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  • End in sight, but flare-ups likely in the Ebola outbreak in the Democratic Republic of the Congo

    End in sight, but flare-ups likely in the Ebola outbreak in the Democratic Republic of the Congo

    Remarks by Dr Ibrahima Socé Fall, World Health Organization Assistant Director-General, Emergency Response

     

    Good afternoon. 

    I hope that your busy week was interrupted, like mine, with a moment of joy on Tuesday.

    That moment was the celebration of a woman being discharged from an Ebola treatment centre in Beni. Her name is Masiko.

    She was the last person in the Democratic Republic of the Congo confirmed to have Ebola.

    Health workers and other responders sacrificed a lot to get to this point. 

    Since the outbreak was declared in August 2018 there have been 420 attacks on health facilities in DRC, resulting in 11 deaths and 86 injuries among health care workers and patients.

    It’s been a huge amount of work. At the peak of the outbreak, more than 120 cases were being reported each week. 28 health zones were affected, with cases appearing 1200 kilometres apart. In response:

    • 11 labs have been set up to test around 3500 samples each week
    • 11 Ebola treatment centres were set up to care for people with Ebola
    • 300 000 people have been vaccinated
    • 250 000 contacts have been registered
    • 26 000 safe and dignified burials have been conducted
    • More than 3000 health facilities were identified for infection prevention and control support
    • More than 1000 metric tonnes of supplies have been delivered
    • An Ebola vaccine has been licensed, and two treatments found to be highly effective
    • Almost 160 000 million people have been screened for Ebola symptoms at borders or other points of control

    This work is continuing. The outbreak isn’t over. WHO recommends waiting two full incubation periods – that’s 42 days – after the last person tests negative a second time before declaring the end of the outbreak.

    We must stay in active response mode to get us over that finish line.

    We have to be prepared for other cases emerging. It’s is a very real risk.

    Remember that during the Ebola outbreak in West Africa flare-ups of new cases occurred after the end of the outbreak.

    There are four reasons why new cases may emerge during this 42-day period, or even after the end of the outbreak.

    • First, because of the complex security environment, Ebola transmission outside of groups under monitoring is possible.  
    • Second, Ebola virus can persist in used needles, syringes or vials for several weeks.
    • Third, Ebola virus can persist in the body fluids of survivors for many months, and can be transmitted well after recovery, or in rare cases can result in relapse – as we’ve already seen during this outbreak.
    • Finally, Ebola virus is present in an animal reservoir in the region, and there is always a risk of a new spillover to humans.

    This is why it’s critical to maintain surveillance and rapid response capacities.

    And that’s what we are doing. We’re still in full response mode.

    In addition to the activities I already mentioned, I have to underline how critical it is to continue supporting the Survivor Programme, which provides follow-up care for almost all of the 1169 survivors in 26 health areas in North Kivu and Ituri. The programme also helps reduce the risks of re-introduction events. 

    We need to continue this work until the end of the outbreak, to keep the capacity in place to rapidly respond to flare-ups, to keep supporting survivors after the outbreak, and to transition the capacities built in this response toward building a stronger health system. 

    But to be very frank, right now the world risks dropping the baton at the finish line. WHO faces an immediate US $20 million funding gap. If no new resources are received, we will run out of money before the end of the outbreak.

    We appreciate the generosity of donors who have supported the response since August 2018. Now we need to get over the finish line. WHO is calling on the international community to help us end this outbreak, and keep our promises to communities to build a stronger health system.

    If we are forced to scale back operations because of a lack of funds, and then a new case emerges, we might not have the people and resources on the ground that we need to shut down transmission quickly. Just a single case could re-ignite the epidemic.

    That would be a tragedy. An avoidable tragedy. 

    It is important that the global community doesn’t only focus efforts when there is an immediate threat, then walk away when the threat subsides.

    The health system has to be strong to stop much more than Ebola. It has to stop malaria, measles, cholera, and now COVID-19.

    There is a lot more work to do.

    Thank you.

