IHR Emergency Committee rules Ebola spread is serious but not a public health emergency

On Friday the meeting of the Emergency Committee summoned by the World Health Organization (WHO) Director-General under the International Health Regulations (IHR) had decided that the spread of Ebola in the Democratic Republic of the Congo is grave but not serious enough to be considered a public health emergency of international concern (PHEIC).

However, the ongoing Ebola outbreak in North Kivu and Ituri provinces is experiencing a recent increase in transmission, said the Committee, and there is a potential risk of spread to nearby countries. Therefore, the Committee released a new and lengthy list of public health advice for dealing with the situation.

A press release issued on Friday contained the following guidelines:

· The committee advises to redouble efforts to detect cases as early as possible, identify and follow up all contacts, ensure the highest level of coverage vaccination of all contacts and contacts of contacts.

· Sustained efforts must be made to prevent nosocomial transmission and to shorten time between onset of disease and access to high standards of care and therapeutics at Ebola treatment units.

· Special emphasis should be placed on addressing the rise in case numbers in the remaining epicentres, notably Butembo, Katwa, Vuhovi, and Mandima.

· The Committee advises WHO and all partners to identify, target, and scale up community dialogue and participation, engagement of traditional healers, and other community engagement tactics to strengthen and broaden community acceptance.

· The Committee also noted the need to follow the recommendations of SAGE (Strategic Advisory Group of Experts) with regards to the vaccination strategy provided at its latest meeting.

· The safety of responders should be prioritized, while avoiding the securitization of the response.

· Because there is a very high risk of regional spread, neighboring countries should continue to accelerate current preparedness and surveillance efforts, including vaccination of healthcare workers and front-line workers in surrounding countries.

· Cross-border collaboration should continue to be strengthened, including timely sharing of data and alerts, cross-border community engagement and awareness raising. In addition, work should be done to better map population movements and understand social networks bridging national boundaries.

· The Committee maintains its previous advice that it is particularly important that no international travel or trade restrictions should be applied. Exit screening, including at airports, ports, and land crossings, is of great importance; however, entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value.

· The committee strongly emphasized the critical need to strengthen currents efforts in both preparedness and response. This will require substantial, immediate and sustained additional financial support.

· While there is no added benefit to declaring a PHEIC at this stage, there was concern about current levels of transmission requiring close attention to the evolving situation. The committee advised the WHO Director General to continue to monitor the situation closely and reconvene the Emergency Committee as needed.

· Members and advisors of the Emergency Committee met by teleconference. Presentations were made by representatives of the Ministry of Health of the Democratic Republic of the Congo on the epidemiological situation, the response strategies, and recent adaptations, including a shift in strategy to improve engagement of the community in the response.