Ebola Outbreak in Congo Has Just Been Declared an "Emergency of International Concern"

The year-old Ebola epidemic in the Democratic Republic of Congo is now considered a global health emergency, the World Health Organization said on Wednesday, in a formal declaration that many public health experts called long overdue.

The disease reached Goma, a city of nearly two million people; the outbreak has raged for a year; the virus has flared again in spots where it had once been contained; and the epidemic hot zone has geographically expanded in northeastern Congo near Rwanda and into Uganda.

A pastor who brought Ebola to Goma used several fake names to conceal his identity on his way to the city, Congolese officials said. WHO on Tuesday said the man had died and health workers were scrambling to trace dozens of his contacts, including those who had traveled on the same bus.

It is the second largest Ebola outbreak in history after the one in West Africa in 2014-15, which infected 28,616 people and caused 11,310 deaths. The decision on Wednesday was based on a vote by 11 members of an expert panel convened by Dr. Tedros to reassess the current outbreak after an infected man carried the virus to the city of Goma, a densely populated transportation hub close to Rwanda that has an international airport.

There have been about 200 attacks on health workers since January alone, and seven have been killed.

"This is the most complex environment there is for an Ebola response," David Gressly, the United Nations' emergency response coordinator, said in an interview last month in Goma, North Kivu's capital.

"We are still at least months away" from a conclusion, he said.

North Kivu has an international airport and two international borders and is close to two others. The province is closely linked by business, family ties and language to communities across the borders in Uganda and Rwanda. Besides the province including Congo's sprawling capital, Kinshasa, North Kivu is the vast country's most populous.

This was the fourth time that the W.H.O. had considered whether to declare a global health emergency in the Congo outbreak. It stopped short the first three times, even though some aid agencies and public health officials had called on the organization to do so in hopes such an order would elicit more funds and recruit more health workers to the region.

The Congo outbreak began a year ago, with the first cases confirmed in August. As of Monday, the disease had infected 2,512 people and killed 1,676 of them. The virus has defied efforts to control its rampant spread in the northeastern part of the country, a conflict zone under unrelenting peril from warring militias.

Dr. Tedros Adhanom Ghebreyesus, the director-general of the W.H.O., has described this outbreak as one of the world’s most dangerous viruses in one of the world’s most dangerous areas. Public health experts warn that the implacable spread of the virus means the outbreak could easily continue well into next year.

Global health groups had been calling for the declaration for months. Labeling the epidemic a global emergency will help raise international support and release more resources — including finance, health care workers, enhanced logistics, security and infrastructure.

The declaration should not be used "as an excuse to impose trade or travel restrictions, which would have a negative impact on the response and on the lives and livelihoods of people in the region," said Robert Steffen, chairman of the Emergency Committee.

The committee said delays in funding had constrained the response and i hoped the declaration would add to the international community's sense of urgency. But members also cautioned against using the declaration to impose punitive travel restrictions on countries in the affected area.

On Wednesday, a fisherwoman died of Ebola in Congo after having spent time last week in Uganda, where she reportedly vomited repeatedly in a market. WHO said nearly 600 fishmongers in Uganda might be targeted for vaccination but that no confirmed case had yet been found to have stemmed from the incident.

Health workers battling Ebola now find themselves facing a new challenge: measles. At least 1,981 deaths due to measles have been reported across DRC this year, over two-thirds of them among children under the age of 5. As of June 23, nearly 115,000 cases of suspected measles have been reported, far more than the 65,000 cases recorded in all of 2018. 

A new vaccine had some success in slowing Ebola. But the rate of infections has increased recently, and health workers worry some cases are going unreported, making the virus's spread harder to contain.

Attacks by armed groups and violent pushback from locals frustrated by the ubiquitous presence of health workers have forced the international response to pause from time to time, allowing the outbreak to grow.

 The current outbreak is spreading in a turbulent Congo border region where dozens of rebel groups are active and where Ebola had not been experienced before. Efforts to contain the virus have been hurt by mistrust among wary locals that has prompted deadly attacks on health workers. Some infected people have deliberately evaded health authorities.

Congo's minister of health resisted the characterization of the outbreak as a health emergency.

"We accept the decision of the committee of experts but one hopes that it's a decision that wasn't made under pressure of certain groups that want to use this as a way to raise funds for certain humanitarian actors," said Dr. Oly Ilunga.