     

    End in sight, but flare-ups likely in the Ebola outbreak in the Democratic Republic of the Congo
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    https://www.who.int/news-room/detail/06-03-2020-end-in-sight-but-flare-ups-likely-in-the-ebola-outbreak-in-the-democratic-republic-of-the-congo

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  • Global gathering of ministers determines road safety agenda to 2030

    The 3rd Global Ministerial Conference on Road Safety convened 1700 delegates from around 140 countries, including more than 70 ministers and vice-ministers and heads of international agencies, civil society organizations, foundations and private companies. Hosted at the request of the UN General Assembly by the Government of Sweden in collaboration with WHO, the theme was “Achieving Global Goals 2030”, highlighting the connections between road safety and achievement of other Sustainable Development Goal targets.

    Through its 6 high-level panels and 18 parallel sessions, the Ministerial Conference addressed a range of topics, from building effective leadership for road safety to promoting sustainable cities and communities, mitigating climate change through road safety, and ensuring the safety of pedestrians and cyclists. The gathering was instrumental in reviewing progress in the Decade of Action for Road Safety 2011-2020 and defining ways to accelerate action on proven strategies to save lives. Among many pre-events, the 2nd World Youth Assembly for Road Safety hosted by YOURS: Youth for Road Safety and co-hosted by WHO, brought 200 young leaders together proclaiming “Enough is enough!” and claiming their space at the decision-making table for sustainable mobility.

    The Ministerial Conference culminated in the forward-looking “Stockholm Declaration”, which calls for a new global target to reduce road traffic deaths and injuries by 50% by 2030. In addition, it invites strengthened efforts on activities in all five pillars of the Global Plan for the Decade of Action: better road safety management; safer roads, vehicles and people; and enhanced post-crash care. It also calls for speeding up the shift to safe, affordable, accessible and sustainable modes of transport like walking, cycling and public transport. WHO is asked to continue to produce the series of global status reports, as a means of monitoring progress towards achievement of the 12 Global Road Safety Performance Targets.

    Today, around 1.35 million people lose their lives on the world’s roads every year, and as many as 50 million are injured. More than one quarter of those killed and injured are pedestrians and cyclists. Road traffic injuries are now the leading cause of death for children and young adults aged 5-29 years. Given the enormous human suffering and major economic losses for families and societies, road traffic deaths remain an unacceptable price to pay for mobility.

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    https://www.who.int/news-room/detail/20-02-2020-global-gathering-of-ministers-determines-road-safety-agenda-to-2030

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  • Shortage of personal protective equipment endangering health workers worldwide

    WHO calls on industry and governments to increase manufacturing by 40 per cent to meet rising global demand

    The World Health Organization has warned that severe and mounting disruption to the global supply of personal protective equipment (PPE) – caused by rising demand, panic buying, hoarding and misuse – is putting lives at risk from the new coronavirus and other infectious diseases.

    Healthcare workers rely on personal protective equipment to protect themselves and their patients from being infected and infecting others.

    But shortages are leaving doctors, nurses and other frontline workers dangerously ill-equipped to care for COVID-19 patients, due to limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons.

    “Without secure supply chains, the risk to healthcare workers around the world is real. Industry and governments must act quickly to boost supply, ease export restrictions and put measures in place to stop speculation and hoarding. We can’t stop COVID-19 without protecting health workers first,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

    Since the start of the COVID-19 outbreak, prices have surged. Surgical masks have seen a sixfold increase, N95 respirators have trebled and gowns have doubled.

    Supplies can take months to deliver and market manipulation is widespread, with stocks frequently sold to the highest bidder.

    WHO has so far shipped nearly half a million sets of personal protective equipment to 47 countries,* but supplies are rapidly depleting.

    Based on WHO modelling, an estimated 89 million medical masks are required for the COVID-19 response each month. For examination gloves, that figure goes up to 76 million, while international demand for goggles stands at 1.6 million per month. 

    Recent WHO guidance calls for the rational and appropriate use of PPE in healthcare settings, and the effective management of supply chains.

    WHO is working with governments, industry and the Pandemic Supply Chain Network to boost production and secure allocations for critically affected and at-risk countries.

    To meet rising global demand, WHO estimates that industry must increase manufacturing by 40 per cent.

    Governments should develop incentives for industry to ramp up production. This includes easing restrictions on the export and distribution of personal protective equipment and other medical supplies. 

    Every day, WHO is providing guidance, supporting secure supply chains, and delivering critical equipment to countries in need.  

