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The World Health Organisation (WHO) made the announcement following a meeting in the Democratic Republic of Congo (DRC).
Dr Nathalie MacDermott, Clinical Research Fellow, Imperial College London, said:
“’It is timely that the IHR Emergency Committee have declared the Ebola outbreak in the DRC to be a Public Health Emergency of International Concern. This will hopefully release more funding for response activities in DRC, but also importantly for neighbouring countries to bolster their preparedness efforts to contain the disease should it spread. The reticence of the committee to declare a PHEIC previously, despite the conditions being met, is understandable given the concern of trade and travel restrictions being placed on an already poverty stricken region of the world. The committee is right to emphasise that trade and travel to the region should not be restricted. The risk of disease spread is largely limited to the immediate neighbouring countries, the risk to the rest of the world is minimal, however the impact of trade restrictions would not only be significant to the people of North-Eastern DRC, but would potentially further hamper response efforts due to the local population feeling increasingly stigmatised. This response is already highly complex due to long term conflict in this region and the distrust of the local population toward political and international actors. Further stigmatisation and the potential for increased poverty of the population would only add increasing complexity to the response and further delay containment of this awful disease.”
Prof Jimmy Whitworth, Professor of International Public Health, London School of Hygiene & Tropical Medicine, said:
“The WHO have declared the current Ebola outbreak in the DRC a PHEIC, and we all fervently hope that this declaration will change the course of the outbreak. The main constraints to the current outbreak response which have allowed it to smoulder on for almost a year are the general insecurity with multiple armed militias in the region, community suspicion of strangers and resistance to control measures, and a lack of funding for necessary activities being run through WHO. While it is very likely that the declaration will increase the international funding made available to support control efforts, it remains to be seen whether it will enable the DRC and international authorities to ensure peace and security in the region, which are essential for delivering effective control measures. If the international assistance can be ramped up too, this can provide much needed support to the DRC, but will need to be done sensitively otherwise it could increase community resistance and erode engagement in efforts to control this outbreak.
“While recent developments, such as the recent case in Goma, have increased the risk of the outbreak spreading in DRC and to the neighbouring countries of South Sudan, Uganda and Rwanda, the risk to the UK remains very low.”
Prof Ian Jones, Professor of Virology, University of Reading, said:
“The PHEIC declaration will be useful if it garners additional resource although a PHEIC in which “the risk of spread outside the region is low” could be confusing to some. Whether the declaration will change the situation on the ground remains to be seen as the issue is less a lack of the ability to treat than lack of the opportunity to treat. I am not sure a change of title will alter that very much.”
Dr Derek Gatherer, Lecturer in the Division of Biomedical and Life Sciences, Lancaster University, said:
“The PHEIC is a declaration of war, once again, on Ebola. Like more conventional declarations of war, it may be followed by immediate action or a distinct lack of enthusiasm. Among the reasons why the latter may apply in this case is that many governments will be reluctant to send their medical staff, even if volunteers, into the midst of a long smouldering civil war. With 7 murders, and over 50 serious injuries, of health care workers so far in the current outbreak, and the failure of the UN peacekeepers over the last two decades to control a complex matrix of local hostilities, it seems unlikely that there will be anything approaching the West African intervention of 2014. On the positive side, the PHEIC may persuade governments to support increased volumes of vaccine production. Without the 160,000 doses of vaccine delivered so far in North Kivu and Ituri, we would have a far worse outbreak on our hands, perhaps one larger even than that seen in West Africa. WHO figures suggest 90% of contacts of cases are successfully traced and offered vaccination, but it is the 10% that go missing or are unreachable for security reasons, that present the real danger of persistent onward transmission. So far we still have a ring vaccination strategy – contacts and contacts-of-contacts together produce lists of 100 or so candidate vaccinees on average for each case. This strategy is designed for small outbreaks, and we are now approaching the situation where we may need to consider moving to a mass vaccination programme, especially in places like Goma. That will mean millions of doses of vaccine need to come off the assembly lines, and if the PHEIC galvanises government opinion to subsidise this, then it may achieve something positive in the very short term. Regarding transmission to a wider area of Africa or even internationally, there have been 75 million optical thermometer readings taken at official border points in the DRC over the last year. This is not 75 million different people, as many individuals make multiple crossings as part of their daily lives, but nevertheless it is a herculean effort. Its success, so far, can be demonstrated in the 21 confirmed cases that have been intercepted following border temperature checks. So far we’ve had one confirmed transmission to Uganda, but we could have had 21 more, and to several other countries. This shows how the outbreak really is potentially an international one.”
Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:
“This doesn’t mean that the global threat of Ebola has increased, but instead acknowledges that the current outbreak in Eastern DRC is showing no signs of letting up, and that increased concerted action is needed to bring the outbreak to a close. It also highlights the significant challenges that lie ahead – in particular the need to bring about political and civil stability and increased and effective interaction and engagement with the communities affected.
