WHO declares Ebola outbreak an international public health emergency

The World Health Organization late Saturday declared the outbreak of Ebola that was first seen in the Democratic Republic of the Congo an international public health emergency, underscoring the concern about the spread of the virus as travel-related cases were reported in Kampala, the capital of Uganda. The speed with which the emergency issuance was made — African health officials only confirmed the outbreak on Friday — is unusual. So too is the fact that WHO Director-General Tedros Adhanom Ghebreyesus issued the declaration without first seeking the advice of an expert panel, called an emergency committee. Tedros confirmed for STAT that this was the first time a public health emergency of international concern was declared without a recommendation from an emergency committee. The WHO said an emergency committee would be convened as quickly as possible to offer advice on how to contain the outbreak. The International Panel for Pandemic Preparedness and Response suggested Tedros’ swift action was prudent. “His decision to proceed ahead of convening a formal Emergency Committee reflects the gravity of the situation and the need for immediate global mobilization,” the group — co-chaired by former President of Liberia, Ellen Johnson Sirleaf, and Helen Clark, former prime minister of New Zealand —said in a statement. An Ebola species called Bundibugyo is responsible for the outbreak. Health officials have less experience dealing with this strain — there have only been two documented Bundibugyo outbreaks before — and there are no licensed vaccines or therapeutics for this viral species. As of Saturday, there have been eight confirmed cases, 246 suspected cases, and 80 suspected deaths in DRC’s remote Ituri province, which borders South Sudan and Uganda. The area was the site of the second largest Ebola outbreak in history, which ran from 2018 to 2020, involving 3,470 cases and 2,287 deaths. (That outbreak was caused by a different species of Ebola, the Zaire ebolavirus.) This part of the country has also been engulfed in a yearslong conflict, which complicates outbreak responses. In addition, people regularly move around the area and among the different countries. The two cases in Kampala were in people who had been in the DRC. It is believed the two individuals did not have links to each other, suggesting at least two introductions of the virus into Uganda. An update the WHO issued Sunday said that, at present, there is no indication of ongoing transmission in Uganda. The statement also said that earlier reports that a case had been detected in DRC’s capital, Kinshasa, have been proven to be untrue. Confirmatory tests conducted on a sample from the individual were negative, the WHO said. At least four health care workers have died of suspected cases, with those cases occurring within a four-day span, the WHO said. The first known suspected case was a health care worker who reported developing symptoms on April 24 in Bunia. This individual subsequently died. The fact that three weeks elapsed between that event and the confirmation that Ebola was again circulating in northeastern DRC “suggests a low clinical index of suspicion among healthcare providers,” the global health agency said, as well as dangerous gaps in infection prevention. There are a number of signs, the WHO said, of “a potentially much larger outbreak than what is currently being detected and reported, with significant local and regional risk of spread.” The WHO issued its emergency declaration when it was the early morning Sunday in Geneva. A public health emergency of international concern, or PHEIC (pronounced like “fake”), can be declared in response to a disease event in which risk of cross-border spread is considered high and international cooperation will likely be needed to contain the threat. The declaration of a PHEIC gives the WHO director-general the authority to issue what are known as temporary recommendations — guidance to countries on steps they should take to address the problem. The declaration of a PHEIC elevates the attention the issue should receive in the world’s capitals. It is sometimes thought to help raise money for a particular health problem, although that is not a given. The WHO has been facing a budget crisis, in part because of the withdrawal of the U.S. from the agency under the Trump administration. Helen Branswell contributed reporting.