The World Health Organization decided on Wednesday that Congo's deadly Ebola outbreak should be treated as an international health emergency, marking a major shift in strategy after the virus reached a city of 2 million people.
The declaration came just days after a single case was confirmed in Congo's northeastern city of Goma, near the Rwandan border, where the United Nations has long shuttled health and peacekeeping officials in and out of the city's international airport and erected displacement and refugee camps on the city's outskirts.
“It is time for the world to take notice and redouble our efforts,” Tedros said in a statement. "Extraordinary work has been done for almost a year under the most difficult circumstances. We all owe it to these responders — coming from not just WHO but also government, partners and communities — to shoulder more of the burden.”
More than 2,500 people have been infected by the virus and nearly 1,700 have died in what is now the second-deadliest Ebola outbreak in history, according to Congo’s Health Ministry. Health officials fear it could spread to neighboring countries such as Burundi, Rwanda, South Sudan and Uganda. However, the U.N. health agency has rejected making an emergency declaration three times before.
In previous debates, WHO experts and officials expressed grave concern about Congo’s surging Ebola outbreak but decided it did not constitute an international public health emergency. The panel still did not recommend an emergency declaration even after the outbreak crossed an international border for the first time last month; a family brought the virus into Uganda from an infected relative's burial in Congo.
But after the panel, known as WHO's Emergency Committee, met for a fourth time since the outbreak was declared on August 1, 2018, its thinking shifted and WHO’s Director General Tedros Adhanom Ghebreyesus announced his decision to accept its recommendation for an emergency declaration. He declared the Ebola virus outbreak to be a Public Health Emergency of International Concern, or PHEIC.
The Emergency Committee also made specific recommendations related to this outbreak such as measures aimed at strengthening community awareness and cross-border screening, and it also said that it was disappointed by delays in getting the money that is needed to properly respond to the outbreak.
“It is important that the world follows these recommendations. It is also crucial that states do not use the PHEIC as an excuse to impose trade or travel restrictions, which would have a negative impact on the response and on the lives and livelihoods of people in the region,” said Robert Steffen, a University of Zurich epidemiologist and emeritus professor in Switzerland, who co-chairs the Emergency Committee.
Also Wednesday, International Medical Corps, a global humanitarian aid organization that has been on the ground in Congo since the beginning of the Ebola outbreak, and runs a treatment center near the country's northeastern border with Uganda, said it found that early treatment of Ebola patients with vitamin A supplements has led to reduced mortality among those diagnosed with the deadly virus.
The findings from the IMC-supported research were published in the Journal of Nutrition. The study was based on data from 2,500 patients admitted to five Ebola treatment centers managed by IMC in Liberia and Sierra Leone during West Africa's Ebola outbreak from 2014 to 2016, the largest such epidemic ever.
Nearly a year in the making
A global emergency is defined as an “extraordinary event” that poses an international risk, and it requires a coordinated response. Declaring Ebola in Congo to be a global health emergency helps to fast-track more international research and action, though it can also prompt governments to close their borders.
This is only the fifth such declaration in WHO's history. Previous emergencies were declared in West Africa's Ebola outbreak, which killed more than 11,000 people; Zika's threat to the Americas; and in the polio and swine flu pandemics.
Experts have long said that the Ebola outbreak in Congo met conditions for an emergency declaration. But the international response to the outbreak has been hampered by political instability, conflicts, dense populations and public mistrust of Ebola services. Armed attackers have targeted doctors and vaccination teams, and others have harassed the families of health workers, apparently mistrustful of outsiders.
There have been dozens of attacks on response teams and Ebola treatment centers, many against local responders. Several dozen local responders have died of Ebola. Two medical clinics run by Médecins Sans Frontières were attacked in February by unknown assailants, forcing MSF to suspend work in two areas, Katwa and Butembo, that have been affected by the outbreak.
In April, armed attackers killed Dr. Richard Valery Mouzoko Kiboung, a Cameroonian epidemiologist working for the WHO, and in May, villagers beat to death an Ebola hygienist, Kambale Sambili.
Still, WHO kept on treating the outbreak as a "level 3" emergency, its most serious designation, fearing that an emergency declaration could provoke more of a backlash. That reasoning changed as Goma was threatened by the virus.
“This is about mothers, fathers and children — too often entire families are stricken. At the heart of this are communities and individual tragedies,” Tedros said. “The PHEIC should not be used to stigmatize or penalize the very people who are most in need of our help.”
Dr. Joanne Liu, president of MSF, said she hoped the emergency designation would bring about a new strategy.
“The signs are clear: people are still dying in the communities, health workers are still infected, and transmission is still going on. The epidemic is not under control and we need a change of gear," said Liu.
"But this should not be about movement restrictions or the use of coercion on the affected population. Communities and patients need to be at the center of the response, they need to be active participants," she said. "MSF has experienced first-hand how difficult it is to respond to this epidemic. We need to take stock of what is working and what is not working."