A WHO expert committee had declined on three previous occasions to advise the United Nations health agency to make the declaration for this outbreak, which other experts say has long met the conditions. More than 1,600 people have died since August in the second deadliest Ebola outbreak in history, which is unfolding in a region described as a war zone.
This week the first Ebola case was confirmed in Goma, a major regional crossroads in northeastern Congo on the Rwandan border with an international airport. Health experts have feared this scenario for months.
A declaration of a global health emergency often brings greater international attention and aid, along with concerns that nervous governments might overreact with border closures.
This is the fifth such declaration in history. Previous emergencies were declared for the devastating 2014-16 Ebola outbreak in West Africa that killed more than 11,000 people, the emergence of Zika in the Americas, the swine flu pandemic and polio eradication.
WHO defines a global emergency as an “extraordinary event” which constitutes a risk to other countries and requires a coordinated international response. Last month this outbreak spilled across the border for the first time when a family brought the virus into Uganda after attending the burial in Congo of an infected relative. Even then, the expert committee advised against a declaration.
Alexandra Phelan, a global health expert at Georgetown University Law Center, said Wednesday’s declaration was long overdue.
“This essentially serves as a call to the international community that they have to step up appropriate financial and technical support,” she said but warned that countries should be wary of imposing travel or trade restrictions.
“Those restrictions would actually restrict the flow of goods and health care workers into affected countries so they are counter-productive,” she said. Future emergency declarations might be perceived as punishment and “might result in other countries not reporting outbreaks in the future, which puts us all at greater risk.”
WHO had been heavily criticized for its sluggish response to the West Africa outbreak, which it repeatedly declined to declare a global emergency until the virus was spreading explosively in three countries and nearly 1,000 people were dead. Internal documents later showed WHO held off partly out of fear a declaration would anger the countries involved and hurt their economies.
The current outbreak is spreading in a turbulent Congo border region where dozens of rebel groups are active and where Ebola had not been experienced before. Efforts to contain the virus have been hurt by mistrust by wary locals that has prompted deadly attacks on health workers. Some infected people have deliberately evaded health authorities.
The pastor who brought Ebola to Goma used several fake names to conceal his identity on his way to the city, Congolese officials said. WHO on Tuesday said the man had died and health workers were scrambling to trace dozens of his contacts, including those who had traveled on the same bus.
“Calling for a (global emergency) to raise funds while ignoring the negative consequences for (Congo) is reckless,” the ministry tweeted following an editorial by Britain’s secretary of state for international development in favor of a declaration. Rory Stewart announced earlier this week that Britain would donate up to another $63 million for the Ebola response and called for other countries, especially Francophone ones, to increase their support.
At a U.N. meeting on Ebola in Geneva on Tuesday, Congo’s health minister, Dr. Oly Ilunga, said the outbreak was “not a humanitarian crisis” and that the risk of Ebola spreading to other cities or regions in Congo remained the same.
“Ebola is not rocket science, it’s very simple,” he said.
WHO has long called the regional Ebola risk “very high.”
Earlier this week, Ugandan health officials said a Congolese fish trader had traveled to Uganda while sick and vomited several times at a local market. The woman returned to Congo last week and died after testing positive for Ebola. Ugandan officials estimate almost 600 people could be targeted for vaccination and follow-up.
Those working in the field say the outbreak is clearly taking a turn for the worse despite advances in this outbreak that include the widespread use of an experimental but effective Ebola vaccine.
Dr. Maurice Kakule was one of the first people to survive the current outbreak after he fell ill while treating a woman last July before the outbreak had even been declared.
“What is clear is that Ebola is an emergency because the epidemic persists despite every possible effort to educate people,” he told the Geneva meeting. “We have sufficiently informed them about the existence of this disease but there are still people who don’t want to believe that it does.”
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