July 17, 2019

The following is a statement by Faculty Director, Lawrence Gostin, on the WHO’s Emergency Committee’s Review of the Ebola Epidemic in the Democratic Republic of Congo.

July 17, 2019 | Today Dr. Tedros Adhanom Ghebreyesus re-convened the Emergency Committee (EC) on the Ebola epidemic in the Democratic Republic of Congo (DRC) for the fourth time, barely a month after the last EC. 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 epidemic under control. It could rage on for months or years. In fact, it is long past time that WHO declared an emergency. The IHR criteria for a PHEIC have 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 Emergency 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.

The WHO has been trying to quell a dangerous epidemic 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 cycle of disease, violence, and distrust.

Until now, the WHO hasn’t called an emergency because it fears repercussions in the form of travel restrictions. WHO also believes a PHEIC provides them 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 UN 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 USD $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 USD $1 Billion.
  • Human Resources: The United States has banned CDC and other crucial human assets from the hot zone. The State Department should develop a plan to safely deploy CDC and other US 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 has to be a secured “safety zone” for health personnel to enter villages to identify cases and vaccinate those at risk. United Nations 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 United Nations and partners including the US State Department, should engage in diplomacy to gain community trust and to negotiate a safe 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 epidemic 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.

Each day that passes precious lives are lost, including brave health workers. Were it not for a highly effective vaccine, the DRC epidemic could easily have been as severe as in West Africa. Since West Africa, and with a new Director-General, the WHO has transformed itself. This is a pivotal moment for the future of the WHO. Declaring an emergency was the first crucial step, but there is much more to do.