Ebola outbreak in Congo not a global public health emergency, committee says

Tedros Adhanom Ghebreyesus
Tedros Adhanom Ghebreyesus

Today, an emergency committee convened by WHO Director-General Tedros Adhanom Ghebreyesus, PHD, MSc, determined that the current Ebola virus outbreak in the Democratic Republic of the Congo, or DRC, does not meet the criteria to be declared a Public Health Emergency of International Concern, or PHEIC.

The outbreak, which is occurring in an area of conflict in the northeastern DRC, has left up to 220 people infected and 142 dead so far, according to the most recent update provided by the country’s health ministry.

“I’ve accepted the recommendation of the committee, but this does not mean that we are not taking the outbreak seriously,” Tedros said. “We will not rest until this outbreak is finished.”

The emergency committee took three main criteria into consideration when making its decision.

“Is it extraordinary? Is there a risk of cross-border spread? Is there potential for requiring international response,” said Robert Steffen, MD, chairman of the emergency committee.

Steffen explained that there have been many Ebola outbreaks in the DRC — this is the 10th since the virus was discovered in the country in 1976 — making it less than extraordinary when one is declared. However, he noted that the added challenge of armed conflict makes this one different.

The outbreak was brought to the “top degree of the difficulty scale” early on with the threat of rebel groups in the area adding to the complexity of containment operations. On Sept. 22, an attack in the city of Beni left 21 people dead, including 17 civilians. Residents of Beni and surrounding communities protested and mourned after the attacks, effectively shutting down WHO operations and negatively impacting Ebola outreach. During the shutdown, nearly 80% of people at risk were unable to be reached just days after the attacks, WHO said.

Officials are monitoring Uganda, a bordering nation just 50 kilometers from the initial outbreak location, for spread. According to Steffen, the committee took Uganda’s preparedness into consideration and determined that the country is ready and would have the situation under control should a case be reported there.

Tedros said that Uganda does not have approvals in place to use the investigational Merck vaccine that has already been administered to more than 18,000 people in the current outbreak, including 4,000 children, but that it is “in the pipeline” and will be approved as soon as possible.

“This outbreak is certainly not an outbreak of global importance but there are concerns for the region,” Steffan said. “Is there a risk of international spread? Yes, but it has not happened.” He added that international response is “already taking place.”

The outbreak was declared just a week after the previous outbreak in the DRC was declared over. With WHO workers and response teams still on the ground, their efforts, and efforts of other international groups, began within 24 hours.

The previous Ebola outbreak, which lasted approximately 3 months and generated 57 cases and 28 deaths, was also not declared a public health emergency. Had there been international spread, the emergency committee would have reconvened and reconsidered the decision.

The committee will continue to monitor the outbreak and will re-evaluate its decision if needed, Steffen explained, noting that it is “a process, not a one-off decision.”

“We had to weigh advantages and disadvantages of declaring a PHEIC,” Steffen said. “The question is, ‘Is there any added value?’ We acknowledge that WHO and other partner organizations have already achieved a great lot. In one province, the outbreak is mitigated; in another, it’s flaring up. But the concentration of the response team is this new area. We have optimism that this outbreak will be logged under control within reasonable time.” – by Caitlyn Stulpin

Disclosures: Steffen and Tedros report no relevant financial disclosures.

Tedros Adhanom Ghebreyesus
Tedros Adhanom Ghebreyesus

Today, an emergency committee convened by WHO Director-General Tedros Adhanom Ghebreyesus, PHD, MSc, determined that the current Ebola virus outbreak in the Democratic Republic of the Congo, or DRC, does not meet the criteria to be declared a Public Health Emergency of International Concern, or PHEIC.

The outbreak, which is occurring in an area of conflict in the northeastern DRC, has left up to 220 people infected and 142 dead so far, according to the most recent update provided by the country’s health ministry.

“I’ve accepted the recommendation of the committee, but this does not mean that we are not taking the outbreak seriously,” Tedros said. “We will not rest until this outbreak is finished.”

The emergency committee took three main criteria into consideration when making its decision.

“Is it extraordinary? Is there a risk of cross-border spread? Is there potential for requiring international response,” said Robert Steffen, MD, chairman of the emergency committee.

Steffen explained that there have been many Ebola outbreaks in the DRC — this is the 10th since the virus was discovered in the country in 1976 — making it less than extraordinary when one is declared. However, he noted that the added challenge of armed conflict makes this one different.

The outbreak was brought to the “top degree of the difficulty scale” early on with the threat of rebel groups in the area adding to the complexity of containment operations. On Sept. 22, an attack in the city of Beni left 21 people dead, including 17 civilians. Residents of Beni and surrounding communities protested and mourned after the attacks, effectively shutting down WHO operations and negatively impacting Ebola outreach. During the shutdown, nearly 80% of people at risk were unable to be reached just days after the attacks, WHO said.

Officials are monitoring Uganda, a bordering nation just 50 kilometers from the initial outbreak location, for spread. According to Steffen, the committee took Uganda’s preparedness into consideration and determined that the country is ready and would have the situation under control should a case be reported there.

Tedros said that Uganda does not have approvals in place to use the investigational Merck vaccine that has already been administered to more than 18,000 people in the current outbreak, including 4,000 children, but that it is “in the pipeline” and will be approved as soon as possible.

“This outbreak is certainly not an outbreak of global importance but there are concerns for the region,” Steffan said. “Is there a risk of international spread? Yes, but it has not happened.” He added that international response is “already taking place.”

The outbreak was declared just a week after the previous outbreak in the DRC was declared over. With WHO workers and response teams still on the ground, their efforts, and efforts of other international groups, began within 24 hours.

The previous Ebola outbreak, which lasted approximately 3 months and generated 57 cases and 28 deaths, was also not declared a public health emergency. Had there been international spread, the emergency committee would have reconvened and reconsidered the decision.

The committee will continue to monitor the outbreak and will re-evaluate its decision if needed, Steffen explained, noting that it is “a process, not a one-off decision.”

“We had to weigh advantages and disadvantages of declaring a PHEIC,” Steffen said. “The question is, ‘Is there any added value?’ We acknowledge that WHO and other partner organizations have already achieved a great lot. In one province, the outbreak is mitigated; in another, it’s flaring up. But the concentration of the response team is this new area. We have optimism that this outbreak will be logged under control within reasonable time.” – by Caitlyn Stulpin

Disclosures: Steffen and Tedros report no relevant financial disclosures.