     *** 

    NOTE TO EDITORS

    Since the start of the COVID-19 outbreak, countries that have received WHO PPE supplies include:

    • Western Pacific region: Cambodia, Fiji, Kiribati, Lao People’s Democratic Republic, Mongolia, Nauru, Papua New Guinea, Samoa, Solomon Islands, Tonga, Vanuatu and the Philippines
    • Southeast Asia region: Bangladesh, Bhutan, Maldives, Myanmar, Nepal and Timor-Leste
    • Eastern Mediteranean region: Afghanistan, Djibouti, Lebanon, Somalia, Pakistan, Sudan, Jordan, Morocco and Iran
    • Africa region: Senegal, Algeria, Ethiopia, Togo, Ivory Coast, Mauritius, Nigeria, Uganda, Tanzania, Angola, Ghana, Kenya, Zambia, Equatorial Guinea, Gambia, Madagascar, Mauritania, Mozambique, Seychelles and Zimbabwe

     

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    https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide

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  • WHO steps up action to improve access to safe blood

    WHO steps up action to improve access to safe blood

    The World Health Organization’s new action plan to speed up universal access to safe blood and blood products pulls together existing recommendations and recommends new improved ways of working. It’s the start of a four-year collaborative effort to improve blood transfusion and blood-based therapies in all countries.

    Safe blood saves lives in all sorts of circumstances, not least in emergency and epidemic settings. Blood transfusion and blood products are critical for birth delivery for both the mother and baby; the survival and quality of life of patients suffering from life-threatening conditions such as haemophilia, thalassemia, immune deficiency and cancer; treating severe injuries and carrying out medical and surgical procedures.  

    But progress in blood safety and availability has been slow in many parts of the world, placing patients’ safety at risk and putting undue pressure on health workers. Progress is also mostly restricted to developed countries. Out of the approximate 118 million blood donations collected globally, 42% are collected in high-income countries, home to 16 % of the world’s population. And one out of four low-income countries do not test all donated blood, while 54% of countries do not have surveillance systems to securitise the supply chain from blood donor to patient. 

    Challenges include: slow implementation of national blood policies and weak blood regulatory systems; insufficient number of voluntary blood donors (who are considered the safest donors); poor quality management of screening tests, blood grouping and compatibility testing; inappropriate clinical use of blood; insufficient national funding for blood safety.

    To address these, WHO has set out six key objectives for all countries and in particular those with weak blood systems:

    • appropriately structured, well-coordinated and sustainably resourced national blood systems;
    • regulatory capacity to ensure the quality and safety of blood;
    • functioning and efficiently managed blood services;
    • effective implementation of patient blood management to optimize transfusion practices;
    • effective surveillance, haemovigilance and pharmacovigilance, supported by comprehensive and accurate data collection systems;
    • partnerships, collaboration and information exchange to achieve key priorities and jointly address challenges and emerging threats at global, regional and national levels.

    The Organization looks forward to working with partners worldwide to implement the plan, improve blood supply particularly in the low and middle-income countries where this is so urgently needed, and save lives. The plan will run from 2020-2024.

    WHO steps up action to improve access to safe blood
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    https://www.who.int/news-room/detail/26-02-2020-who-steps-up-action-to-improve-access-to-safe-blood

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  • To eliminate cervical cancer in the next 100 years, implementing an effective strategy is critical

    To eliminate cervical cancer in the next 100 years, implementing an effective strategy is critical

    Vaccination, screening, treatment and palliative care are the key interventions of WHO’s Draft Global Strategy towards the Elimination of Cervical Cancer as a Public Health Problem,
    the fourth most common cancer in women.

    On World Cancer Day, new estimates show that this strategy could save more than 62 million girls and women from a cervical cancer death and prevent 74 million cases within the next 100 years – but only if these interventions are used effectively
    together.

    No single intervention can eliminate cervical cancer

    These estimates, published by the WHO Cervical Cancer Elimination Modelling Consortium (CCEMC) in The Lancet, are based on the draft strategy’s targets to achieve a global coverage of 90% vaccination, 70% screening and 90% treatment by 2030.

    lancet

    Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries

    Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries


    Developed by Member States, UN agencies and other partners, the draft global strategy seeks to redress the unequal burden of cervical cancer around the world. Nine in 10 cervical cancer deaths occur in low and lower-middle-income countries, where
    women lack access to health services.

