‘Long past time’: WHO takes crucial step in declaring Ebola an emergency
Dr. Tedros Adhanom Ghebreyesus reconvened the emergency committee on the Ebola outbreak in the Democratic Republic of the Congo, or DRC, for the fourth time, barely a month after the last committee meeting. The precipitating event was a case found in Goma, a major urban center in DRC. There has also been international spread to Uganda.
I applaud Dr. Tedros for declaring a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations (IHR). He has sounded a global alert, giving the clearest possible signal that WHO needs more financial and human resources. Without a surge response, it will be impossible to bring the DRC Ebola outbreak under control. It could rage on for months or years. In fact, it was long past time that WHO declared an emergency. The IHR criteria for a PHEIC had been met for many months. The legal criteria for a global emergency do not require international spread but only a high risk, which has been clear for a long while.
Now that WHO has declared a global emergency, it is time for bold action. Until now, the international community has lacked any sense of urgency, essentially allowing WHO’s health emergencies department and a few NGOs to fight the Ebola battle alone. This has come with enormous risk to life and safety for first responders, who have come under attack by rebel groups.
WHO has been trying to quell a dangerous outbreak using the same public health game plan that has worked in the past. But it isn’t working now, and it won’t. Standard strategies like case identification, vaccination and treatment can’t succeed in a complex humanitarian crisis like the situation in the DRC. Responders in the field are facing intense violence, along with deep community mistrust. They often can’t get into the hot zone due to escalating violence, and they can’t find cases to vaccinate and treat because families are hiding the sick. There has been no clear strategy to break the vicious circle of disease, violence and distrust.
WHO hadn’t called an emergency because it feared repercussions in the form of travel restrictions. WHO also believes a PHEIC provides it with no additional power or resources. But the status quo is no longer tenable. The complacency in the international community, including the United States, is crippling the response.
So, what do we need? We need a sense of international urgency, mobilizing resources and deploying experienced personnel. We need smart diplomacy from the U.S. State Department and United Nations to ameliorate the violence. We need a bottom-up social engagement of the community.
Sustainably fund WHO to scale: WHO urgently needs a surge in funding. The official funding deficit for WHO is $54 million. The funding shortfall is immediate and critical: If the funds are not received, WHO will be unable to sustain the response at the current scale. The response risks being driven by decisions related to financial capacity rather than operational needs. In fact, WHO has underestimated the overall funding shortfall, which also includes other first responders. In reality, the response needs more than $1 billion.
Human resources: The U.S. has banned the CDC and other crucial human assets from the hot zone. The State Department should develop a plan to safely deploy CDC and other U.S. personnel to the front lines.
Security on the ground: First responders can’t succeed when they are under attack. After every concussive attack, there has been a spike in Ebola cases. There must be a secured “safety zone” for health personnel to enter villages to identify cases and vaccinate those at risk. U.N. peacekeepers, with the mission and training explicitly to protect health personnel and work with local communities, should maintain safety. We don’t want to militarize the situation, so peacekeepers must adopt a “community policing” role working closely with the local population and health workers.
Smart diplomacy: The U.N. and partners including the U.S. State Department should engage in diplomacy to gain community trust and to negotiate a haven for the response with rebel groups. This is a complex humanitarian emergency requiring new skills and assets.
Until we galvanize international support and we change the playbook, we can expect the DRC outbreak to either spin out of control or, more likely, we will have a steady drumbeat of needless suffering and death for the next year, maybe much longer.
With each day that passes, precious lives are lost, including brave health workers. Were it not for a highly effective vaccine, the DRC outbreak could easily have been as severe as in West Africa. Since that epidemic, and with a new director-general, WHO has transformed itself. This is a pivotal moment for the future of WHO. Declaring an emergency was the first crucial step, but there is much more to do.
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- Lawrence O. Gostin, JD, is a professor at Georgetown Law and director of the O’Neill Institute for National and Global Health at Georgetown University. He can be reached at gostin@ georgetown.edu.