Decision will Amplify Intervention Efforts

The WHO declared the Ebola virus disease outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern this week. The declaration follows several decisions in the last few months to not make that call. 

The WHO cited recent developments in the outbreak in making its recommendation, including the first confirmed case in Goma (a city of almost 2M and a major transportation hub).  The outbreak has been underway for more than a year now and there have been insufficient resources including funding to fight the outbreak – impairing the effectiveness of the public health interventions. 

Policy interventions for controlling Ebola are dicey because of the need to protect livelihoods of the people most affected by the outbreak by keeping transport routes and borders open. Interventions that effect travel and trade can have negative economic consequences, but not implementing some restrictions can impair the public health response.

The WHO made the following recommendations that relate to the declaration:

Strengthen community awareness, engagement, and participation, including at points of entry to identify and address cultural norms and beliefs that are barriers to the response.

Improve cross-border screening and screening at main internal roads to ensure that no contacts are missed and enhance screening through improved sharing of information with surveillance teams.

Enhance coordination with the UN and partners to reduce security threats to enable public health operations.

Strengthen surveillance and reduce the time between detection and isolation and implementing interventions.

Optimal vaccine strategies that have maximum impact on curtailing the outbreak should be implemented rapidly (they are using a ring-vaccination strategy).

The public health tools are available to eliminate the transmission of Ebola in the DRC. The challenge is really getting the resources deployed and implementing the proven intervention methods. Plus, and important new tool- an Ebola vaccination- is now available (it was not widely available during the 2014 West African epidemic). Security concerns, local and regional infrastructure, cultural practices and access to care are all important factors that need to be addressed in order to stop the on-gong transmission of the virus.

In an example of what the Declaration can do- the Congolese government this week tasked the military and policy with enforcing hand-washing and fever checks in Kivu Province.