    As Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General has said, “It doesn’t have to be this way. Cervical cancer
    is one of the most preventable and treatable forms of cancer, as long as it is detected early and managed effectively.”

    This new analysis compares the impact of vaccination, screening and treatment of cervical pre-cancer lesions as single or combined interventions. Focusing on 78 countries where cervical cancer mortality is highest, the results clearly show that no
    single intervention will be sufficient to reduce levels of cervical cancer in the next 100 years to below the elimination target of 4 cases per 100,000 women per year.

    Acting immediately on all three fronts is crucial.                                                                                       

    90-70-90: a triple intervention by 2030 and beyond

    Vaccinating girls against cancer-causing types of human papillomavirus (HPV) before the age of 15 is the foundation for bringing every country’s incidence rate of cervical cancer down to the agreed elimination level.

    Right now, however, vaccination is not enough. As a single strategy, vaccination targets would only deliver a 0.1% reduction in cervical cancer mortality by 2030. Scaling up screening and treatment of cervical pre-cancer lesions at the same time would
    reduce mortality by more than one third, or 300,000 deaths, in the same period.

    The evidence shows that when all adult women are screened for cervical cancer at least twice, at ages 35 and 45, abnormalities are more likely to be detected before they become cancerous. When cancer has developed, screening increases a women’s
    likelihood of early and successful treatment, as well as palliative care if recovery is no longer an option.

    Meeting these triple-intervention targets would be a major contribution to target 3.4 of the UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030.

    The future of cervical cancer elimination

    WHO’s global strategy towards eliminating cervical cancer aims to set the world on the right track by 2030, but it is just the beginning.

    At this pace, global elimination of cervical cancer is not predicted until 2120.

    While high HPV vaccination coverage is the primary prevention intervention, ensuring every woman has two cervical screenings in her life would accelerate elimination by 11 – 31 years, depending on the country.

    If no action is taken, cervical cancer deaths will rise almost 50% by 2030. Approval of the draft global strategy at the WHO World Health Assembly in 2020, and investment in mechanisms to deliver it, is vital.

    As the new World Cancer Report shows, only 18% of countries that currently provide screening for cervical cancer reached the recommended target of more than 70% coverage. An estimated 55% of low-income countries that reported offering
    cervical cancer screening generally lack accessible radiotherapy or surgery services.

    Elimination of cervical cancer is possible within the lifetime of today’s youngest girls, but the clock starts now and every intervention counts.

     

    To eliminate cervical cancer in the next 100 years, implementing an effective strategy is critical
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    https://www.who.int/news-room/detail/04-02-2020-to-eliminate-cervical-cancer-in-the-next-100-years

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  • WHO outlines steps to save 7 million lives from cancer

    WHO outlines steps to save 7 million lives from cancer

    The World Health Organization (WHO) today spells out the need to step up cancer services in low and middle-income countries. WHO warns that, if current trends continue, the world will see a 60% increase in cancer cases over the next two decades. The greatest increase (an estimated 81%) in new cases will occur in low- and middle-income countries, where survival rates are currently lowest.

    This is largely because these countries have had to focus limited health resources on combating infectious diseases and improving maternal and child health, while health services are not equipped to prevent, diagnose and treat cancers. In 2019, more than 90% of high-income countries reported that comprehensive treatment services for cancer were available in the public health system compared to less than 15% of low-income countries.

    “This is a wake-up call to all of us to tackle the unacceptable inequalities between cancer services in rich and poor countries,” says Dr Ren Minghui, Assistant Director-General, Universal Health Coverage/ Communicable and Noncommunicable Diseases, World Health Organization. “If people have access to primary care and referral systems then cancer can be detected early, treated effectively and cured. Cancer should not be a death sentence for anyone, anywhere.”

    Yet, progress in poorer countries is achievable. WHO and the International Agency for Research on Cancer (IARC) are releasing two coordinated reports on World Cancer Day (4 February), in response to government calls for more research into the scope and potential policies and programmes to improve cancer control.

    “At least 7 million lives could be saved over the next decade, by identifying the most appropriate science for each country situation, by basing strong cancer responses on universal health coverage, and by mobilizing different stakeholders to work together”, said Dr Tedros Adhanom Ghebreyesus, Director-General, WHO.

