In a controversial decision, the World Health Organization (WHO) has again decided not to declare Africa’s latest Ebola outbreak, which has killed more than 1400 people and just crossed into a new country, a Public Health Emergency of International Concern (PHEIC). “It was the view of the committee that the outbreak is a health emergency in the Democratic Republic of Congo [DRC] and the region, but it does not meet all [the PHEIC] criteria,” Preben Aavitsland, acting chair of an expert committee convened by WHO, said at a press conference on Friday evening in Geneva, Switzerland.
The committee gathered for the third time after news emerged this week that the virus had spread from the DRC to neighboring Uganda, so far killing two people there—a 5-year-old boy and his grandmother—who had crossed the border. Many infectious disease experts and public officials had expected, and called for, WHO to declare a PHEIC when Ebola broke out of the DRC. “I’m baffled and deeply troubled by this decision,” Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University in Washington, D.C., tells ScienceInsider. “The status quo is no longer tenable. It is time to sound a global alert.”
Gostin and others say declaring a PHEIC would focus global attention on the ongoing health crisis. More than 2400 people have been sickened since the outbreak started in August 2018—the largest outbreak of Ebola other than when it ravaged West Africa 5 years ago. “If I look back to a similar time in West Africa in 2014, prime ministers and presidents were talking about Ebola,” says infectious disease researcher Jeremy Farrar, who runs the Wellcome Trust in London. “Frankly, that has not happened in this outbreak.”
WHO has declared a PHEIC only four times since the tool was introduced into the agency’s arsenal in 2005: for the 2014 West African Ebola outbreak, pandemic flu in 2009, polio in 2014, and the Zika virus in 2016. Farrar says not declaring one now is a missed opportunity. “Declaring this a PHEIC would have raised the levels of international political support, which has been lacking to date; enhanced diplomatic, public health, security, and logistic efforts as well as released more financial resources to support the incredibly brave and committed teams working in North Kivu, DRC,” he wrote to ScienceInsider in an email.
But the WHO committee saw little to gain and much to lose, Aavitsland explained at the press conference. Although declaring a PHEIC would allow WHO to share information about the disease’s spread without the affected countries’ consent and to make temporary recommendations that member states have to follow, those measures are not necessary because countries are already sharing information and following WHO’s advice. On the other hand, declaring a PHEIC could be interpreted as the outbreak being a global emergency, Aavitsland said. “As we have seen with previous Public Health Emergencies of International Concern, we risk seeing restrictions on travel and trade, we risk [seeing] airlines stopping their flights to the area and we also risk border closures.” All of that could hamper public health efforts in the country, Aavitsland argued.Still, he agrees with Farrar that more help is needed, saying "The committee is deeply disappointed that WHO and the affected countries have not received the funding and resources needed for this outbreak. The international community must step up."
The spread of the virus to Uganda is worrying, but not unexpected, says Oyewale Tomori, a virologist at Redeemer’s University in Ede, Nigeria. “I am surprised that it took so long. My take is that cases may have occurred earlier and undetected in Uganda.”
The two people from the DRC who died in Uganda had crossed the border after the boy’s grandfather died from Ebola. Uganda has done an amazing job preparing for this spread, Farrar says, and has probably caught the case early enough to nip the outbreak in the bud. But more spread to the DRC’s neighbors, Rwanda and Burundi, is likely, he warns. “This epidemic is in a frightening phase and shows no sign of stopping anytime soon,” he adds.