Outside the Beltway

W.H.O. Declares Congo Ebola Outbreak A World Health Emergency

The World Health Organization has declared the year-long Ebola outbreak in the Democratic Republic of Congo a "world health emergency."

Doug Mataconis · Monday, July 22, 2019 · 1 comment

The World Health Organization has declared the ongoing Ebola outbreak in the Democratic Republic of Congo to be a world health emergency, hopefully a sign that public health authorities are prepared to take a far more aggressive posture toward fighting the outbreak:

The year-old Ebola epidemic in the Democratic Republic of Congo is now considered a global health emergency, the World Health Organization said on Wednesday, in a formal declaration that many public health experts called long overdue.

“This is still a regional emergency and by no way a global threat,” said Robert Steffen of the University of Zurich, chairman of the W.H.O. emergency committee that recommended the declaration.

But the panel was persuaded by several factors that have made combating the epidemic more urgent in recent weeks: The disease reached Goma, a city of nearly two million people; the outbreak has raged for a year; the virus has flared again in spots where it had once been contained; and the epidemic hot zone has geographically expanded in northeastern Congo near Rwanda and into Uganda.

Violence against health workers has been a constant worry, and intensified after two Congolese workers were killed in their homes in Beni last week.

Officials are also dismayed by the persistence of the epidemic even with the extensive use of a successful vaccine.

This was the fourth time that the W.H.O. had considered whether to declare a global health emergency in the Congo outbreak. It stopped short the first three times, even though some aid agencies and public health officials had called on the organization to do so in hopes such an order would elicit more funds and recruit more health workers to the region.

But government officials have repeatedly expressed competing concerns about interrupting trade or restricting travel, which Dr. Steffen emphasized should not result from the emergency status issued on Wednesday.

Emergency declarations are issued sparingly, reserved for outbreaks that pose a serious threat to public health and could spread to other countries. Only four such declarations have been made in the past: in 2009, for pandemic influenza; in 2014, for a polio resurgence in several countries; in 2014, for the Ebola epidemic in West Africa; and in 2016, for the Zika virus epidemic.

The Congo outbreak began a year ago, with the first cases confirmed in August. As of Monday, the disease had infected 2,512 people and killed 1,676 of them. The virus has defied efforts to control its rampant spread in the northeastern part of the country, a conflict zone under unrelenting peril from warring militias.

Dr. Tedros Adhanom Ghebreyesus, the director-general of the W.H.O., has described this outbreak as one of the world’s most dangerous viruses in one of the world’s most dangerous areas. Public health experts warn that the implacable spread of the virus means the outbreak could easily continue well into next year.

It is the second largest Ebola outbreak in history after the one in West Africa in 2014-15, which infected 28,616 people and caused 11,310 deaths

The decision on Wednesday was based on a vote by 11 members of an expert panel convened by Dr. Tedros to reassess the current outbreak after an infected man carried the virus to the city of Goma, a densely populated transportation hub close to Rwanda that has an international airport. That patient has died.

Global health groups had been calling for the declaration for months. Josie Golding of the Wellcome Trust, a research charity based in London, said in statement, “We commend the W.H.O. for making this tough decision, it is right to do so.” The public health response in Congo, she added, was “overstretched and underfunded.”

Labeling the epidemic a global emergency will “help raise international support and release more resources — including finance, health care workers, enhanced logistics, security and infrastructure,” she predicted.

These latest developments come several months after reports that the fight against the epidemic was not going well and that it was threatening to spread into major cities. This is happening notwithstanding the fact that the 2014 outbreak in western Africa that became an international crisis when it spread to the United States and Europe. That vaccine has proven to be as close to 100% effective in halting the spread of the disease as possible. While those results came under controlled experiments rather than use in the field, even a moderate to high success rate would be better than nothing and would go a long way toward stopping the rapid spread of the disease, especially in underdeveloped countries such as the DRC where sanitation and the disposal of medical waste are less than ideal and long-standing customs regarding the handling of dead bodies ends up contributing to the spread of the disease.

The problems that public health authorities have had such difficulty appear to be due to three key reasons. First of all, it’s not nearly quite as easy to get beyond long-standing cultural practices and taboos that tend to make it easier for a disease like Ebola to spread as experts may have thought it was. Second, there is understandable skepticism about vaccination from people who aren’t sufficiently educated about the actual benefits (and risks) of vaccination in general and the Ebola vaccine in particular. Finally, it appears from the reports that the DRC authorities have been utilizing heavy-handed tactics in an effort to force public compliance. This last development seems like a mistake. A better option would be to educate the populace more effectively about the spread of the disease and the effectiveness of vaccination. These same people can already see the impact that Ebola is having on their communities, but forcing them to comply with public health orders at the point of a gun is most assuredly not the best way to get people to cooperate, and more likely to make people suspicious of public health authorities, physicians, nurses, and others attempting to deal with this serious health problem even when they aren’t directly tied to the central government.

Considering the fact that leaders in the DRC and, indeed, throughout Africa have done practically everything possible to bolster citizen distrust of government authorities, this doesn’t bode well for efforts to contain Ebola or some other highly infectious disease in virtually any part of the continent. This is especially true of those places where civil war and rebellions that have been flaring hot and cold for decades are still an issue that government authorities and residents must deal with on a regular basis. Without that basic level of trust, citizens are less likely to accept representations from any authority figure about the threat posed by the disease and what they must do to protect themselves and their communities.

The good news, if there is any good news, is that the latest outbreak appears to be staying within a relatively limited geographic area. The first reports of an outbreak in the DRC came out in the spring of 2017. Last spring, it became apparent that the 2017 outbreak had not been suppressed as easily as previously thought and there were signs that it had hit a major city in the DRC. While those are serious issues, it does not appear that the disease has spread beyond that area, or outside the DRC in the time since then. There have been some limited reports of individual carriers arriving in neighboring countries and testing positive for Ebola, but they have been quickly isolated and treated. This is in stark contrast to the 2014 western Africa outbreak, which spread quickly to three nations and also managed to make it, in limited cases, as far as the United States and Europe, To that extent, one could arguably say that the public health response to this outbreak has been a huge success, but that’s hardly sufficient for the people of the DRC who are still under threat. They need better policies and approaches than what we’re seeing now if Ebola is going to be defeated there.