    WHO highlights a wide range of proven interventions to prevent new cancer cases. These include controlling tobacco use (responsible for 25% of cancer deaths), vaccinating against hepatitis B to prevent liver cancer, eliminating cervical cancer by vaccinating against HPV, screening and treatment, implementing high-impact cancer management interventions that bring value for money and ensuring access to palliative care including pain relief.

    “The past 50 years have seen tremendous advances in research on cancer prevention and treatment,” says Dr Elisabete Weiderpass, Director of IARC. “Deaths from cancer have been reduced. High-income countries have adopted prevention, early diagnosis and screening programmes, which together with better treatment, have contributed to an estimated 20% reduction in the probability of premature mortality between 2000 and 2015, but low-income countries only saw a reduction of 5%. We need to see everyone benefitting equally.” The challenge will be for countries to select treatments balancing considerations including cost, feasibility and effectiveness. Each government is tasked with choosing the appropriate innovative cancer therapies, while recognizing that established treatments, many of which are very effective and affordable, can provide benefits for cancer without causing financial hardship.

    Note to editors

    World Health Organization

    Report on Cancer: Setting priorities, investing wisely and providing care for all

    The report aims to set the global agenda on cancer, mobilize stakeholders and help countries set priorities for investing in cancer control and universal health coverage. It introduces the principles, tools and current priority cancer control interventions in the context of the current and future cancer burden and opportunities.

    International Agency for Research on Cancer

    World Cancer Report “Cancer research for cancer prevention”

    The report focuses on prevention and offers the most comprehensive overview of relevant research available to date, ranging from descriptive etiology, cellular and molecular biology, toxicology and pathology through to behavioural and social science. Key chapters include discussions on the impact of inequalities in cancer, vaccination and screening, genomic individual susceptibility to cancer and the finer identification of those at risk, which may allow ‘precision cancer prevention’.

    WHO outlines steps to save 7 million lives from cancer
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    https://www.who.int/news-room/detail/04-02-2020-who-outlines-steps-to-save-7-million-lives-from-cancer

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  • WHO Action framework to advance universal access to safe, effective and quality assured blood products 2020 -2023

    WHO Action framework to advance universal access to safe, effective and quality assured blood products 2020 -2023

    In response to calls for action, WHO has provided guidelines, physical standards, training and technical support to improve blood product quality, safety and availability in WHO regions and in countries. Despite these actions, progress in blood availability and safety under effective regulation has been slow in many parts of the world.

    For that reason, the WHO Action framework for blood products 2020-2023, proposes a renewed effort to scale up programme implementation to improve global adequacy of blood donation, and universal access to quality and safe blood and blood components for transfusion, and plasma derived medicinal products.

    The Action Framework provides strategic direction to WHO’s work for the years 2020-2023. It identifies six strategic objectives: appropriately structured, well-coordinated and sustainably resourced national blood systems; regulatory capacity to ensure the quality and safety of blood; functioning and efficiently managed blood services; effective implementation of patient blood management to optimize transfusion practices, effective surveillance, haemovigilance and pharmacovigilance, supported by comprehensive and accurate data collection systems; and partnerships, collaboration and information exchange to achieve key priorities and jointly address challenges and emerging threats at global, regional and national levels.

    The Action Framework will improve coordination and collaboration at all levels of WHO. The document will promote and strengthen new and existing partnerships, as areas for collaborative action are clearly identified. Moreover, it demonstrates the need for support to WHO (including sustainable funding) to coordinate the implementation of this ambitious plan. As a result, the Action Framework for blood products will allow WHO to more effectively carry out its mandate on blood, and to increase the impact of WHO activities to strengthen blood systems and blood regulation in countries and regions and eventually to ensure universal access to blood products worldwide.

