The Ebola epidemic in the Democratic Republic of the Congo is a public health emergency of international concern, the World Health Organization has declared, calling for more funds and international support to close it down.
The second biggest Ebola outbreak ever, after the 2014-16 epidemic in West Africa, has reached a critical point with the diagnosis of a case in Goma, a city of 2 million people, which is a transport hub on the border with Rwanda. That follows the case last Thursday of a women who crossed into Uganda to buy fish – and the arrival of a family harbouring the virus, three of whom died, in Uganda last month.
Dr Tedros Adhanom Ghebreyesus, the WHO director general, appealed for the international community to help with funds. WHO is working on a new plan to control the epidemic, he said, which would cost “hundred of millions” of dollars.
“It is time for the world to take notice and redouble our efforts. We need to work together in solidarity with the DRC to end this outbreak and build a better health system,” said Tedros.
“Extraordinary work has been done for almost a year under the most difficult circumstances. We all owe it to these responders – coming from not just WHO but also government, partners and communities – to shoulder more of the burden.”
He has made previous appeals for donors to provide the money they have promised. So far, only about half the pledges have come in. WHO was not aware of any donor who has withheld funding because an emergency had not been declared, he said, “but if that was the excuse, it can no longer be used”.
Tedros appealed for countries not to close their borders or close down travel to the DRC, arguing that it would only harm the attempts to shut down the epidemic.
One year on from the start of the epidemic in North Kivu, there have been 2,512 cases of the disease and 676 deaths, most of which have been confirmed.
This is the second biggest Ebola outbreak, after the west Africa epidemic, where 28,616 cases of disease and 11,310 deaths were reported in Guinea, Liberia, and Sierra Leone between 2014 and 2016.
WHO is not only alarmed about the arrival of the virus in Uganda and on the Rwandan border, but also by the flare-up again in Beni. “The geographical expansion is now 500km,” said Prof Robert Steffen, chair of the IHR emergency committee on Ebola in DRC as he announced their advice to Tedros.
The 46-year-old pastor who was diagnosed in Goma had travelled there from Butembo. He was said by the health ministry to give regular services in seven different churches, where he laid his hands on worshippers including the sick.
It is thought he had undertaken the journey by bus after he began to feel ill. At three checkpoints he passed the temperature checks designed to pick up anyone with fever, but he gave different names each time, suggesting a desire to hide his identity. He has been sent back to Butembo for care.
The possible arrival of the virus in Goma has long been feared by the agencies responding to the outbreak, because of its density and the movement of people through it to Rwanda.
“Ring” vaccination of the contacts of those who fall ill and their contacts has not succeeded in limiting the spread of the virus. There is mistrust of the vaccine. Some people falsely believe that the vaccine is what is making people sick, in part because it can’t protect anyone who is already infected when they have the shot. It is also very hard to track and trace the friends and relatives of the sick in areas where violent conflict is taking place.
“If we cannot contain Ebola at the epicentre, we will continue to see cases spread to metropolitan areas and across borders,” said Bob Kitchen, International Rescue Committee’s vice-president for emergencies.
“Today’s declaration should spring the international community into action and wake up the world to the severity of the situation. This is a public health emergency in a complex humanitarian emergency – failure to respond accordingly will lead to a failure to contain the disease.
“The inability to build community trust has proven a major barrier to stopping the spread of this disease. Local communities are perplexed and frustrated by continued increase in the number of people dying juxtaposed with a massive influx of international organisations into the region during the past year.”
There have been four declarations of public health emergencies since 2005, when WHO’s new regulations were introduced: swine flu in 2009, polio in 2014, when there was a resurgence after near-eradication, Ebola in west Africa in 2014 and Zika virus in Brazil in 2016.