The World Health Organization (WHO) has declared that the Ebola virus outbreak in the northeast of the Democratic Republic of the Congo (DRC) — although extremely worrying — is not a ‘public health emergency of international concern’ (PHEIC).

The organization accepted the conclusions of its independent emergency committee that declaring the status would not significantly improve an already robust containment effort, and could, in fact, hamper it.

The WHO had convened the committee because of increasing concern over armed conflicts in the region that are hampering containment efforts, and because of the risk that the outbreak could spread across borders, given the proximity of the outbreak region to Uganda and other countries.

The outbreak in the North Kivu and Ituri provinces began in early August and is centred in and around the city of Beni. So far, there have been 185 confirmed cases, 35 probable cases and 32 suspect cases of Ebola — including 139 deaths.

The situation has deteriorated in recent weeks, but epidemiologist Robert Steffen, chair of the WHO emergency committee, told a press conference on 17 October in Geneva, Switzerland, that the committee was nonetheless “optimistic” that the outbreak could be be brought under control relatively quickly.

The committee assessed the situation using the three criteria that define a PHEIC: whether there is need for greater international coordination of efforts to contain the outbreak; whether the outbreak is extraordinary; and whether there is risk of cross-border or international spread. The committee concluded that declaring an emergency would not add any value — but stressed that it “remains deeply concerned by the outbreak and emphasized that response activities need to be intensified and ongoing vigilance is critical”.

The conclusion seems to be based in part on the DRC’s long experience in dealing with Ebola outbreaks. The international response has also been relatively rapid and well-coordinated from the outset, Steffen said, and that declaring an emergency could inadvertently result in travel and trade bans being imposed on the DRC, hampering existing efforts.

The high level of preparedness in Uganda and other nearby areas was also an important factor, said Peter Salama head of the WHO’s Health Emergencies Programme told the press conference.

Conflict zone

The latest Ebola episode is the DRC’s tenth since the first report of Ebola in the country in 1976. All past outbreaks in the DRC — including one that began in May and was declared over in August — have been contained in a matter of months. The nation has over decades gained extensive experience in rapidly implementing the public-health measures needed to contain the virus’s spread. These include identifying new infections, monitoring and isolating people with whom infected people have had contact, and carrying out safe burials.

But the security situation in the northeastern region — where many different militias are fighting for power and resources — has brought increased challenges for healthworkers, who are often working in war zones.

Tedros Adhanom Ghebreyesus, director-general of the WHO, told the press conference that he had asked the United Nations Security Council to consider how the UN might increase peacekeeping efforts in the region to improve security.

This year’s previous outbreak saw the first use, at the onset of an Ebola outbreak, of a novel public-health measure: the deployment of several thousands doses of an experimental Ebola vaccine made by drug company Merck. Health officials used a ‘ring vaccination’ strategy, in which all contacts of infected people, and their contacts, are vaccinated — as are front-line responders.

In the latest outbreak, 17,976 people had been vaccinated as of 15 October.