An international group of public health and legal experts say the time has come for the World Health Organization to convene the Emergency Committee once again, and for the WHO Director-General Tedros Adhanom Ghebreyesus to consider declaring the Ebola epidemic in the Democratic Republic of Congo a "Public Health Emergency of International Concern" (PHEIC).
Writing in The Lancet, (Ebola in the Democratic Republic of Congo: Time to Sound a Global Alert? published 4 February), the experts say declaring a PHEIC would sound a vital "clarion call" to action - galvanizing high-level political, financial, and technical support to address the Ebola outbreak that started last May.
"A PHEIC would provide a clear signal from the world's global health body that United Nations leadership is urgent," writes the group. "A PHEIC also empowers the Director-General to make temporary recommendations which, while non-binding, have normative force."
The Ebola epidemic is the worst in Democratic Republic of Congo (DRC) history and is the second largest outbreak ever recorded in the world.
"The DRC Ebola epidemic is extraordinary," says lead author Lawrence Gostin, faculty director of Georgetown University's O'Neill Institute for National and Global Health Law. "It is a toxic brew of armed conflict, political instability, and mass displacement. The epidemic is not under control, and has a high risk of spread to the region, perhaps globally."
The authors commend WHO but express the need for additional expertise.
"WHO has demonstrated leadership and operational endurance, working tirelessly to combat the DRC epidemic," the authors write. "But WHO and partners cannot succeed alone. We live at a political moment when international solutions to collective threats are increasingly hard to achieve."
Of particular concern, say the authors, is the high risk of Ebola spreading to DRC's neighboring countries especially South Sudan. South Sudan is among the most fragile states in the world with far less capacity to control an outbreak like Ebola.
"Taking bold measures to prevent the spread of the disease in this country where violence is prevalent, and a famine is predicted, is critical to preventing a humanitarian disaster," says Gostin.
The authors note that the International Health Regulations' criteria for declaring a PHEIC have been met: public health impact; novelty and scale; and movement of persons. They call on Dr. Tedros to convene the WHO's Emergency Committee, and include members with a diverse skill-set to reflect the current challenges in DRC.
"[Dr. Tedros] should invite states, United Nations, and NGOs to attend and submit evidence. MONUSCO (UN Peacekeeping operation), UNHCR, and civil society could provide critical information. The EC should recommend proactive measures on health, diplomacy, security, and community engagement. Concrete recommendations could specify the level and kind of resources needed and composition of security and diplomatic assets."
However, the global health and legal experts identify potential negative consequences of a PHEIC declaration such as unilateral decisions to ban trade or create travel barriers in the DRC, which would have "devastating impacts."
"WHO, backed by UN support, should take active steps to prevent unlawful and harmful restrictions including calling out countries that violate laws designed to prevent this sort of unwarranted action," says author Matthew Kavanagh, director of Global Health Policy & Governance Initiative at the O'Neill Institute.
Also concerning to the public health law group is the chaos that could be created by armed groups.
"A PHEIC could increase incentives to target Ebola responders to gain leverage," they write. "As in South Sudan, armed groups could manipulate aid for non-humanitarian purposes. Like any complex multilateral negotiation, cultural competence and smart diplomacy are required."
The group concludes by characterizing a public health crisis like Ebola against a background of political violence and instability as the "new abnormal."
"WHO and the UN system will be called upon with ever greater frequency in the future to manage complex humanitarian crises," they say. "We must plan for a future in which political violence and instability become the new abnormal."
The O'Neill Institute for National and Global Health Law at Georgetown University Law Center is the premier center for health law, scholarship, and policy. Its mission is to contribute to a more powerful and deeper understanding of the multiple ways in which law can be used to improve the public's health, using objective evidence as a measure. The O'Neill Institute seeks to advance scholarship, science, research, and teaching that will encourage key decision-makers in the public, private, and civil society to employ the law as a positive tool for enabling more people in the United States and throughout the world to lead healthier lives.