The World Health Organization has declared the Ebola outbreak in the Democratic Republic of Congo that has killed more than 1,600 people a “public health emergency of international concern.”
It’s the agency’s highest alarm, and this is only the fifth time in its history the designation has been used. The designation is used for an emergency that poses a risk to other states “through the international spread of disease and to potentially require a coordinated international response.”
The declaration highlights the growing concern in the international community about aid agencies’ inability to bring the virus under control in conflict-riven regions of DRC, almost a year after the outbreak began.
“It is time for the world to take notice,” WHO chief Tedros Adhanom Ghebreyesus told a news conference in Geneva on Wednesday.
While Tedros said the declaration was not about raising more money, the WHO has warned there is a significant shortfall in the amount of money needed to tackle the problem.
“The reality check is that a year into the epidemic, it's still not under control, and we are not where we should be,” said Joanne Liu, president of Doctors Without Borders. “We cannot keep doing the same thing and expect different results.”
WHO’s emergency designation has only been used four times in the past: the devastating 2014-16 Ebola outbreak in West Africa that killed more than 11,000 people, the emergence of Zika in the Americas, the swine flu pandemic and polio.
How many people have been affected?
The first case of Ebola in the DRC was reported in August 2018 in the eastern region of Kivu and this outbreak has affected two regions in the country, North Kivu and Ituri.
The virus initially spread relatively slowly, taking more than 220 days to infect 1,000 people. But since April, the rate of infection has increased rapidly, taking just 71 days to reach 2,000 people,
In total, more than 2,500 people have been infected and up to 1,670 of them have died. About 12 new cases are being reported every day.
Why has an emergency been declared now?
The tipping point came this week when a priest in the city of Goma was diagnosed with the disease. Goma is a major regional hub home to two million people in northeastern Congo and sits on the Rwandan border. It also has an international airport.
WHO described the case as a “game-changer” and it is now scrambling to trace dozens of people the priest came into contact with, including passengers on a bus he rode from Butembo, one of the epicenters of the outbreak.
Congolese officials said the situation was made more difficult as the priest had used several fake names as he traveled to Goma.
Why hasn’t it been contained?
A lack of funding has made it difficult for the authorities and aid agencies to bring the outbreak under control, and so has the on-going conflict in northeastern Congo.
Dozens of warring militias continue to operate in the mineral-rich region, though the government pledged last month to conduct “large-scale operations” to address the problem.
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There is also a serious lack of trust in health workers in the region, with many of those infected refusing to go to special Ebola containment centers. The result is that up to one-third of victims have died in their communities, where they are more likely to continue to spread the disease.
The deep mistrust of those charged with dealing with the crisis has fueled almost 200 attacks against healthcare workers or Ebola treatment facilities. Seven healthcare workers have died and 58 have been injured since the start of the year.
What about the vaccine?
During the devastating 2014 outbreak in West Africa, scientists helped develop a vaccine that was 99 percent effective.
The vaccine has yet to be approved by a regulator such as the Food and Drug Administration, but it is being widely deployed in the DRC. More than 160,000 people have been inoculated. However, it is only being given to those who come into contact with Ebola patients.
Merck, the company that makes the vaccine, says it had another 245,000 doses ready to ship.
A second vaccine, developed by pharmaceutical giant Johnson & Johnson, was due to be tested in DRC during the current outbreak, but Health Minister Oly Ilunga this week rescinded an offer to allow the testing of the vaccine, suggesting that the company was seeking to profit from the crisis in his country.
“We are in the presence of a very, very dangerous situation. We have people who don’t want to discuss [their plans] with the government. People who have no respect for ethics. And they are ready to introduce a new vaccine and to create new communications problems and trust problems with the community,” Ilunga told STAT. “So I just made the decision to say no. We are not going to start a discussion again.”
Michael Ryan, the executive director for WHO’s health emergencies program said on Wednesday that his organization still supports the use of a second vaccine, and said it was in discussions with the Congolese government.
Will borders be closed?
Despite two confirmed cases in Uganda last month and this week’s case in Goma, the WHO has recommended against closing borders, warning that the Ebola outbreak “should not be used to stigmatize or penalize the very people who are most in need of our help.”
Though the risks of the disease spreading regionally are high, the WHO said the risk of the disease spreading outside the region was not.
As a result, there will be no restrictions on travel or trade, and no entry screening of passengers at ports or airports outside the immediate region.
During the last Ebola outbreak in West Africa, aid agencies criticized WHO for its slow response, and internal documents subsequently revealed that it delayed making an emergency declaration for fear it would anger the countries involved and damage their economies.
The DRC government has cautiously welcomed this week’s declaration, but raised the possibility that it was made at the behest of unnamed interests.
“We accept the decision of the committee of experts but one hopes that it's a decision that wasn't made under pressure of certain groups that want to use this as a way to raise funds for certain humanitarian actors,” Ilunga said.
Cover: In this photograph taken Sunday July 14, 2019, an Ebola victim is put to rest at the Muslim cemetery in Beni, Congo DRC. (AP Photo/Jerome Delay)