     

    WHO Action framework to advance universal access to safe, effective and quality assured blood products 2020 -2023
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    https://www.who.int/news-room/detail/19-02-2020-who-action-framework-to-advance-universal-access-to-safe-effective-and-quality-assured-blood-products-2020–2023

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  • Immunization is the best protection against tick-borne encephalitis

    Immunization is the best protection against tick-borne encephalitis

    immunization-is-the-best-protection-against-tick-borneIn a new position paper, published in the Weekly
    Epidemiological Record today, WHO recommends vaccination against
    tick-borne encephalitis in people of all ages where the disease is
    highly endemic. Where the prevaccination incidence of the disease is
    moderate or low or is limited to particular geographical locations or
    certain outdoor activities, immunization should target individuals in
    the most severely affected groups. People travelling from non-endemic
    areas to endemic areas should be offered vaccination if their visits
    will include extensive outdoor activities.

    Since the incidence of tick-borne encephalitis may vary
    considerably between and even within geographical regions, public
    immunization strategies should be based on risk assessments conducted at
    country, regional or district level, and should be appropriate to the
    local endemic situation.

    Immunization offers the most effective protection against
    tick-borne encephalitis. Currently, there are four widely used vaccines
    of assured quality: FSME-Immun and Encepur, manufactured in Austria and
    Germany respectively, and TBE-Moscow and EnceVir, manufactured in the
    Russian Federation. The four vaccines are considered to be safe and
    efficacious.

    Tick-borne encephalitis virus is an important cause of viral
    infections of the central nervous system in eastern, central and
    northern European countries, and in northern China, Mongolia, and the
    Russian Federation.

    Approximately 10 000–12 000 clinical cases of tick-borne
    encephalitis are reported each year, but this figure is believed to be
    significantly lower than the actual total. Most infections with the
    virus result from tick bites acquired during outdoor activities in
    forested areas.

    Immunization is the best protection against tick-borne encephalitis
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    https://www.who.int/news-room/detail/19-02-2020-immunization-is-the-best-protection-against-tick-borne-encephalitis

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  • Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 12 February 2020

    Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 12 February 2020

    The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) to review the current Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) took place on Wednesday, 12 February 2020, from 14:00 to 16:45 Geneva time (CEST).

    Proceedings of the meeting

    Members and advisors of the Emergency Committee were convened by teleconference.

    The Secretariat welcomed the Committee and thanked them for their support. The meeting was turned over to the Chair, Dr Robert Steffen.

    Dr Steffen also welcomed the Committee and gave the floor back to the Secretariat.

    Representatives of WHO’s legal department and the department of compliance, risk management, and ethics briefed the Committee members on their roles and responsibilities.

    Committee members were reminded of their duty of confidentiality and their responsibility to disclose personal, financial, or professional connections that might be seen to constitute a conflict of interest. Each member who was present was surveyed and no conflicts of interest were judged to be relevant to the meeting.

    The Chair then reviewed the agenda for the meeting and introduced the presenters.

    Presentations were made by representatives of the Ministry of Health of the Democratic Republic of the Congo (DRC), the WHO Secretariat, and the UN Ebola Emergency Response Coordinator.

    The current situation in the DRC was reviewed. As of 10 February 2020, there were a total of 3431 cases, of which 3308 were confirmed and 123 were probable. 2253 persons have died (66%). Between 3 and 9 February 2020, three new confirmed cases were reported in Beni Health Zone, North Kivu. These three cases were already registered as contacts and two were under surveillance at the time of detection. More than 2000 contacts are being followed. There has been an increase in the number of security incidents in recent months.

    Challenges that remain include: strengthening of community acceptance for full commitment to response measures; protection of personnel at strategic health checkpoints; improvement of infection prevention and control practices in health facilities; strengthening of the local health system; and comprehensive treatment and support for patients in recovery.

    The WHO Secretariat gave an overview of the epidemiological situation, which shows an overall encouraging trend in case incidence and geographic spread. It was noted that sustaining this progress depends on the security situation and control of the well-known drivers of transmission, particularly in traditional health facilities, and on continued trust and communication with the community.

    A risk communication and community engagement programme has been developed, as has an EVD survivors programme. It is critical to ensure the long-term sustainability of these two initiatives.   

    The situation in countries neighbouring DRC was reviewed, as was preparedness in nonaffected areas of DRC. An EVD operational readiness standardized approach has been implemented in 9 priority countries. More than 2400 alerts have been investigated, and more than 14,600 health workers have been vaccinated.

    The UN Ebola Emergency Response Coordinator gave a brief report on operational support, focused on security challenges and preparations for any resurgence of disease.

