WHO declares Ebola outbreak in DRC a global public health emergency

Tedros Adhanom Ghebreyesus
Tedros Adhanom Ghebreyesus

An emergency committee convened by WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, met for the fourth time today to review the ongoing Ebola outbreak in the Democratic Republic of the Congo, or DRC, and determined that the outbreak meets the criteria to be declared a Public Health Emergency of International Concern, or PHEIC.

Tedros reconvened the emergency committee for the fourth time since October following reports that a man with Ebola had traveled to the large Congolese city of Goma and died. The committee had previously voted against declaring a PHEIC three times, including just last month after the first cross-border cases were reported in neighboring Uganda.

“This is still a regional emergency and by no way a global threat,” Robert Steffen, MD, chair of the emergency committee, said in news conference after Tedros declared the PHEIC.

“Why this change of opinion? First, there is concern of the spread from Goma, although there are no new cases in the city. Two, there is disappointment that there has been an occurrence of intense transmission in Beni, making the geographic expansion some 500 km. Third, the fight is ongoing for a year now. Lastly, the deaths of two Ebola workers demonstrates the ongoing risk of responders due to security situation,” Steffen explained.

Photo of a health care worker adminstiering the Ebola vaccine 
More than 160,000 people have been vaccinated against Ebola in the current outbreak, which WHO has now declared to be a global public health emergency.
Source: World Bank/Vincent Tremeau. This work has not been changed and is licensed under: https://creativecommons.org/licenses/by-nc-nd/2.0/

The outbreak, which has been ongoing in an area of conflict in northeastern DRC since August 2018, has left more than 2,500 people infected and 1,675 dead.

Last month, officials reported cases in Uganda, where a 5-year-old boy and his 50-year-old grandmother died. Earlier this week, the ministry reported a case in Goma, a city with a population of 2 million people located near the border with Rwanda.

Tedros called the Goma case a “game-changer” in the outbreak and asked that the emergency committee convene promptly.

Now that a PHEIC has been declared, temporary recommendations will be in place, including health measures implemented by the affected areas or other countries to prevent the international spread of Ebola and to avoid unnecessary interference with international traffic. Once implemented, the regulations will be reviewed at least every 3 months by the emergency committee.

Per the recommendations, affected countries should continue to improve community awareness, engagement and participation in preventive and preparation strategies, continue cross-border screenings to ensure no contacts are missed, enhance coordination with the United Nations and other partners, strengthen surveillance, implement optimal vaccine strategies, and strengthen measures to prevent nosocomial infections. Neighboring countries should put approvals in place for investigational medicines and vaccines, map population movements and work to improve preparedness.

The emergency committee also encouraged increased production of Merck’s experimental Ebola vaccine, and said there are plans to double its production for 2020. More than 162,00 people have received the vaccine, which has been shown to be more than 97% effective.

According to Michael Ryan, MD, executive director of the WHO Health Emergencies Program, there is some support for the introduction of a second vaccine.

“We’ve worked closely with Johnson & Johnson for introduction of a second vaccine,” Ryan said. “[Theirs] is the most likely candidate to be used.”

WHO has not recommended that countries restrict travel or trade with the DRC — restrictions that could “hamper the fight,” according to Tedros.

"Now is the time for the international community to stand in solidarity with the people of the DRC, not to impose punitive and counterproductive restrictions that will only serve to isolate DRC,” Tedros said.

He said officials are finalizing the plan that will outline the resources needed for the next phase of the response. Ryan and Tedros explained that the cost will be more than $230 million. – by Caitlyn Stulpin

Disclosures: Ryan, Steffan and Tedros report no relevant financial disclosures.

Tedros Adhanom Ghebreyesus
Tedros Adhanom Ghebreyesus

An emergency committee convened by WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, met for the fourth time today to review the ongoing Ebola outbreak in the Democratic Republic of the Congo, or DRC, and determined that the outbreak meets the criteria to be declared a Public Health Emergency of International Concern, or PHEIC.

Tedros reconvened the emergency committee for the fourth time since October following reports that a man with Ebola had traveled to the large Congolese city of Goma and died. The committee had previously voted against declaring a PHEIC three times, including just last month after the first cross-border cases were reported in neighboring Uganda.

“This is still a regional emergency and by no way a global threat,” Robert Steffen, MD, chair of the emergency committee, said in news conference after Tedros declared the PHEIC.

“Why this change of opinion? First, there is concern of the spread from Goma, although there are no new cases in the city. Two, there is disappointment that there has been an occurrence of intense transmission in Beni, making the geographic expansion some 500 km. Third, the fight is ongoing for a year now. Lastly, the deaths of two Ebola workers demonstrates the ongoing risk of responders due to security situation,” Steffen explained.

Photo of a health care worker adminstiering the Ebola vaccine 
More than 160,000 people have been vaccinated against Ebola in the current outbreak, which WHO has now declared to be a global public health emergency.
Source: World Bank/Vincent Tremeau. This work has not been changed and is licensed under: https://creativecommons.org/licenses/by-nc-nd/2.0/

The outbreak, which has been ongoing in an area of conflict in northeastern DRC since August 2018, has left more than 2,500 people infected and 1,675 dead.

Last month, officials reported cases in Uganda, where a 5-year-old boy and his 50-year-old grandmother died. Earlier this week, the ministry reported a case in Goma, a city with a population of 2 million people located near the border with Rwanda.

Tedros called the Goma case a “game-changer” in the outbreak and asked that the emergency committee convene promptly.

Now that a PHEIC has been declared, temporary recommendations will be in place, including health measures implemented by the affected areas or other countries to prevent the international spread of Ebola and to avoid unnecessary interference with international traffic. Once implemented, the regulations will be reviewed at least every 3 months by the emergency committee.

Per the recommendations, affected countries should continue to improve community awareness, engagement and participation in preventive and preparation strategies, continue cross-border screenings to ensure no contacts are missed, enhance coordination with the United Nations and other partners, strengthen surveillance, implement optimal vaccine strategies, and strengthen measures to prevent nosocomial infections. Neighboring countries should put approvals in place for investigational medicines and vaccines, map population movements and work to improve preparedness.

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The emergency committee also encouraged increased production of Merck’s experimental Ebola vaccine, and said there are plans to double its production for 2020. More than 162,00 people have received the vaccine, which has been shown to be more than 97% effective.

According to Michael Ryan, MD, executive director of the WHO Health Emergencies Program, there is some support for the introduction of a second vaccine.

“We’ve worked closely with Johnson & Johnson for introduction of a second vaccine,” Ryan said. “[Theirs] is the most likely candidate to be used.”

WHO has not recommended that countries restrict travel or trade with the DRC — restrictions that could “hamper the fight,” according to Tedros.

"Now is the time for the international community to stand in solidarity with the people of the DRC, not to impose punitive and counterproductive restrictions that will only serve to isolate DRC,” Tedros said.

He said officials are finalizing the plan that will outline the resources needed for the next phase of the response. Ryan and Tedros explained that the cost will be more than $230 million. – by Caitlyn Stulpin

Disclosures: Ryan, Steffan and Tedros report no relevant financial disclosures.

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