The World Health Organization has held back from declaring the Ebola epidemic in the Democratic Republic of Congo an international emergency despite the virus crossing into neighboring Uganda earlier this week.
The UN agency convened its expert emergency committee on Friday and was expected to upgrade the status of the outbreak to a “public health emergency of international concern” - its highest alert level.
However, in a statement on Friday evening it said the epidemic does not yet merit being declared a global emergency and instead described it as "an extraordinary event" of deep concern.
Dr Preben Aavitsland, the acting chair of the committee, said the outbreak was "a health emergency in the Democratic Republic of the Congo" but the situation did not yet meet the criteria for being declared a global emergency.
To be declared a global emergency, an outbreak must constitute a risk to other countries and require a coordinated international response, according to the WHO.
WHO director general Tedros Adhanom Ghebreyesus, who is in DRC reviewing the Ebola response, said he accepted the committee's advice.
"Although the outbreak does not at this time pose a global health emergency, I want to emphasise that this outbreak is, for those affected, very much an emergency," he said.
The Ebola outbreak is the second-deadliest in the history of the hemorrhagic disease, with more than 2,000 cases and 1,400 deaths since first being declared in August last year.
It has been raging in DRC for 10 months and earlier this week it jumped the border to Uganda, killing a five-year-old by and his grandmother. A further 90 people are reported to be being kept under observation by the Ugandan authorities, 10 of whom are considered “high risk”.
Nevertheless, the WHO takes a cautious approach and has only declared an international emergency on four previous occasions.
These included the 2009 swine flu pandemic which is estimated to have killed up to 500,000 people globally; the 2013-2016 West African Ebola outbreak which killed 11,300 people; and the Zika outbreak of 2016 which resulted in at least 4,000 children in Brazil and surrounding countries being born with microcephaly and other neurological disorders.
Several experts had urged the WHO to declare a global emergency on Friday, citing the border incident in Uganda and the rising number of cases in DRC.
"This epidemic is in a truly frightening phase and shows no sign of stopping," warned Jeremy Farrar, an infectious disease specialist and director of the Wellcome Trust.
“I respect the advice of the Emergency Committee but do believe a Public Health Emergency of International Concern (PHEIC) would have been justified.
“A step up in the response with full international support is critical if we’re to bring the epidemic to an end and ensure protection for the communities at risk. The response in DRC remains overstretched and underfunded".
Ian Vale, regional director for Save the Children in East and Southern Africa, also called for more action: “The international community must step up support and do all it can to stop the disease in its tracks in the DRC, and to prevent it from spreading any further.”
Despite a strong initial response to the outbreak in DRC and the availability of an experimental but effective vaccine, health workers have struggled to contain the virus in recent months because of armed conflict and widespread distrust.
Several health workers, including a senior WHO official, have been killed and medical facilities have been attacked and burned down. Wild myths and conspiracy theories are also circulating locally, making the containment of the disease extremely challenging.
On Thursday, WHO's emergencies chief acknowledged the agency has been unable to track the origins of nearly half of new Ebola cases in Congo, suggesting it doesn't know where the virus is spreading.
Nevertheless formally designating the outbreak an international emergency is not without its own risks.
It could have an adverse economic impact on Uganda, Rwanda and Tanzania which all border eastern DRC despite the risk to tourists and business travellers in those countries being miniscule.
Uganda - a much more stable country than DRC - is well prepared to deal with cases like those picked up this week and is widely expected to contain it. The same is true of Rwanda and Tanzania, although South Sudan to the north is less developed and arguably more vulnerable.
WHO's expert panel, officially known as the International Health Regulations and Emergency Committee, has met twice previously to consider the outbreak’s alert ranking but, like today, backed away from the decision on both occasions.
In April, it concluded the outbreak was of "deep concern" but officials were "moderately optimistic" it could be contained within a "foreseeable time."
Members of the panel must base their advice on the available evidence, matching it to the criteria for different alert levels.
They will also be conscious of the importance of never exaggerating a threat in order to retain credibility within the UN and not to undermine the global response to future epidemics.
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