“There are worrying signs that show that the current efforts are simply not effective enough and despite the availability of an effective vaccine and extensive expertise of how to deal with an Ebola outbreak, people continue to die unnecessarily. That’s why we need to mobilise increased effort and support and that is no doubt what has led WHO to this decision.”
Prof Tom Solomon, Director of the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, said:
“This is a very sensible decision by the World Health Organisation. Whilst every Ebola outbreak should not automatically be declared a global public health emergency, the spread of disease to the large city of Goma on the Rwandan border, and the fact that we have been unable to contain the outbreak for almost a year, mean that it has now become a larger concern.
“The declaration of this public health emergency of international concern will help focus attention and funding on the need to bring this outbreak under control.”
Prof Arne Akbar, President of the British Society for Immunology, said:
“The ongoing Ebola outbreak in the Democratic Republic of Congo, and its recent spread to the city of Goma, is concerning. Ebola is just one of many emerging global health threats where pathogens have jumped the species barrier to infect humans, and we can be sure that it won’t be the last. The Ebola outbreak of 2014–16 in West Africa showed the full extent of the devastation that this disease can inflict and the difficulties in combatting it. During that outbreak, the international research community came together in a way not seen previously to develop and trial an effective vaccine to protect people from contracting Ebola. Although this experimental vaccine has proved itself very effective in the current outbreak, protecting over 97% of people who receive it, the highly volatile situation on the ground means that it has been difficult for healthcare workers to vaccinate everyone in need. With a Public Health Emergency of International Concern now declared, speed is of the essence and the global health community must come together again and act quickly to use all means at our disposal to contain this outbreak.
“It is now crucial that we continue to energise, organise and fund the UK research community to be able to respond to this type of emerging health threat at short notice. We are a global leader in this space and since 2016, the UK Government has taken steps forward with a number of new initiatives including the Joint Initiative on Epidemic Preparedness. With the right investment and leadership going forwards, we can be sure that the UK will have the infrastructure in place to quickly and efficiently mobilise our research base to develop vaccines and novel therapeutics to help lead global health efforts while maintaining our own resilience against such emerging threats.”
Prof David Heymann, Professor of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, said:
“The Emergency Committee appears to have interpreted the need for funding as one of the reasons a PHEIC was called – this has not been done in the past, but the Emergency Committees continue to evolve in their interpretation of the IHR, and this will now set a precedent to be considered at emergency committee meetings in the future.”
Prof Peter Piot, Director of the London School of Hygiene & Tropical Medicine and a member of the team who discovered Ebola, said:
“The response to the ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC) is at a critical juncture. With more than 2,500 cases, over 1,600 deaths, and the recent case of a pastor with Ebola who travelled from Butembo to the border city of Goma, it shows no sign of coming under control.
“That is why I welcome the World Health Organization’s (WHO) decision to declare a Public Health Emergency of International Concern. I hope that today’s decision serves as a wake-up call to drive high-level political action, improved coordination, and greater funding to support DRC in their efforts to stop this devastating epidemic. Critically, this support must reach the people of North Kivu and Ituri and contribute to vital work at the community level, providing the dedicated teams fighting this epidemic on the ground with the support they need and deserve.
“Facing this exceptionally complex epidemic, we must use all of the tools and approaches at our disposal, including the coordinated use of both the Merck and Johnson & Johnson vaccines. WHO has sounded the global alarm. Now, it is up to the world to act.”
Dr Josie Golding, Epidemics Lead at Wellcome, said:
“We commend the WHO for making this tough decision, it is right to do so. As it moves into a second year this incredibly challenging epidemic shows no sign of stopping soon. Over 1,600 people have died already, with children accounting for around a third of cases. The teams in the DRC deserve all our thanks, respect and support. There is a grave risk of a major increase in numbers, or spread to new locations – as we’ve seen this week in Goma, again in Uganda and recently close to the border of South Sudan.
“This is perhaps the most complicated epidemic the world has ever had to face, yet still the response in the DRC remains overstretched and underfunded. The calling of a PHEIC is an opportunity for a change in the response to help stop Ebola spreading and save lives. A step-up in the response, led by the DRC and with full international support, is critical if we are to bring the epidemic to an end. This must include enhanced diplomatic, public health, security and logistic efforts as well as releasing much needed financial resources.
“There is also a pressing need to introduce a second vaccine, by Johnson and Johnson, in the DRC – to protect communities outside of the current outbreak zone who are likely to be affected next. Countries should not wait for Ebola to spread across borders or appear on their doorstep before acting.”
Declared interests
Dr Nathalie MacDermott: “I am a Wellcome funded Clinical Research Training Fellow investigating genetic susceptibility to Ebola virus disease. I have no other disclosures.”
Prof Jimmy Whitworth: “No interests to declare.”
Dr Derek Gatherer: “I declare that I have no financial or other interests that might influence my opinions on Ebola.”
Prof Tom Solomon: “No conflicts.”
None others received.