Ebola, WHO confirms international emergency: “Low risk for third countries, no border closures” Following the second meeting of the Emergency Committee on the Bundibugyo Ebola outbreak in the Congo, WHO has updated its recommendations: for third countries, the risk remains “low,” without…
Ebola, WHO confirms international emergency: “Low risk for third countries, no border closures”
Following the second meeting of the Emergency Committee on the Bundibugyo Ebola outbreak in the Congo, WHO has updated its recommendations: for third countries, the risk remains “low,” with no border closures or suspension of flights. Meanwhile, there are more than 5,500 cases and 2,600 deaths. MSF: “One death every half hour”
The Bundibugyo virus Ebola outbreak in the Democratic Republic of the Congo remains a public health emergency of international concern (PHEIC), but for non-neighboring countries the risk continues to be considered “low,” and at present there is no reason to close borders or suspend air connections. This is the key point of the new temporary recommendations issued by the World Health Organization (WHO), published on August 24 following the second meeting of the Emergency Committee established under the International Health Regulations (IHR). The experts met on August 18 to reassess an outbreak that continues to spread rapidly. The Committee confirmed that the event constitutes a “Public Health Emergency of International Concern” (PHEIC), as established on May 17, but it still does not meet the criteria to be defined as a “pandemic emergency.” The latest data, updated to August 23, indicate that confirmed cases have risen to 5,514, with 2,642 deaths, corresponding to a case fatality rate of 47.9%. The number of people who have recovered since the beginning of the outbreak has also increased, reaching 1,200 in total, according to the government bulletin released today. Transmission has spread to 57 health zones in the provinces of Ituri, North Kivu, South Kivu, Haut-Uele, Bas-Uele, and Tshopo.
Tedros: “The outbreak is far from being under control”
WHO Director-General Tedros Adhanom Ghebreyesus gave an unvarnished description of the situation as he opened the second meeting of the Committee. “We need to be frank: the outbreak is far from being under control,” he said. According to Tedros, it is now the second-largest Ebola outbreak ever recorded and is moving faster than any previous outbreak. He described this speed as “unprecedented.” At the time of the meeting, nearly 5,000 people had been infected and more than 2,300 had died across six provinces and 55 health zones. Even more alarming are the figures from national authorities reported by Médecins Sans Frontières (MSF): as of August 16, there were more than 5,000 confirmed cases and more than 2,400 deaths. And during the most recent week considered, Ebola deaths were occurring at a rate of approximately one every half hour. The outbreak, MSF stresses, has become the largest and deadliest in the history of the Democratic Republic of the Congo, in a territory where communities are already dealing with conflict, violence, displacement, hunger, and other health emergencies.
The problem of deaths at home and infections escaping control
One particular figure is especially concerning to Tedros: where patients are dying. “What worries me most is where people are dying: at home, in their communities, outside treatment centers and outside known contact lists,” he explained. For the WHO Director-General, every death of this kind potentially signals “a chain of transmission that we have not yet found,” and until all transmission chains are identified and interrupted, the outbreak will continue. MSF data confirm the problem: since the outbreak was declared, more than 60% of deaths have occurred outside, and often far from, treatment centers. Many patients therefore die in their homes or communities without receiving care, while the virus can continue to spread before the case is identified. “This outbreak continues to spread and is moving faster than the response that has been put in place,” says Javid Abdelmoneim, MSF International President. For this reason, he adds, increasing the number of beds is not enough: “The response must be built with communities, not around them.”
The problem of deaths at home and infections escaping control
For the Democratic Republic of the Congo, WHO considers the risk to be “very high.” The new recommendations call for strengthened active case finding, rapid investigation of alerts, increased diagnostic capacity, daily monitoring for 21 days of contacts of confirmed or probable cases, and prompt isolation of suspected cases. Treatment centers close to transmission areas, trained and protected personnel, and safe and dignified burials are needed. For the nine neighboring countries—Angola, Burundi, the Central African Republic, the Republic of the Congo, Rwanda, South Sudan, Tanzania, Uganda, and Zambia—the regional risk is instead considered “high.” However, the recommendation is not to close borders: surveillance, laboratories, rapid response teams, and isolation and treatment capacity should be strengthened. Uganda, Tedros noted, has already succeeded in interrupting transmission after the virus initially spread, an achievement for which the WHO Director-General praised the response of both the authorities and the population.
For third countries, including Italy, the risk remains “low”
The assessment is very different for the rest of the world. For all third countries, including European countries and therefore Italy, the risk remains classified by WHO as “Low.” This is an essential point for correctly interpreting the international alert: the exceptional severity of the outbreak in the Congo does not mean that WHO considers the danger to the European population to be high. Imported cases remain possible. Tedros recalled that in July a traveler brought the virus to France. Third countries must therefore be prepared to rapidly identify, assess, report, and manage people with compatible symptoms arriving from transmission areas. Hospitals, physicians, travel clinics, and health authorities at points of entry must be familiar with the procedures; diagnostic laboratories and facilities capable of safely isolating and caring for a potential case should be identified in advance. Travelers arriving from affected areas should also be informed about what to do if symptoms develop during the subsequent 21 days.
“Borders do not stop a virus”
It is precisely regarding borders that Tedros’s words take on particular significance. “Borders can slow down a response; they do not stop a virus,” he said, recalling the imported case in France. WHO’s recommendations translate this principle into very concrete guidance: suspension of flights from countries with community transmission is not recommended, nor is denying entry to travelers or means of transport arriving from those countries. For neighboring countries, suspension of air connections or river routes is likewise not recommended. Instead, the strategy is to strengthen information, surveillance, and early detection capacity. In the Democratic Republic of the Congo, WHO recommends health screening at airports, ports, and land border crossings, while third countries must be prepared to manage a potential imported case and rapidly trace its contacts.
Vaccines, trials, and a response still playing catch-up
“It had a major head start, and we are still trying to catch up,” Tedros said, describing the relationship between the spread of the outbreak and the public-health response. WHO, Africa CDC, and partners are strengthening community surveillance, increasing treatment capacity, supporting safe burials, and working to build greater trust with local populations. Meanwhile, research is progressing. For the first time, two vaccines specifically developed against Bundibugyo virus have entered human trials. The Democratic Republic of the Congo has also been allocated 70,000 doses of Ervebo, an authorized vaccine against Zaire Ebola virus: 20,000 will be used in a Phase 3 clinical trial to assess possible protection against Bundibugyo, while 50,000 are intended for healthcare and frontline workers. Laboratory and animal data suggest possible cross-protection, but this still needs to be demonstrated in humans. The Emergency Committee will meet again within three months, or sooner if necessary.
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