With cases rapidly mounting in four West African countries, the World Health Organization (WHO) today declared the Ebola outbreak a Public Health Emergency of International Concern (PHEIC), a designation that allows the agency to issue recommendations for travel restrictions but also sends a strong message that more resources need to be mobilized to bring the viral disease under control.
"The outbreak is moving faster than we can control it," said WHO Director-General Margaret Chan at a press conference in Geneva, Switzerland, this morning. Chan said the declaration of a PHEIC serves as "an urgent call for international solidarity." The affected countries don't have the resources to battle the disease alone, and neither does her agency. With three major humanitarian crises on its hands—in Syria, South Sudan, and the Central African Republic—as well as three important disease outbreaks—Ebola, the H7N9 influenza virus, and MERS—WHO is "extremely stretched," she said. So are organizations such as Doctors Without Borders, which do much of the control work on the ground.
This is only the third time the health agency has issued a PHEIC declaration since the new International Health Regulations (IHR), a global agreement on the control of diseases, were adopted in 2005. The previous two instances were in 2009, for the H1N1 influenza pandemic, and in May for the resurgence of polio.
The WHO declaration is “an alarm call that will hopefully stimulate the richer countries to provide more money and personnel," says Preben Aavitsland, a Norwegian epidemiologist who helped draft the IHR. But Aavitsland says that alarm should have gone out earlier. "In my view it should have happened months ago, when the infection spread to other countries than Guinea," he says.
With 1779 cases and 961 deaths officially recorded as of Wednesday, the outbreak in Guinea, Liberia, Sierra Leone, and Nigeria is by far the worst for Ebola in history. There were only 425 cases in the most serious outbreak thus far, in 2000 to 2001 in Uganda*, and many other outbreaks were contained after just a few dozen cases.
What's more, WHO's official tally is probably far too low, one expert told a congressional hearing yesterday in Washington, D.C. “Our epidemiologists and medical personnel believe that these numbers represent 25 to 50% of what is happening,” Ken Isaacs, a vice president at Samaritan’s Purse—the group that repatriated two staffers suffering from Ebola and helped provide an experimental treatment for them—told a hearing of the U.S. House of Representatives’ Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations. Chan today acknowledged that infected people often don't seek care and that the real number of victims is probably higher.
At yesterday's hearing, Isaac labeled the international response to the outbreak as a "failure." Doctors Without Borders and Samaritan's Purse, where he oversees international programs and government relations, have provided the bulk of outside medical support so far, he stressed. “The international community was comfortable in allowing two relief agencies to provide all of the clinical care for the Ebola victims in three countries,” he charged. “It was not until July the 26th, when [U.S. patients] Kent Brantly and Nancy Writebol were confirmed positive, that the world sat up and paid attention.”
His organization's epidemiologists predict that the disease soon will come out “with a fury” in Nigeria. “We’re going to see death tolls in numbers that we can’t imagine now,” he warned. “The truth is the cat is most likely already out of the bag.”
Asked why WHO convened the emergency committee only this week, WHO Assistant Director-General Keiji Fukuda this morning said the organization was initially focused on coordinating the response on the ground and on raising awareness and drumming up political support, for instance at a meeting of health ministers in Accra in early July and a meeting with Chan and West African presidents last week. It was the spread of the virus to Nigeria that triggered WHO to call the committee's meeting, Fukuda said.
The declaration of a PHEIC came after the panel held a 4.5 hour teleconference on Wednesday and another 6-hour conference on Thursday, Fukuda said. The committee issued a range of specific recommendations for stopping the spread of the virus. Among other things, Ebola-affected countries should check every person leaving the country for possible signs of Ebola infection. "The exit screening should consist of, at a minimum, a questionnaire, a temperature measurement and, if there is a fever, an assessment of the risk that the fever is caused" by the Ebola virus, it said.
Anybody who has an illness consistent with Ebola should not be allowed to travel, the panel said, unless as part of an appropriate medical evacuation. Neither should people who have been in contact with patients; they should be monitored for Ebola symptoms and fever for 21 days.
Wider restrictions on travel—such as halting airline traffic—would be counterproductive, Fukuda said, because they would not help control the disease and would increase anxiety. "Most people who go to business meetings or family gatherings [in the affected countries] are at low risk of Ebola infection. So we don't think a ban on that kind of travel makes any sense at all," he said. "But it will have a lot of bad effects on the community."
With reporting by Jon Cohen and Kai Kupferschmidt.
*Correction, 8 August, 8:55 a.m.: This story originally said the Ebola outbreak of 2000 to 2001 was in Sudan instead of Uganda.
*Update, 8 August, 12:24 p.m.: This article has been updated to include the most recent case numbers, as of 6 August, which were released today.
*The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicine have made a collection of research and news articles on the viral disease freely available to researchers and the general public.