WHO says Ebola is global emergency

The World Health Organization (WHO) said Wednesday that an outbreak of the deadly Ebola virus rampaging through Congo represents an international public health emergency, a rare red alarm meant to spur international aid to combat the virus.

The declaration comes after a new case showed up in a major city that connects the region to other African capitals.

In the 11 months since the new outbreak began in the North Kivu Province, the Ebola virus has infected 2,512 people, the Congolese health ministry said, and 1,676 of those victims have died.

{mosads}Rampant violence against health responders has caused problems and delays that have allowed the virus to spread. Doctors Without Borders pulled its personnel out of the most impacted areas after several attacks on medical facilities. The WHO said there had been as many as 200 attacks on health care workers during the response.

A WHO epidemiologist was killed in one attack on a facility in the city of Butembo in April. Over the weekend, two Congolese health workers in Beni were murdered in their homes.

The virus has crossed international borders at least twice, once when an infected family avoided border checkpoints to cross into Uganda and again this week when a woman crossed the same border twice. No other cases have been identified in Uganda, but a new case was recently detected in a small town just a few dozen miles from the Congolese border with South Sudan. 

“Our risk assessment remains that the risk in the DRC [Congo] and the region remains very high, and the risk of spread outside the region remains low,” said Tedros Adhanom Ghebreyesus, WHO’s director-general. “The outbreak is confined in the two provinces of Ituri and North Kivu, but with a very high risk of spread to neighboring provinces and also regionally. Our aim is to finish this outbreak. Our aim is actually zero.”

On Sunday, a pastor who had become infected while traveling through the epicenter of the outbreak arrived in Goma, the capital of North Kivu Province. He sought treatment, though the health ministry said he died on Monday. The health ministry said it is tracking 97 people in and around Goma who had been in contact with the pastor.

Goma is a city of 2 million people and home to an airport that offers flights to the Congolese capital of Kinshasa and Addis Ababa, the capital of Ethiopia. Congolese authorities are screening air travelers, concerned by the threat of a potential victim making it onto a plane and spreading the virus.

“The situation is extremely concerning. We’re one year into the outbreak and we’re not where we’d like to have been,” said Trish Newport, deputy program manager for the Doctors Without Borders mission to Congo. “For the population, they’re scared.”

More than 650 health care responders are already on the ground in Goma, said Mike Ryan, who heads the Ebola outbreak response for WHO. Health responders are tracking 22 potential cases in the city, though those are likely to be false positives.

The declaration is only the fifth time the WHO has labeled a viral outbreak a public health emergency of international concern. Previously, the WHO has used the declaration to highlight the spread of swine flu in 2009, polio and the Ebola virus in 2014 and the Zika virus in 2016.

The number of actual victims is likely much higher than the official statistics reflect. About a third of recent victims have not appeared on the list of those who have come into contact with an Ebola patient, an indication that there are lines of transmission about which health officials do not know — that the virus is, in effect, spreading more widely than is known.

There had been some cause for hope in recent weeks as the number of Ebola cases discovered on a daily basis declined. The number of cases in the twin cities of Butembo and Katwa, once the epicenter of the outbreak, has fallen this month. But at the same time, new hotspots are popping up in the city of Beni and the neighboring Mandima region, where an earlier round of the outbreak seemed to be under control.

“There is disappointment that there has been a recurrence of intense transmission in Beni,” said Robert Steffen, who chairs the emergency committee. “We need to intensify the actions, also to become more active.”

The WHO’s emergency declaration is meant to get the world’s attention at a time when the international sense of urgency has faded.

The outbreak has already cost about $233 million, Ryan said, and donor countries and nonprofit groups have already contributed or pledged tens of millions of dollars to the response. Much of that money has not yet arrived.

WHO alone has more than 700 responders in North Kivu and Ituri provinces, the two areas that have experienced the brunt of the outbreak. Groups like UNICEF and the Red Cross and Red Crescent have hundreds more people in the field.

“The government of the DRC is doing everything they can. They need the support of the international community. That includes the financial support,” Tedros said. He estimated that the total response would cost hundreds of millions of dollars.

The U.S. Agency for International Development (USAID) said earlier this month it had provided more than $98 million to combat the virus in Congo. Administrator Mark Green traveled to the region last month to witness the response on the ground.

But the security situation has delayed more robust American involvement. Responders from the Centers for Disease Control and Prevention and USAID have been limited to preparing neighboring countries and organizing the response from Goma and Kinshasa after the State Department decided the region presented too great a security risk.

Neighboring countries have been preparing for the possibility that the virus might jump borders in a region where the population is highly mobile and where more than a million people are displaced from their homes because of decades of ethnic conflict. 

Thousands of medical personnel in Uganda, Rwanda and South Sudan have already received a vaccine to protect themselves, and border guards have screened more than 74 million people crossing through 80 ports of entry and operational health checkpoints.

— Updated at 2:22 p.m.