The World Health Organization (WHO) should declare a public health emergency of international concern (PHEIC) for the current Ebola outbreak in the Democratic Republic of the Congo (DRC), and CDC experts should be allowed by the U.S. to return to the area, two public health experts argued.
Due to the rapidly increasing numbers of cases, a limited ability to investigate in the field, and potential risk of cross-border spread, the situation now merits the additional attention and resources that declaring a PHEIC would provide, stated Jennifer B. Nuzzo, DrPH, and Thomas V. Inglesby, MD, both of the Center for Health Security at Johns Hopkins Bloomberg School of Public Health in Baltimore.
Moreover, even if a PHEIC is not declared, additional resources are needed to contain the epidemic — and the CDC needs to be a part of those efforts, they wrote in a Perspective in the New England Journal of Medicine.
They pointed out that current efforts to contain the DRC’s outbreak haven’t succeeded, and that a PHEIC would increase “political attention and financial resources” for efforts to control the epidemic.
Nuzzo and Inglesby cited the large increase in the numbers of Ebola cases, with WHO estimates indicating that incidence has more than doubled since September, and that the virus has spread to 11 health zones within the DRC.
They said that efforts to contain the epidemic must be stepped up, and that starts with additional personnel. Nuzzo and Inglesby said that increased efforts are needed to “detect all cases, conduct thorough case investigations, monitor case contacts, and rapidly isolate anyone with symptoms.”
They cited the fact that more than 10% of Ebola cases have occurred in healthcare workers.
“Vaccinating health workers, strengthening infection-control practices, and increasing workers’ capacity to recognize and report potential cases of Ebola are all essential,” they wrote.
As part of these efforts, Nuzzo and Inglesby said that the U.S. government should allow CDC workers to return to the field “for as long as the WHO and others deem necessary,” after being pulled due to security concerns.
They also emphasized the importance of addressing these security concerns, so that CDC staff could return to the field. The authors suggested using the same organization currently protecting WHO staff, the United Nations Organization Stabilization Mission in the DRC (MONUSCO), as well as “epidemic response agencies and organizations from other countries with Ebola experience that are not already engaged in the current response.”
The authors also cautioned about the potential cost of an outbreak “spiraling out of control.” They cited the World Bank estimates of $2.2 billion in 2015 in lost gross domestic product for the three countries affected by the Ebola epidemic in West Africa, as well as the $5 billion the U.S. spent in response to the epidemic. While not quite on that scale yet, they added that the response to the Ebola outbreak in the DRC alone could be estimated to cost $44 million.
“If we do not act now, the outbreak may become far harder and more expensive to stop,” they cautioned. “The WHO, the DRC, and local partners won’t be able to succeed without sufficient human and financial resources.”