A health worker sprays disinfectant on his colleague after working at an Ebola treatment center in Beni, Eastern Congo

A health worker sprays disinfectant on a colleague after working at an Ebola treatment center in Beni in the Democratic Republic of the Congo. Credit: Al-hadji Kudra Maliro/AP/REX/Shutterstock

The World Health Organization (WHO) has declared that the current Ebola virus outbreak in the northeast of the Democratic Republic of the Congo (DRC) — although extremely worrying — is not a ‘public-health emergency of international concern’ (PHEIC).

The organization accepted the conclusions of its independent emergency committee that declaring the status would not significantly improve an already robust containment effort, and could, in fact, hamper it.

The WHO had convened the committee because of increasing concern over armed conflicts in the region that are hindering containment efforts, and because of the risk that the outbreak could spread across borders. The outbreak region is close to Uganda and other countries.

The outbreak in the provinces of North Kivu and Ituri began in early August and is centred in and around the city of Beni. So far, there have been 185 confirmed cases, 35 probable cases and 32 suspected cases of Ebola — including 139 deaths.

The situation has deteriorated in recent weeks, but epidemiologist Robert Steffen, chair of the WHO emergency committee, told a press conference on 17 October in Geneva, Switzerland, that the committee was nonetheless “optimistic” that the outbreak could be be brought under control relatively quickly.

The committee assessed the situation using the three criteria that define a PHEIC: whether there is need for greater international coordination of efforts to contain the outbreak; whether the outbreak is extraordinary; and whether there is a risk of international spread. The committee concluded that declaring an emergency would not add any value — but stressed that it “remains deeply concerned by the outbreak and emphasized that response activities need to be intensified and ongoing vigilance is critical”.

The conclusion seems to be based in part on the DRC’s long experience in dealing with Ebola outbreaks. The international response has also been relatively rapid and well coordinated from the outset, Steffen said. He added that declaring an emergency could inadvertently result in travel and trade bans being imposed on the DRC, hampering existing efforts.

The high level of preparedness in Uganda and other nearby areas also reduces the need to declare a PHEIC, said Peter Salama, head of the WHO’s Health Emergencies Programme, at the press conference.

Conflict zone

The latest Ebola episode is the DRC’s tenth since the first report of the illness in the country in 1976. All past outbreaks in the DRC — including one that began in May and was declared over in July — have been contained in a matter of months. Over decades, the nation has gained extensive experience in rapidly implementing the public-health measures needed to contain the virus’s spread. These include identifying new infections, monitoring and isolating people with whom infected people have had contact, and carrying out safe burials.

But the security situation in the northeastern region has brought increased challenges. Many militias are fighting for power and resources in the area, and health workers are often working in war zones.

Tedros Adhanom Ghebreyesus, director-general of the WHO, told the press conference that he had asked the United Nations Security Council to consider how the UN might increase peacekeeping efforts in the region.

This year’s previous episode saw the first time that several thousand doses of an experimental Ebola vaccine were deployed at the start of an outbreak. Health officials used a ‘ring vaccination’ strategy, in which all contacts of infected people, and their contacts, receive the vaccine — made by drug company Merck — as do front-line responders.

In the current outbreak, 17,976 people had been vaccinated as of 15 October.