    Context and Discussion

    The Committee noted a great deal of progress in the situation since its last meeting and commended the response, under the leadership of the DRC Ministry of Health and the multisectoral coordination commission established in July 2019. Support provided by WHO, UN agencies, nongovernmental organizations and other partners has also contributed to limiting the spread and impact of this virus in a difficult context. An increase in the number of alerts was attributed to strong and proactive community surveillance.

    Conclusions and Advice

    It was the unanimous view of the Committee that this event still constitutes a public health emergency of international concern (PHEIC) under the IHR (2005).

    The Committee acknowledged the revised risk assessment, which puts the risk now as high at national and regional levels, and low at the global level.

    The Committee was concerned that withdrawing the PHEIC now might have adverse consequences for the response efforts through diminishing focus. Additionally, although the primary concern of the Committee is EVD, there are serious ongoing outbreaks of other diseases, including measles and cholera, in DRC. The country continues to need support to combat infectious diseases as well as to strengthen its health system. Further, there remains an urgent need to maintain international solidarity for the response.

    The Committee noted the ongoing discussions about the interpretation in the text of the IHR (2005) of the terms international and regional spread, and about creating an intermediate level of response between the binary possibilities of PHEIC or no PHEIC, in a way that does not require reopening negotiations on the Regulations. The Committee supports these discussions, as an intermediate level would be as useful for gradually ending a PHEIC and for signaling the potential for one to be declared.

    The Committee provided the following advice to the Director-General for his issuance as revised Temporary Recommendations under the IHR (2005).

    For DRC:

    • Sustain the political commitment and multisectoral coordination approach to the response.
    • Continue to engage and build trust with associations of survivors to facilitate rapid detection of any cases arising from exposure to infected bodily fluids of survivors.
    • Continue to strengthen capacity, implementation, and coordination for community awareness and engagement, including a focus on hotspots, preventing resurgence where cases have declined, and to support survivors in their communities.
    • Further enhance the acceptance of response measures and address access and security issues by engaging influencers and decision makers for all interventions.
    • Strengthen measures to prevent and manage nosocomial infections, including systematic mapping of health facilities, targeting of IPC interventions and sustain support to those facilities through monitoring and supervision, including in private-sector and traditional health facilities.
    • Continue cross-border screening and step up monitoring at checkpoints around hotspots and at main roads.
    • Continue to implement and share real-time full-genome genetic sequencing of all new confirmed cases.
    • Strengthen measures to prevent and manage nosocomial infections, including systematic mapping of health facilities, targeting of IPC interventions and sustain support to those facilities through monitoring and supervision.
    • Strengthen preparedness in non-affected provinces of DRC, and more generally strengthen the health system across the country to respond to concurrent health emergencies.
    • Continue to implement optimal vaccine strategies that have proven maximum impact on curtailing the outbreak, as recommended by WHO’s Strategic Advisory Group of Experts (SAGE).

    For countries at risk:

    • At-risk countries should maintain their work with partners to improve their preparedness for detecting and managing imported or locally acquired cases, including the transparent sharing of detailed information on suspect cases, as required by the International Health Regulations (2005), and sharing laboratory samples of suspect cases for confirmatory testing in accordance with WHO norms and guidance.
    • Countries should continue to map population movements and sociological patterns that can predict risk of disease spread.
    • Risk communications and community engagement, especially at points of entry, should be maintained.

    For all countries:

    • As recommended previously, no country should close its borders or place any restrictions on travel and trade.
    • The Committee does not consider entry screening at airports or other ports of entry outside the region to be necessary.

    The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of these recommendations.

    Based on this advice, the reports made by the affected State Party, and the currently available information, the Director-General accepted the Committee’s assessment and on 12 February 2020 maintained the Ebola outbreak in the Democratic Republic of the Congo as a Public Health Emergency of International Concern (PHEIC).

    The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005) to reduce the international spread of Ebola, effective 12 February 2020. The Director-General thanked the Committee Members and Advisors for their advice and requested their reassessment of this situation within two months or earlier if the situation requires.

    Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 12 February 2020
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    https://www.who.int/news-room/detail/12-02-2020-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-for-ebola-virus-disease-in-the-democratic-republic-of-the-congo-on-12-february-2020

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