A year ago this week, the first patient was diagnosed with Ebola in the northeastern region of Congo, launching a new outbreak of the disease. Today — notwithstanding the first-ever large-scale deployment of an Ebola vaccine, improved performance by the World Health Organization and valiant efforts by Congolese health workers and global nongovernmental organizations — that single case has grown into the second-worst Ebola outbreak in history.
As the case count approaches 2,500 with no end in sight, it is time for the WHO to declare the outbreak a public health emergency of international concern, or PHEIC, to raise the level of global alarm and signal to nations, particularly the United States, that they must ramp up their response.
A few months ago, it looked like the response efforts then underway might succeed in bringing the outbreak under control. Yet the disease has since crossed one border (into Uganda) and continues to spread. In the absence of a trajectory toward extinguishing the outbreak, the opposite path — severe escalation — remains possible. The risk of the disease moving into nearby Goma, Congo — a city of 1 million residents with an international airport — or crossing into the massive refugee camps in South Sudan is mounting. With a limited number of vaccine doses remaining, either would be a catastrophe.
WHO Director-General Tedros Adhanom Ghebreyesus has convened a WHO Emergency Committee meeting on this latest outbreak three times before, but he has declined to declare a public-health emergency. It is time for Tedros, as he is known, to trigger the process one more time and make the emergency declaration that is overdue.
Why? Because the failure to make such a declaration — fairly or unfairly — has fed global complacency about the outbreak, which in turn is edging us closer to the brink of true disaster. Moreover, when an official PHEIC is declared, specific recommendations are issued by the WHO; these could make a difference in Congo. Such steps could lead to improved security for health workers in the region, stepped-up community engagement and extended health care beyond Ebola treatment.
The last of these is most overlooked: Expanding the health-care response to include diagnosis and treatment of malaria, diarrheal diseases and maternal health can build trust and community engagement critical to stopping Ebola. Improved trust will improve the effectiveness of the Ebola response and make the responders safer.
Moreover, an emergency declaration will step up Ebola preparedness measures in neighboring nations, especially South Sudan, where diseases that mimic Ebola — such as malaria and hepatitis — are already present. As a result, Ebola could spread there and be masked for some period.
Such a declaration does not require border closures or trade or travel restrictions, as some fear. These restrictions would make the current response less effective, not more. Declaring an emergency and accelerating the response ultimately reduce the risk that such unproductive measures are imposed; it is the current threat of unchecked escalation of the outbreak that makes these measures more likely.
A declaration might also get the United States to do more to help fight Ebola in Congo. While the Trump administration has taken some positive steps, it has not been on par with the increasing challenge. A
news release last week from the U.S. Agency for International Development was telling: It boasted how much aid the United States has previously sent to fight the disease, without clearly promising to send any more. That’s not going to change anything on the ground.
Instead of self-congratulation, the United States should release “non-emergency” aid to Congo that is being withheld in the absence of a presidential waiver under the Trafficking Victims Protection Act of 2000. Such aid could enable the proposed expansion of public health efforts in Congo beyond Ebola.
Second, the White House should reverse its policy ordering Centers for Disease Control and Prevention personnel to stay out of outbreak zones in northeast Congo. While security is paramount, optimizing the involvement and number of CDC personnel in areas close to these outbreak zones, as well as in neighboring nations, could help stop the epidemic from expanding further and from reaching international airports.
Third, the United States must step up to do more to make Ebola countermeasures — specifically the leading Ebola vaccine — more available. While a new recommendation to use fractional doses of this Ebola vaccine will make existing supplies go further, the risk of spread of the disease to cities or refugee camps that could swamp existing supply demands immediate action. The United States should put its weight and pocketbook behind increasing vaccine supply before a critical shortage occurs.
This is the second-largest Ebola outbreak in history, and it will only get worse as it enters its second year. The WHO and the United States must urgently step up their actions before this simmering tragedy explodes into something far worse.
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