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Why has WHO declared Ebola emergency a year after outbreak started?

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A health worker sprays disinfectant on an ambulance at a Health Centre in Goma, Democratic Republic of Congo, July 18, 2019
A health worker sprays disinfectant on an ambulance at a Health Centre in Goma, Democratic Republic of Congo, July 18, 2019 -
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The World Health Organisation (WHO) declared the Ebola outbreak in the Democratic Republic of the Congo a "public health emergency of international concern" on Wednesday.

This was the fourth such meeting of WHO's emergency committee on the current Ebola outbreak in the country, which began in August 2018.

Ebola is a highly contagious hemorrhagic fever that spreads quickly. There are at least 2,522 cases and 1698 deaths from the ongoing outbreak which is centred in eastern DRC.

The WHO decision is a rare one — there have only been four other such global public health emergencies: Swine Flu in 2009, Polio resurgence in 2014, the Ebola outbreak in 2014, and Zika in 2015.

The last outbreak of Ebola resulted in over 11,000 deaths.

Why now - what does WHO say?

The decision comes after a pastor took a bus to Goma, a transportation hub and city of two million people which lies on the DRC's border with Rwanda. The pastor later died of Ebola.

The WHO estimates that roughly 15,000 people cross that porous border daily between Goma and Rwanda.

A woman with Ebola symptoms also travelled to Uganda from the DRC last week.

"Although there is no evidence yet of local transmission in either Goma or Uganda, these two events represent a concerning geographical expansion of the virus," WHO director-general Dr Tedros Adhanom Ghebreyesus said as he announced the organisation's determination.

Almost a year after the outbreak first started, cases are also still on the rise.

There have been almost 300 deaths since the WHO's emergency committee last met in June.

"The intensity of the epidemiological situation is fluctuating, with about 80 new cases reported weekly," the WHO wrote in a statement on this week's decision.

Just one month ago, however, WHO stopped short of declaring the crisis in the DRC a global health emergency.

"This is not a global emergency," but rather a "severe emergency" in the DRC, Dr Preben Aavitsland, previous acting chair of the organisation's emergency committee had said last month. The emergency committee reiterated that sentiment this week.

What does the DRC say?

The DRC's health minister, Dr Oly Ilunga, expressed concerns about the decision, stating that it could have adverse effects on the community.

Dr Ilunga said that he hoped "the decision isn't the result of pressure from different stakeholders who want to use this decision as an opportunity to raise funds for humanitarian actors despite the potential adverse and variable consequences for the affected communities that greatly depend on cross-border commerce for their survival."

WHO specified that the declaration of a global health emergency was not for "fundraising" but rather for "preventing the international spread of disease."

The organisation advised states not to close borders or place travel or trade restrictions on the DRC.

Such restrictions "are usually implemented out of fear and have no basis in science. They push the movement of people and goods to informal border crossings that are not monitored, thus increasing the chances of the spread of disease," WHO said in a statement.

A complex crisis

A key difference in this crisis from the last outbreak of Ebola in West Africa in 2014 has also been access to a vaccine.

WHO said Wednesday the vaccine supplies were insufficient despite the DRC's health minister's statement last week that there were enough doses of the Merck vaccine currently in use.

The health minister refused to authorise the use of any other Ebola vaccine in the country given "the risk of confusion" and "communication problems".

"The vaccine produced by the firm Merck, currently used in this epidemic, is the only one that has demonstrated its effectiveness for reactive vaccination in the case of the current response," Dr Illunga said earlier this week.

A committee of experts to the World Health Organisation had recommended in May to vaccinate lower risk populations with other vaccines such as a new Johnson & Johnson vaccine.

The security situation has also made the outbreak particularly challenging.

Last month, Euronews spoke to a Médecins sans Frontières (MSF) coordinator in Beni, which is the current centre of the crisis. She said that often insecurity and violence can prevent people from getting the treatment that they need.

"In the town where I work there are still massacres that go on that we’re aware of all the time," MSF coordinator Claire Manera said last month.

Watch the Euronews interview with MSF's coordinator Claire Manera, here.

WHO's director-general maintained the DRC was cooperating with the international effort.

"The government of DRC is showing exceptional transparency in sharing information every single day. It was the DRC government which informed Uganda about the family with Ebola that crossed the border last month. It was the government of DRC that informed the international community immediately last week that there was a case in Goma," Dr Adhanom Ghebreyesus said on Wednesday.

What experts say

Many experts welcomed WHO's decision and said that it was long overdue.

"Almost all international legal and policy experts agree that the conditions for declaring a [global health emergency] were met long ago, so we are delighted to see that the Emergency Committee and the Director-General have finally come to this decision," said Rebecca Katz, Georgetown University's director of the Center for Global Health Science and Security.

The committee had lamented the lack of public health funding for the humanitarian effort back in June, stating that less than one-third of the resources needed were available.

Alexandra Phelan a global health law expert from Georgetown University said the decision is the right one.

"There needs to be an investment in health systems rather than waiting for these emergencies," Phelan told Euronews, but with the declaration, "ideally one of the outcomes is we do get this international response."

"It is now imperative that the entire global health community engages with, and understands the gravity of this particular outbreak, and its potentially destabilising implications for the Eastern DRC and surrounding countries," said Stephen Roberts, a London School of Economics fellow in Global Health Policy.