April 12, 2018
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.
April 12, 2018 | Dr. Tedros Adhanom Ghebreyesus was right to re-convene the Emergency Committee to review the Ebola epidemic in the Democratic Republic of Congo (DRC). This is the second Emergency Committee (EC), with the first taking place on October 17, 2018. That Committee did not declare a Public Health Emergency of International Concern (PHEIC).
Dr. Tedros should have declared a PHEIC and made bold new recommendations for bringing the DRC Ebola epidemic under control. WHO declared a PHEIC in West Africa on August 8, 2014 when the epidemic reached 1070 cases. The DRC epidemic has a reported 1186 cases. Epidemic projections are bleak: deaths are rapidly rising, and most deaths are not on known contact lists. Eighty-two health care workers have been infected, with 29 deaths. Many health care workers are dying at home and are growing distrustful of the health system. Given the worsening conditions in the DRC, Dr. Tedros should have sounded a global alert. Declaring a PHEIC could have mobilized funding and political will, raising global attention to a lethal epidemic that WHO has thus far failed to contain.
The legal criteria for declaring a PHEIC have been met for several months now. The International Health Regulations do not require actual international spread but only the potential for international spread. Clearly, the DRC epidemic could spill over to neighboring countries and even to other parts of Africa, even potentially through air travel to North America and Europe.
WHO has acted bravely. Dr. Tedros has been deeply engaged personally, showing great leadership. But WHO cannot do it on its own. Several NGOs such as Doctors without Borders have withdrawn temporarily. The Trump Administration has banned all US personnel from the area, including highly experienced CDC staff.
The EC’s recommendations are sound public health advice. Yet, we simply cannot play by the old public health rulebook and expect success in the DRC. WHO is operating in a country experiencing a complex humanitarian crisis, with intense political violence, deep community distrust, and a million migrants on the move. Front line workers, including health workers, are under attack. The public is not cooperating with WHO’s public health measures such as contact tracing, vaccinations, and isolation.
We need bold new recommendations to cope with public health crisis in these kinds of unstable conditions. The EC should have recommended measures beyond public health such as smart diplomacy, peacekeeping, community policing, and deep engagement with key leaders in the community. The United Nations needs to be actively engaged. The Director-General should also be setting highly visible targets for funding and public health “boots on the ground”, urging the international community to mobilize resources, including expert human resources, such as the active presence of the CDC and other public health agencies.
Each day that passes precious lives die, 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, and we cannot let this DRC epidemic slip out of control. The status quo is no longer acceptable. As a friend of WHO, I urge it to act boldly. I was deeply disappointed that under these harsh conditions and with so many deaths, that WHO did not do more to break from the usual mold.