Ebola Public Health Emergency Still In Force, Despite Decline In Cases

The World Health Organization is not yet ready to declare that the Ebola public health emergency in the Democratic Republic of Congo is over – despite significant recent declines in the pace of new infections.

WHO Director General Dr Tedros Adhanom Ghebreyesus said Friday that he did not find it prudent to end the “Public Health Emergency of International Concern (PHEIC)” designation for the DRC outbreak, due to continued uncertainties about the rate of case transmission in rural areas, where new infections are not always reported.

Community engagement activities raise awareness of Ebola in the DRC.

While there has been a steep decline in the number of cases over the past few weeks,  continued circulation of the virus in hard-to-reach communities means that the risk of further Ebola resurgence nationally or regionally remains high, the WHO Director General said, following a meeting with the International Health Regulations (IHR) Emergency Committee.

“The public health emergency of international concern will be maintained for the next 3 months… This outbreak remains a complex and dangerous outbreak. We need the full force of all partners to bring this outbreak under control and meet the needs of all people affected,” said Tedros in a press conference. He said his decision was in line with the IHR recommendations, following their review of the latest data on the situation today.

In a related development, the European Medicines Agency (EMA) announced that it would issue a conditional marketing approval for the Ebola vaccine (rVSV-ZEBOV-GP ) produced by Merck, which has been given to more than 236,000 people in the DRC outbreak and shown to be highly effective in protecting people from the virus.

WHO declared a PHEIC for the current Ebola outbreak on July 17, just two weeks before the EVD outbreak in the DRC hit its one-year anniversary. To date, there have been 3228 total cases (3114 confirmed & 114 probable), including 2157 deaths and 1038 survivors, with 15 new confirmed cases between and 14 new confirmed cases the week prior, significantly down from a peak of 126 cases per week in April and 85 per week in August.

However, the risk of the outbreak spreading nationally and regionally remains high due to the shift in transmission to more rural areas, bringing new operational challenges to identifying and treating cases.

Major security risks and difficulties in accessing remote areas, along with low awareness about the dangers of the Ebola virus and a lack of community engagement, have hindered the public health response in these new hotspots.

For instance, a recent WHO survey conducted in Mandima Health Zone, where most of the cases from the past three weeks have originated, found that less than half of the respondents would call an Ebola hotline if they suspected a member of their community of having Ebola.

Just under half of respondents said that they would encourage a family member suspected of having Ebola to seek treatment at an Ebola Treatment Center. This, WHO said, reaffirms the importance of engaging communities in response activities in upcoming weeks to ensure prompt case reporting, investigation of suspected cases, treatment in health centers, vaccination of suspected Ebola contacts, and safe burial of Ebola victims.

Outbreak preparedness activities are being conducted in the DRC and neighboring countries to mitigate the risk of resurgence, with support from a consortium of international partners (See related Op-Ed).

However, WHO is still facing a funding shortfall of at least US $70.5 million for outbreak response activities in the DRC and US$ 16.7 million for strengthening regional preparedness. Dr Tedros appealed to donors and regional countries to increase funding, calling the current lack of funding for regional preparedness “grossly inadequate.”

“This is dangerously shortsighted,” Tedros warned.

He highlighted that WHO and partners have in recent weeks actually stepped up efforts to control Ebola, emphasizing that “although the outbreak is concentrated in a smaller geographic area, we must treat every case as if it is the first, because every single case has the potential to spark a new and bigger outbreak.”

First Ebola Vaccine to Gain Conditional EMA Approval
A health worker administers the Merck vaccine to an Ebola contact.

The Merck vaccine is the first Ebola vaccine candidate to receive conditional marketing approval from the EMA, and the first licensed doses will hit the market in mid-2020.

The vaccine protects against the Zaire strain of the Ebola virus – the strain that caused the devastating 2014 West African outbreak and is one of the major strains currently circulating in the DRC.

“This vaccine has already saved many lives in the current Ebola outbreak, and the decision by European regulator will help it to eventually save many more,” said Dr Tedros, WHO Director-General, in a press release.

WHO is concurrently taking steps to prequalify the vaccine, a move which will give the green light for other countries to begin looking into licensing the product. However, the announcements are unlikely to impact how the vaccine is currently accessed or administered on the ground in the DRC.

Under this emergency context, the vaccine is licensed for use under a highly monitored research protocol, also known as an “expanded access” or “compassionate use” protocol. Under normal regulatory processes, new medical products can take years to reach market. WHO approves use of novel drugs and vaccines in emergency situations under such “expanded access” protocols to increase timely access to life-saving innovations.

To date, the Merck vaccine has been administered to 236,000 people impacted by the current outbreak, including more than 60,000 health and frontline workers in the DRC, Uganda, South Sudan, Rwanda and Burundi.

WHO, collaborating initially with the Government of Guinea, initiated a randomized trial to test the efficacy of the vaccine during the West Africa Ebola outbreak in 2015.

A global coalition of funders and researchers provided the critical support required for the success of the clinical trial. Funders included the Canadian Government (through the Public Health Agency of Canada, Canadian Institutes of Health Research, International Development Research Centre, Global Affairs Canada); the Norwegian Ministry of Foreign Affairs (through the Research Council of Norway’s GLOBVAC programme); the Wellcome Trust; the UK government through the Department for International Development; and Médecins Sans Frontières.

WHO is working with Gavi, the Vaccines Alliance, UNICEF and other partners to develop a Global Ebola Vaccines Security Plan, as increased supply capacity and multiple manufacturers will be needed in the short- to medium-term to meet the anticipated demand for the Ebola vaccine.

Elaine Ruth Fletcher contributed reporting to this story.

Image Credits: OMS RDC Twitter, World Health Organization Twitter.

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