WHO & UN Emergencies Leadership Call For Major Funding Infusion To End Ebola Outbreak

In the wake of a new Ebola case in the border city of Goma, WHO and its UN partners are calling on donors to make major new funding commitments to halt the outbreak in the Democratic Republic of Congo (DRC) – while WHO will reconvene an expert Emergency Committee to consider if the outbreak should be considered a “public health emergency of international concern.”

WHO Director General Dr Tedros Adhanom Ghebreyesus made the twin announcements at a high-level meeting in Geneva today on the emergency response, hosted by the UN Office for the Coordination of Humanitarian Affairs (OCHA). The meeting followed confirmation of the first Ebola case in Goma, a major city along the Rwandan border, as well as the weekend murder of two Ebola responders in their homes in Beni, in North Kivu, where the outbreak has raged since last August.

Ring Vaccination in Goma – Photo: WHO/Tania Seburyamo

Dr Tedros’ call for donors to “step up to the bat” was echoed by the British Secretary of State for International Development Rory Stewart and the UN’s Under-Secretary-General for Humanitarian Affairs Mark Lowcock, among others.

The Geneva meeting also included DRC’s Minister of Health, as well as other top WHO and UN emergency response officials speaking live from DRC and Washington DC. The event further included Geneva’s UN representatives of the European Union, USA, Sweden and Norway, as well as the International Committee of the Red Cross, Wellcome Trust, and other civil society groups.

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, on 15 July addressed the first case of the Ebola virus in the city of Goma, Congo. (Reuters)

“We need a bigger, more comprehensive response,” Lowcock told a packed room of some 200 people, noting that the global community had spent some US$ 2 billion on the 2014-15 epidemic in West Africa, but only “a fraction of that” in the DRC.

Lowcock said that since January, major improvements in the emergency effort had better aligned the UN agencies with each other, as well as with the DRC government and NGOs on the ground. Local communities in the DRC’s North Kivu and Ituri regions, where the outbreak has festered against a background of chronic civil unrest, have also been engaged more constructively, he said.

“But, if we don’t get an increase in the funding level, treatment centres are going to close, there will be fewer teams to conduct vaccinations, fewer mobile teams available to identify contacts, isolate cases and get them to treatment,” Lowcock warned.

While the USA has so far been the largest national donor to the Ebola response, the United Kingdom took the lead in today’s meeting, pledging more money to a fourth phase of outbreak fund-raising that is getting underway. The Secretary of State for International Development said that the UK would commit some US$ 63 million to the next phase, and challenged “our dear friends from the other G7 [Group of 7 most industrialised] countries” to respond in kind.

“One of the sad truths of the situation is that we are going to need considerably more investment if we are going to get [Ebola transmission] down to zero in eastern DRC,” Stewart said. Reflecting on a recent visit to an Ebola treatment centre in Butembo, at the epicentre of the outbreak, which had been burned down earlier in the year, Stewart praised the work of WHO, civil society, government and other UN partners to rebuild and “address everything from disease prevention to child care in a very difficult environment.”

And at the same time, operations remain “literally on a knife edge,” he added. “You will see that although there is really good medical procedure, there are really worrisome security procedures, with only a few sandbags behind which doctors and nurses can hide if they are attacked. There is still an enormous amount of work to be done.”

Goma Case Highlights Risk of DRC Outbreak Spreading to Other Countries

The Ebola case confirmed in Goma highlights the need to further scale up preparedness in neighboring countries that share a border with the DRC, Lowcock and others underlined. The case involved a pastor who had traveled by bus from the city of Butembo in North Kivu to Goma, a border city of 1 million people that sees heavy foot traffic every day between the DRC and neighboring Rwanda.

While speakers praised Uganda’s response after 3 Ebola cases were identified there several weeks ago, involving people who had crossed over from the DRC along a frontier marked by dense jungle areas, the situation in neighboring Burundi and South Sudan, which also share a border with the DRC, is regarded as far more fragile.

