It has been about a year since an Ebola outbreak was reported in the Democratic Republic of Congo (DRC), and the disease shows no signs of abating.
The World Health Organisation (WHO) on Wednesday pressed the panic button, declaring the outbreak a “public health emergency of international concern”, a rare designation only used for the gravest epidemics.
The WHO, however, stressed that no country should close its borders or place any restrictions on travel or trade, adding that the risk of the disease spreading outside the region was not high.
“It is time for the world to take notice and redouble our efforts. We need to work together in solidarity with the DRC to end this outbreak and build a better health system,” said WHO Director-General Tedros Adhanom Ghebreyesus in Geneva.
Currently, the viral disease has been all but confined to Congo, killing 1,673 people there – more than two-thirds of those who contracted it – over the past year, and three in Uganda last month.
As a result, it was in February stated that the outbreak was “an extraordinary event which is determined, and constituted a public health risk to other States through the international spread of disease, and potentially required a coordinated international response”.
Regardless, the United Nation’s health agency was, until Wednesday evening, reluctant to sound its highest level of alarm against the deadly haemorrhagic fever.
“This is about mothers, fathers and children – too often entire families are stricken. At the heart of this are communities and individual tragedies,” said Dr Tedros. “The PHEIC should not be used to stigmatise or penalise the very people who are most in need of our help.”
Public health emergency of international concern (PHEIC) is a rare designation only used for the gravest epidemics. Between 2009 and 2019, there have been four PHEIC declarations: For H1N1 (or swine flu) pandemic in 2009, polio declaration, and outbreak of Ebola in Western Africa in 2014, and the 2015–16 Zika virus epidemic.
The WHO international health regulations, drafted in 2005, say that the international emergency label should apply to a situation that is “serious, unusual or unexpected; carries implications for public health beyond the affected State’s national border; and may require immediate international action.”
This therefore means that UN member states have a legal duty to respond promptly. It is a “call to action” and “last-resort” measure and, often-times, most epidemics and emergencies will not gain public attention or fulfil the criteria.
Temporary recommendations include measures to be implemented by countries to prevent or reduce the international spread of the disease and avoid “unnecessary interference with international traffic”.
The responsibility of determining whether an event is within this category lies with the WHO Director-General and requires the convening of a committee of experts – the IHR Emergency Committee.
Although the experts yielded to pressure to declare the PHEIC this time, they did not do so earlier because of concerns that doing so would hurt the DRC economically.
During the 2014 outbreaks, airlines cancelled more than a third of international flights to three West African countries over fears that the disease could spread. Kenya Airways (KQ), which flies 44 times a week to 10 West African cities, was left staring at a ticket-refund nightmare following flight cancellations to two key West African routes due to the Ebola outbreak.
The airline has at least seven flights to Liberia and Sierra Leone per week, comprising at least 16 per cent of its West African flights.
As a result, Guinea, Liberia and Sierra Leone have increasingly been isolated, despite WHO advising against imposing travel restrictions. The outbreak in DRC has remained uncontrolled, despite the use of an effective vaccine in a ring vaccination campaign.
Early this week, the situation got worse after the first confirmed case in Goma, a city of almost two million people on the border with Rwanda, and the gateway to the rest of DRC and the world. This prompted WHO to press the panic button.
Dr Ghebreyesus this week said the case in Goma was a potential game-changer, since it meant Ebola might now spread among the urban population and into neighbouring Rwanda, which on Wednesday warned its citizens against travelling to Goma.