Congo Ebola outbreak not an 'emergency of international concern,' WHO says

Since the outbreak began August 1, there have been 216 cases of Ebola including 139 deaths, according to WHO. Fifty-seven patients have recovered from the illness, the nation's Ministry of Health reported Tuesday.

"We do have some optimism that this outbreak, just like the one in May, will be brought under control in reasonable time," Robert Steffen, chairman of the WHO International Health Regulations Emergency Committee, said Wednesday.

The emergency committee reviewed the latest information on the latest outbreak and determined that it is of regional concern but not of global concern at this time.

Lawrence O. Gostin, a professor and faculty director of the O'Neill Institute for National and Global Health Law at Georgetown Law, wrote in an email that the WHO committee "should have declared a public health emergency of international concern due to the high level of risk to the Congo and neighboring countries." This would have mobilized resources for neighboring countries and garnered the attention of political leaders, said Gostin, who is not a member of the committee.

If an emergency had been declared, it might have negatively affected travel and trade, which in turn might have hindered the response team efforts, said Steffen, who is also a professor in the Department of Epidemiology and Prevention of Infectious Diseases at the University of Zurich.

Dr. Tedros Adhanom Ghebreyesus, WHO's director-general, said Wednesday that the committee's decision was backed by "good reasons." He also said vaccine approvals have been filed by the Ministry of Health: "We believe the vaccine will be approved as soon as possible."

Steffen noted that international partners are working on the ground with WHO and the Ministry of Health. Their efforts, by every standard, have been fruitful.

Dr. Peter Salama, WHO's deputy director-general of emergency preparedness and response, tweeted this week that "over 10,000 at risk people have been identified & followed up" since the beginning of the outbreak. Meanwhile, 18,000 people have been vaccinated against Ebola in Congo, "including 7,000 health/frontline workers and 4,000 children."

Salama said Wednesday that 75 people in this outbreak have been treated with four major experimental drugs under a "compassionate use" framework.

"We are planning a randomized, controlled clinical trial, and we expect that to start within the time frame of this outbreak, so within the next couple of months in DRC," Salama said. In all likelihood, the trial will compare the four drugs, but the need for many participants in the clinical trials means "it will be a multicountry, multioutbreak, multiyear trial."

The four drugs used during the outbreak are ZMapp, developed by San Diego-based Mapp Biopharmaceutical Inc.; remdesivir, developed by Gilead Sciences Inc. in collaboration with the US government; REGN3470-3471-3479, developed by Regeneron Pharmaceuticals; and favipiravir, developed by Toyama Chemical of Japan.

This is the 10th outbreak since 1976 in Congo, where the virus is endemic, and the second this year.

The outbreak is in the eastern part of the country, having started in North Kivu province before spreading to Ituri province. Both areas are densely populated and border Uganda, Rwanda and South Sudan.

Along with the spread of deadly Ebola, Congo is experiencing a long-term humanitarian crisis that includes intermittent armed conflict, according to WHO. The agency has estimated that more than 1 million refugees and internally displaced people are in North Kivu and Ituri, and their movement through and out of the provinces is a potential risk factor for the spread of Ebola.

Gostin said this outbreak "is the first time the WHO has formally asked the United Nations Security Council to address the worsening security situation in a major outbreak." Because of ongoing security concerns, the Security Council took minimal action, he said, and it should adopt a resolution giving peacekeepers the "express mission and mandate to protect front-line workers and enable a robust public health response including contact tracing and a systematic vaccination campaign."

Steffen said that if Ebola were to spread beyond the borders of Congo, the emergency committee might revise its decision and declare instead that the outbreak is a public health emergency of international concern.

The decision to reconvene the emergency committee in such an event would be made by Tedros, he said.

WHO declared a public health emergency of international concern for an Ebola in August 2014 for the outbreak in West Africa that claimed 11,000 lives and was later determined to be the deadliest such outbreak.

The agency also declared a public health emergency of international concern in February 2016 over the Zika virus.