World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus declared the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) a Public Health Emergency of International Concern (PHEIC) on July 17, 2019.
The declaration followed a meeting of the International Health Regulations Emergency Committee for EVD in the DRC held in Geneva on July 17, WHO said in a statement. It was the 4th Emergency Committee meeting since the outbreak was declared on August 1, 2018. The outbreak has been classified as a level 3 emergency since it started – the most serious – by WHO, triggering the highest level of mobilization from WHO. The UN has also recognized the seriousness of the emergency by activating the Humanitarian System-wide Scale-Up to support the Ebola response, WHO said.
The Committee cited recent developments in the outbreak in making its recommendation, including the first confirmed case in Goma, a city of almost 2 million people on the border with Rwanda, and the gateway to the rest of DRC and the world.
"It is time for the world to take notice and redouble our efforts. We need to work together in solidarity with the DRC to end this outbreak and build a better health system," said Dr. Tedros.
"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. This is about mothers, fathers and children - too often entire families are stricken. At the heart of this are communities and individual tragedies,” said Dr. Tedros. “The PHEIC should not be used to stigmatize or penalize the very people who are most in need of our help."
Press briefing on the behalf of the 4th meeting of the International Health Regulations Emergency Committee for EVD in the DRC held in Geneva on July 17
There are increased numbers of cases in Butembo and Mabalako; the epicenter has moved from Mabalako to Beni; and there is one imported case in Goma, the Emergency Committee said in a statement:
Factors affecting the outbreak include population movement in highly densely populated areas; weak infection and prevention control practices in many health facilities; complex political environment; continued reluctance in the community; and the ongoing unstable security situation, which led to the recent murders of two community health workers.
More than 70 entry points are being monitored and 75 million screenings have been conducted, with 22 cases detected in this manner. Beni is the main hotspot; cases in other areas are decreasing.
There are 2 512 confirmed or probable cases, including 136 health workers affected, with 40 deaths among them.
Beni remains the epicenter of the outbreak, with 46% of the cases over the last 3 weeks. Mangina has 18% of the cases, and one new case in Goma came from Beni, with diagnosis confirmed within one hour of the patient’s arrival at a health facility.
The patient, who was not known to be a contact, traveled to Goma with several other people in a bus. When the vehicle broke down, he went to a health facility via motorbike. He was transferred to an Ebola Treatment Centre, but later died. Response to the case in Goma took place within 72 hours. Contact tracing was performed, with 75 contacts vaccinated, as well as co-travelers, and family members are being monitored.
Surveillance is being reinforced and readiness strengthened. 15 000 people cross the border from Goma to Rwanda every day, as Goma is an important center of economic activities with Rwanda.
Closing this border would strongly affect the population of Goma and have adverse implications for the response. There is a continuing need for increased awareness among the population on the outbreak situation and stronger engagement on health-seeking behaviors.
The risk remains very high at national and regional levels but still low at the global level. There is cause for concern linked to the recent case in Goma, as the city is a provincial capital with an airport with international flights.
It was the view of the Committee that a coordinated international response under the International Health Regulations (2005) is required. Thus, the conditions for a Public Health Emergency of International Concern (PHEIC) under the IHR (2005) have been met.
The Committee discussed the impact of a PHEIC declaration on the response, possible unintended consequences, and how these might be managed.
The global community should anticipate possible negative consequences and proactively prevent them from occurring, taking into account experience with Ebola in West Africa in 2014.
The declaration of the PHEIC is not a reflection on the performance of the response team but rather a measure that recognizes the possible increased national and regional risks and the need for intensified and coordinated action to manage them.
The Committee provided the following advice to the Director-General for his issuance as formal Temporary Recommendations under the IHR (2005).
For affected countries:
Continue to strengthen community awareness, engagement, and participation, including at points of entry, with at-risk populations, in particular to identify and address cultural norms and beliefs that serve as barriers to their full participation in the response.
Continue cross-border screening and screening at main internal roads to ensure that no contacts are missed and enhance the quality of screening through improved sharing of information with surveillance teams.
Continue to work and enhance coordination with the UN and partners to reduce security threats, mitigate security risks, and create an enabling environment for public health operations as an essential platform for accelerating disease-control efforts.
Strengthen surveillance with a view towards reducing the proportion of community deaths and the time between detection and isolation, and implementing real-time genetic sequencing to better understand the dynamics of disease transmission.
Optimal vaccine strategies that have maximum impact on curtailing the outbreak, as recommended by WHO’s Strategic Advisory Group of Experts (SAGE), should be implemented rapidly.
Strengthen measures to prevent nosocomial infections, including systematic mapping pf health facilities, targeting of IPC interventions and sustain support to those facilities through monitoring and sustained supervision.
For neighboring countries:
At-risk countries should work urgently with partners to improve their preparedness for detecting and managing imported cases, including the mapping of health facilities and active surveillance with zero reporting.
Countries should continue to map population movements and sociological patterns that can predict risk of disease spread.
Risk communications and community engagement, especially at points of entry, should be increased.
At-risk countries should put in place approvals for investigational medicines and vaccines as an immediate priority for preparedness.
For all States:
No country should close its borders or place any restrictions on travel and trade. Such measures are usually implemented out of fear and have no basis in science. They push the movement of people and goods to informal border crossings that are not monitored, thus increasing the chances of the spread of disease. Most critically, these restrictions can also compromise local economies and negatively affect response operations from a security and logistics perspective.
National authorities should work with airlines and other transport and tourism industries to ensure that they do not exceed WHO’s advice on international traffic.
The Committee does not consider entry screening at airports or other ports of entry outside the region to be necessary.
Featured image credit: DFID