“We also need to scale up the response to deal with the high risk of the virus spreading further,” said Lowcock, adding: “The cheapest strategy is to invest fully and stop the current outbreak, rather than have it linger, and spread further.”

WHO’s Dr Tedros said that since yesterday’s case was identified in Goma, people who had been in contact with the pastor had already been vaccinated with the experimental vaccine that has shown a high degree of efficacy, and other containment measures were also being taken.

However, he stressed that the simultaneous murders of the two Beni health workers underlined the fact that “we are dealing with one of the world’s most dangerous viruses in one of the most dangerous areas of the world. Every attack sets us back, makes it more difficult to trace contacts, vaccinate and perform safe burials. And Ebola gets a free ride.” There have been 198 attacks on responders over the past year, with seven killed, including the Beni victims, he said in remarks that were also published online.

While WHO, UN and DRC government speakers displayed a united front in describing the improved quality of the emergency response, some doubts over vaccine strategy were expressed by Wellcome Trust at the meeting. Dr Josie Golding, Epidemics Lead at Wellcome, questioned if supplies of the current vaccine, approved for “compassionate use” while still undergoing clinical trial development, were indeed sufficient to sustain the massive “ring vaccination strategy” of Ebola case contacts that has dramatically reduced virus transmission. She said that use of a second vaccine in-the-waiting should be reconsidered.

“We are very concerned that supplies of the Merck vaccine currently being used will run out before this epidemic ends, which would have devastating consequences. There is an urgent need to deploy a second vaccine, which has been developed by Johnson & Johnson, complementary to the Merck vaccine and as a primary prevention to protect all who may be at risk,” said Golding to the meeting heads, in a statement also published online.

“We regret the recent announcement against the use of the J&J vaccine and ask for this to be reconsidered. The lives of healthcare workers and the people in North Kivu, across DRC and the region depend on it,” she added, saying: “There is a grave risk of a major increase in numbers, or spread to new locations – as we’ve heard today in Goma. There is also always the potential another Ebola outbreak will begin elsewhere.”

Golding also echoed remarks made by the WHO UN leadership that overall the DRC Ebola response remains, “overstretched and underfunded, with only a small number of countries providing funding. Funding needs to reach the communities affected. A step-up in the national and international response is critical. We need support at the highest political levels, including at the UN and G20. Countries should not wait for Ebola to spread across borders or appear on their doorstep before acting.”

Building Stronger Health Systems Key to Sustained Ebola Control

To be successful over the long term, health and humanitarian efforts need to dispel community mistrust that create fertile ground for violence against Ebola responders – and that means building stronger health systems that tackle other long-standing disease control issues in the DRC, stressed WHO’s Dr Tedros as well as the DRC Health Minister, Oly Ilunga.

“The Ebola epidemic is not a humanitarian crisis, it is a public health crisis,” said DRC’s Ilunga. “Strengthening the health system allows us to maintain the sustainability of the response. It is time to think about the post-Ebola period and about development plans which are properly tailored, ambitious, and the only response to the vital problems faced by the population.”

Since the outbreak began last August, some 2500 people have become infected by the Ebola virus and over 1665 have died, according to the WHO’s Director General, in remarks also published online. However that pales in comparison to malaria, the leading cause of death in the DRC – which kills more than 50,000 people every year in the DRC – or even the current outbreak of measles, which has killed almost 2,000 children since January, said Dr Tedros.

“Frankly, I am embarrassed to talk only about Ebola,” Dr Tedros told the gathering. “Together, we will end this outbreak. But unless we address its root causes – the weak health system, the insecurity and the political instability – there will be another outbreak.”

“This is the moment to practice what we preach. WHO is committed not just to ending this outbreak, but to strengthening DRC’s health system so that it never comes back. That’s also what the community in North Kivu is asking. To build trust, we must demonstrate that we are not simply parachuting in to deal with Ebola and then leaving once it’s finished.”

Find out more about the Ebola outbreak here.

Image Credits: WHO/Tania Seburyamo.

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