For the Third Time, W.H.O. Declines to Declare the Ebola Outbreak an Emergency

For the third time, the World Health Organization declined on Friday to declare the Ebola outbreak in the Democratic Republic of Congo a public health emergency, though the outbreak spread this week into neighboring Uganda and ranks as the second deadliest in history.

An expert panel advising the W.H.O. advised against it because the risk of the disease spreading beyond the region remained low and declaring an emergency could have backfired. Other countries might have reacted by stopping flights to the region, closing borders or restricting travel, steps that could have damaged Congo’s economy.

Dr. Preben Aavitsland, a Norwegian public health expert who served as the acting chairman of the emergency committee advising the W.H.O., said there was “not much to be gained but potentially a lot to lose.”

At the same time, the committee of 10 infectious disease experts said in a statement that it was “deeply disappointed” that donor nations have not given as much money as the W.H.O. and affected nations need to battle the outbreak.

But some global health experts have argued in recent months that the W.H.O. should declare an emergency to bring the world’s attention to the Ebola crisis in the region. Dr. Jeremy Farrar, director of the Wellcome Trust, a major health foundation based in London, said on Friday that such a declaration would have strengthened efforts to control the outbreak.

“It would have raised the levels of international political support and enhanced diplomatic, public health, security and logistic efforts,” he said.

Dr. Tedros Adhanom Gebreyesus accepted the committee’s recommendation, saying that, even if the outbreak did not meet the criteria for an emergency declaration, “for the affected families this is very much an emergency.”

The W.H.O. has requested $98 million for its response and has received only $44 million. In an interview before the announcement, Dr. Tedros said it had recently received commitments from Britain, the United States and Germany.

“We’ve never seen an outbreak like this,” he said. “It happened in a chronic war zone and overlapped with an election that politicized the whole situation. Militia attacks kept interrupting the operations, and when that happens, the virus gets a free ride.”

As a result, there are now no confirmed cases of Ebola in Uganda, the ministry said Thursday.

For the moment, experts do not expect the Ugandan outbreak to spiral out of control.

Uganda has a strong central government, a cash-starved but organized health care system and less ethnic and political conflict than most other east African countries. It has endured and beaten three previous Ebola outbreaks, in 2000, 2007 and 2012.

On Thursday, Ugandan health officials announced that they had agreed with their Congolese counterparts to set up more health posts at “unofficial points of entry” like those used by the affected family.

Also, with outside help, Uganda has been intensively preparing for Ebola to invade from Congo.

“This was not a surprise,” Dr. Tedros said. “We’d been expecting it. It was when, not if.”

About 4,700 health workers and others who might come into contact with the infected have been immunized.

Unicef has held over 14,000 meetings at schools, churches, mosques, markets, taxi stands, bus stops and even funerals to discuss Ebola prevention and the need to seek care as soon as symptoms appear. It has also supplied water, toilets and hygiene supplies to more than 500 clinics and hospitals and trained their staff members in infection control.

In recent months, experts have been alarmed by an acceleration in infections, though more than 130,000 people have been vaccinated. While it took about eight months to reach the first 1,000 cases, it has taken only a few more to surpass 2,000.

Officials believe many deaths are taking place in villages where families refuse to bring sick relatives in for testing and fear the vaccine.

Only a little over half of new cases in Congo are in people with known connections to previous cases, an indication that contact tracing, considered essential to beating an outbreak, has fallen apart.

Last month, health officials modified their vaccination tactics: Along with “ring-vaccinating” contacts of known cases, they began “pop-up” operations in areas considered safe but close to known case clusters, offering smaller doses to anyone willing to take them.

There are now 14 treatment or isolation units in Congolese towns considered relatively safe, and some have four experimental treatments on hand. Early results were encouraging, but many patients arrive already riddled with virus and in the throes of organ failure, beyond hope.

The fatality rate among known cases is about 66 percent, but the number of unknown cases makes the real number impossible to calculate.

Ebola is not Congo’s only health problem, Dr. Tedros noted, and possibly not even its biggest. It has recently seen almost 100,000 cases of measles with 1,500 deaths. And cholera is spreading. The W.H.O. is helping distribute 3.4 million doses of vaccine against measles and 800,000 against cholera.

“We go to the communities and people say: ‘Why are you focusing on Ebola? We’re dying from measles, from cholera, from malaria, we have no clean water,’” he said. “The world should be supporting Congo in a very comprehensive way.”

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