WHO stops short of declaring health emergency over DRC Ebola outbreak

The World Health Organization declined Friday to declare a "Public Health Emergency of International Concern," (PHEIC} its highest alert level, despite a sharp uptick in the number and geographical spread of cases of the Ebola virus in the Democratic Republic of the Congo (DRC).

Why it matters: This is already the second-largest Ebola outbreak on record, with more than 1,000 cases of the hemorrhagic fever so far, and it's the first to occur in a country where there is widespread civil unrest.

The details: The outbreak, which began in August, has killed 751 and sickened 1,186 as of April 9, according to WHO and DRC Ministry of Health data.

• During the past few weeks, a dramatic increase in the number of cases, and the prevalence of community cases — patients unknown to health workers who often die at home, exposing caretakers to the virus — have raised concerns and prompted a WHO committee meeting to determine if an emergency declaration was warranted.
• "The emergency committee almost unanimously decided against recommending a public health emergency of international concern," said Robert Steffen, chair of the WHO's Emergency Committee, during a press conference in Geneva.
• Steffen said an emergency was not warranted because the outbreak has not spread to any other country, though there's nothing preventing its spread.

Between the lines: The WHO has been criticized for moving too slowly to declare a public health emergency during this outbreak while issuing optimistic outlooks about its ability to contain it, despite a steady rise in cases, an anemic international response effort and multiple deadly attacks on Ebola treatment facilities and workers.

• According to Jennifer Nuzzo, a public health expert at the Johns Hopkins Center for Health Security, an emergency declaration is the best option at the WHO's disposal:

"I am deeply disappointed by today’s decision to not declare a PHEIC. The statement that there would be no added benefits of a PHEIC declaration is misplaced. Potential benefits are not criteria by which these decisions should be made. The decision to declare a PHEIC should be made on technical merits, not political ones."

• Alexandra Phelan, a health expert at Georgetown University, also criticized the WHO's decision:

"The persistence of community and health care workers’ cases and high risk of regional spread means that significantly greater financial, political, and technical support is urgently needed. A PHEIC declaration is intended to garner this support and provide guidance to the international community. This is not only a missed opportunity but undermines the international law developed to safeguard global health.” 

By the numbers: The WHO's director, Dr. Tedros Adhanom Ghebreyesus, said the WHO needs $104 million until July 31 to close a funding gap in order to continue to fight the disease in the DRC.

• The WHO says it needs a total of $148 million to carry out its Ebola fight.

But, but but: A lack of an emergency declaration may work against the fundraising effort, Nuzzo says.

• "The reason that’s been given for not declaring a [Public Health Emergency] has been skepticism that it will result in anything," she says, referring to additional resources from the international community.
• "While I can understand where that skepticism is coming from ... I also know that not declaring it certainly doesn’t wake up world leaders either."

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