergency of international concern (PHEIC) can have advantages but also consequences, Steffen noted.

Steffen said the committee thought the declaration would add little value, given the number of international workers already deployed. Conversely, a PHEIC could have have a negative effect on travel and trade, which could hurt efforts of response teams to control the outbreak, he said.

“We do have some optimism that this outbreak, just like the one in May, will be brought under control within reasonable time,” Steffen said.

Threat Has Escalated

On August 1, the DRC’s Ministry of Health declared an Ebola outbreak in North Kivu Province. It was the tenth outbreak in the country in the past 40 years. Before the current outbreak, the most recent was in May 2018. On September 28, the WHO revised its risk assessment from high to very high.

Teams from the Ministry of Health, the WHO, and its partners are responding to the outbreak, particularly in the area surrounding Beni, a city of several hundred thousand, where most of the cases are centered.

Earlier this week, Reuters reported that containment is being made more difficult because some who have contracted Ebola are suspicious of healthcare workers and are avoiding them, fearing that hospitalization means death. Some families also fear they won’t get loved ones’ bodies’ back to perform traditional burials and so are not reporting cases.

According to Reuters, local authorities in Beni have indicated that people who harbor suspected patients could face a 3-month jail sentence. The authorities are also offering police protection for healthcare workers at burials.

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