The World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus recently declared the ongoing Ebola outbreak in the Democratic Republic of Congo (DRC) a Public Health Emergency of International Concern (PHEIC), citing deep concern over the outbreak’s escalating scale and spread, particularly into densely populated and previously unaffected areas.
Understanding the Context of Ebola Outbreaks
Ebola virus disease (EVD) is a severe, often fatal illness in humans, first identified in 1976. The virus is transmitted to people from wild animals and spreads in the human population through direct contact with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids. Fatality rates can be high, often exceeding 50% in past outbreaks.
The current outbreak, primarily centered in North Kivu and Ituri provinces of the DRC, began in August 2018. It marks the country’s tenth outbreak of Ebola and is the second-largest in history, surpassed only by the 2014-2016 West Africa epidemic. This region of the DRC is highly complex, grappling with prolonged armed conflict, significant population displacement, and widespread distrust in authorities, all of which severely complicate containment efforts.
The Rationale Behind the PHEIC Declaration
The WHO’s declaration of a PHEIC is a rare and significant step, reserved for extraordinary events that pose a public health risk to other states through the international spread of disease and potentially require a coordinated international response. Criteria for a PHEIC include the seriousness of the public health impact, the unusual or unexpected nature of the event, the potential for international spread, and the risk of international travel or trade restrictions.
Dr. Tedros emphasized that the outbreak’s continued expansion, including a recent confirmed case in Goma, a major regional hub with an international airport, was a critical factor in the decision. The declaration aims to galvanize greater international attention and resources, ensuring a more robust and unified response to prevent further geographical spread and to bring the outbreak under control. It also serves as a call for all countries to enhance their preparedness for potential imported cases.
Challenges on the Ground and Response Efforts
Response teams face immense challenges, including insecurity and violence perpetrated by armed groups, which frequently disrupt vaccination campaigns, contact tracing, and safe burials. Misinformation and community resistance, fueled by historical grievances and political tensions, further impede efforts. For instance, attacks on treatment centers have led to the temporary suspension of critical services and the relocation of healthcare workers, as reported by Médecins Sans Frontières (MSF).
Despite these obstacles, significant progress has been made using an experimental but highly effective vaccine (rVSV-ZEBOV), which has been administered to over 160,000 people under a
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