Tuesday, April 16, 2019

World Must 'Step Up' in the Fight Against an Escalating Ebola Outbreak
 Sarah Newey
16 APRIL 2019 • 4:30PM

The world needs to “step up” its response to the Ebola outbreak in Democratic Republic of Congo (DRC) and turn messages of support into financial commitments, International Development Secretary Penny Mordaunt has said.

She added that it was in everyone's interest to support efforts to contain the highly contagious disease, which is notoriously difficult to control.

“We know all too well the deaths and devastation that Ebola can inflict on communities,” she said. “The UK has been a major donor since the start. But this outbreak requires a truly global response if we’re to stop this threat.

“It’s time for other countries to step up. Diseases like this do not respect borders and it’s in all of our interests to help contain the spread of Ebola.”

Ms Mordaunt's comments come after Dr Tedros Adhanom Ghebreyesus, director general of the World Health Organization, announced that the emergency response has a total funding gap of around US$104 million for operations between now and the end of July.

There are also concerns that the Ebola outbreak, which has been ongoing in DRC since August, is gathering pace. April has already seen more infections than any other month since the epidemic began, with more than 230 cases reported in the last three weeks.

But a WHO emergency committee almost unanimously agreed last week that the epidemic was not a public health emergency of international concern (PHEIC) - a formal classification used to identify outbreaks with the potential to cross borders.

The decision has sparked criticism, with global health lawyers believing it demonstrates a “fundamental misunderstanding” of international law. 

In August 2014, when the West African Ebola epidemic was declared a global emergency, 1,070 infections had been reported. As of Monday, the current outbreak had reached 1,264 cases, including 814 deaths.

“I think it was a poor [decision] which misapplied the International Health Regulations,” Mark Eccleston-Turner, lecturer in global health law at Keele University, told The Telegraph. “It’s quite a narrow reading to think that if the outbreak is contained to one country, it is not of international concern.

“Following the law correctly at the moment would lead you to declare a PHEIC. We can't just ignore the law because we don't like the outcome,” he said.

But others have questioned how important a legal classification is, and whether it would help or hinder the emergency response. Declaring a PHEIC comes with no guarantees of added funding or resources, but could result in trade and travel restrictions which might further destabilise an already troubled region.

The current Ebola outbreak is focused in the North Kivu region of DRC - a volatile area which has been at the centre of conflict for over two decades, with more than one hundred armed rebel groups in operation.

Efforts to bring the outbreak to a close have been hampered by violent attacks on treatment centres and community distrust, with a quarter of people in the cities at the epicentre believing that Ebola does not exist.

“Do I think that whether a PHEIC is declared matters? I don’t think it does,” Dr Jeremy Farrar, director of the Wellcome Trust, told The Telegraph.

“I think too much attention is paid to that call. It is an emergency - the second largest Ebola outbreak in history - which will continue to be incredibly destructive. I don’t think our response needs to be any less because a PHEIC has not been declared.”

AnneMarie Pegg, clinical lead for epidemic response and vaccination at Médecins Sans Frontières, said the decision has no impact on the ground.

“The most important thing right now is to evaluate what has and hasn’t been working so far. I don't necessarily think that the PHEIC will or will not change the trajectory of the response,” she said.

Controlling Ebola is notoriously difficult. Safe burials and rapid access to specialist treatment are key, as is tracking the contacts of Ebola patients - and the contacts of contacts - to identify potential transmission chains.

Those at risk, as well as healthcare workers, have been offered an experimental vaccine, which has been widely credited with preventing the rampant spread of the disease. The WHO announced last week that of some 90,000 people inoculated in the “ring vaccination” process, just 71 went on to develop Ebola. None of them died.

But overcoming scepticism and encouraging vaccine uptake remains central to stalling the spread of Ebola. 

“Regardless of the efficacy, an effective vaccine is no good if people don’t get it,” Dr Mike Ryan, WHO executive director for health emergencies, told The Telegraph. “So many cases in the last few weeks came up among contacts [of patients] who have not been vaccinated. They don’t believe in the response and they don’t believe they have Ebola.

“We need the support of communities if we have a fighting chance of stopping the outbreak,” he added. “And we have to take into account the risks that limiting travel and trade would have to the economy in North Kivu, which is central to the social, political and health security of the region.”

But what happens over the next six weeks could determine whether the outbreak will be contained within localised hotspots in North Kivu and Ituri, said Dr Farrar. The WHO has said that if the situation continues to escalate, it will reevaluate whether a public emergency should be declared.

“We are in a critical phase, where it’s not out of control and it’s not under control,” said Dr Farrar. “Because of the mistrust, the violence, the lack of acceptance of Ebola, no component of the response is working at a high enough level.

“If that continues, then I would say it cannot be brought under control.”

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