Democratic Republic of Congo Ebola Outbreak Should Constitute a Public Health Emergency of International Concern

A Public Health Emergency of International Concern (PHEIC) is an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response. PHEIC emanate from the World Health Organization (WHO) International Health Regulations (IHR) 2005. The purpose of IHR (2005) is to prevent, protect against, control, and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.
International Health Regulations (2005) is implemented using a framework of core capacities required to detect, assess, notify and report events, and respond to public health risks and emergencies of national and international concern, as stipulated in Articles 5 and 13, and Annex 1, of the Regulations. The eight (8) core capacities for implementation of IHR (2005) are legislation and policy, coordination, laboratory, surveillance, response, preparedness, risk communication, human re-sources, and points of entry. They guide states on prevention, preparedness, and response to IHR-related hazards and these may be biological (zoonotic, food safety, and other infectious hazards), chemical, radiological or nuclear in nature.

The determination of a PHEIC follows a strict criterion and thus must conform to being;

• to constitute a public health risk to other Member States through international spread of disease and
• to potentially require a coordinated international response

However, this still follows a prescribed decision instrument with a set of the following questions;

• Is the public health impact of the event serious?
• Is the event unusual or unexpected?
• Is there a significant risk of international spread?
• Is there a significant risk of international travel or trade restrictions?

And if the answer to any two of the above questions is YES, re-quires a member state to notify WHO.

The questions may further require determination of; if the event may result into high number of people falling sick (morbidity) and death (mortality), the event have potential for high impact assessed on population at risk, cases in health staff; highly infectious, factors affecting response e.g. war, natural catastrophe, high population density but also requiring immediate or potential need for external assistance.

If the cause of the event is unknown, circumstances unusual, cases worse than usual, treatment failures, event unusual for place/season or/and caused by eliminated/eradicated agent. Suspected or known intentional or accidental release of chemical, biological or radiological agent.
In relation to international spread an assessment to ascertain if similar cases in other countries where it was unexpected and factors alerting to cross-border implications. The event is caused by epidemic-prone organism, source suspected/ known to be related to food import/export, index case with international travel history, in area with international tourism/ traffic, person or goods.

Additionally, if similar events previously led to restriction on travel/ trade, attracts media attention and in border areas with limited capacity for control.
The declaration of a PHEIC is a prerogative of the Director General of WHO who upon advice of committee of experts and in accordance with the criterion discussed above determines if an event constitutes a PHEIC. The declaration typically triggers more funding and political attention.

Since the IHR (2005) came into force, a first PHEIC was issued in April 2009 when the H1N1 (or swine flu) pandemic. The second PHEIC was issued in May 2014 with the resurgence of polio after its near-eradication, deemed “an extraordinary event, on, August 8, 2014. WHO declared its third PHEIC in response to the out-break of Ebola Virus Disease (EVD) outbreak in Western Africa and on February 1, 2016, and the fourth PHEIC in response to clusters of microcephaly and GuillainBarré syndrome in the Americas, which at the time were suspected to be associated with the ongoing outbreak of Zika virus.

On the 01 August 2018; the National Minister of Health Democratic Republic of Congo declared an EVD outbreak in Beni town located North Kivu Province, DRC. The outbreak has spiralled for 10 months with minimal success registered in prevention and management of case-patients. According to WHO, as of 22nd June 2019, a total of 2239 EVD case-patients ( 2145 confirmed, and 94 probable) have been identified out of which 67.3%(1506/2239) died. Case-patients continue to rise among health workers, with the cumulative number infected rising to 5.5% (122/2239) of the total cases. The outbreak started from Mangina town spreading to towns of Mandima, and Mambasa in Ituri Province, Beni, Butembo, Oicha, Musienene, and Mabalako in the North Kivu Province with some case-persons crossing to Kasese District, Uganda.

The current EVD outbreak in Eastern Democratic Republic of Congo presents a precarious challenge where the outbreak is happening in a protracted war zone. It’s hence not so much of a surprise that an imported EVD outbreak occurred in Uganda in June 2019. Subsequently, with further spread in Eastern DRC, WHO found it appropriate to declare the EVD outbreak in DRC a Public Health Event of International Concern. This will enable the inter-national community intensify efforts to bring the outbreak under control