Statement on the 5th meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 14 April 2020

The 5th 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 Friday, 10 April 2020, from 12:30 to 14:15 Geneva time (CEST) and on Tuesday, 14 April from 12:30 to 14:05 Geneva time (CEST). The Committee’s role is to give advice to the Director-General, who makes the final decision on
the determination of a Public Health Emergency of International Concern (PHEIC) and issues temporary recommendations as appropriate.<h2>Proceedings of the meeting</h2><a href="https://www.who.int/ihr/procedures/ebola-2020-april-ec-members/en/">Members and advisors of the Emergency Committee </a>were convened by teleconference.The Secretariat welcomed the Committee and thanked them for their support. The Director General welcomed the Committee and expressed strong determination for addressing the current resurgence of EVD cases. 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 meeting was turned over to the Chair, Dr Robert Steffen. Dr Steffen also welcomed the Committee, outlined the objectives of the meeting, introduced the presenters, and gave the floor back to the Secretariat.Presentations were made by a representative of the Ministry of Health of the Democratic Republic of the Congo (DRC) and the WHO Secretariat to update the Committee on the situation. DRC provided an update of the epidemiological situation. As of 8 April 2020, a total of 3 453 EVD cases were reported from 29 health zones, including 3 310 confirmed and 143 probable cases of which 2 273 cases died (overall case fatality rate 66%). As
of 13 April 2020, three confirmed cases, including two deaths, occurred in Beni city in the last four days. These cases were reported 40 days after the second negative test of the last previously confirmed patient. DRC, WHO, and partners are investigating
the infection source, validating the reported alerts, and conducting public health measures for confirmed cases and contacts. Ongoing challenges include: the low alert rate for suspected cases and deaths; community reticence in the context of the emerging cases; presence of armed groups in the affected health area; the unidentified source of infection for these patients; and
the movement of contacts.   In response to the current resurgence of cases, DRC and partners are tracing and vaccinating confirmed case contacts and contacts of contacts; isolating high risk contacts; sequencing confirmed case samples; decontaminating health facilities and households
with confirmed cases; ensuring safe and dignified burial of cases; involving political and administrative authorities in negotiations with the armed groups; activating community dialogue committees and relaunching community action units to pass on
alerts and conduct community-based surveillance; and strengthening screening measures at points of entry.  WHO noted that the current resurgence is unfortunate, but not unexpected considering the human and animal reservoirs. The rapid risk assessment is moderate at the national and regional levels, and low at the global level. As the investigation is ongoing,
the risk assessment will be continuously reassessed in the coming days based on available and shared information. Alerts and community deaths are being investigated to identify the source of infection. The engagement of community leaders to address
challenges with community mistrust and access to critical areas for response teams remains a priority. Three vaccination teams have been activated. While approximately 6,000 doses are available in Beni, WHO anticipates potential challenges with the
vaccine pipeline because of limited flight ability as a result of the coronavirus disease (COVID-19) pandemic. WHO highlighted that the capacities built for EVD preparedness are also contributing to COVID-19 preparedness and response in DRC and the nine neighbouring countries. These capacities include: multi-sectoral, multi-partner coordination mechanisms; planning
processes and development of standard operating procedures; laboratory diagnostic and testing capacity; availability of rapid response teams established for EVD; prepositioned personal protective equipment kits and infection prevention and control
materials; as well as points of entry, community, and health facility-based systems for surveillance and reporting. <h2>Context and Discussion</h2>The Committee conveyed their appreciation to the Director General for his leadership and dedication to end this challenging outbreak. The Committee expressed its gratitude for achieved success and strong support for conducting further response activities
to control the current situation to all national and international partners, particularly those active in the field under difficult conditions. The Committee commended preparedness amongst the neighbouring countries which is helping to prevent
international spread of EVD. The Committee discussed the potential negative impact of community reticence on the response activities related to the most recent confirmed cases. Community engagement is critical to ensuring the continued success of the EVD response activities. As such,
the population is being sensitized to the recently identified cases by political and administrative authorities. Vaccination activities are continuing following the successful strategy of vaccinating cases, contacts, and contacts of contacts. DRC is intensifying its surveillance activities to identify and contain the spread of EVD. While the presence of violence
in Beni is challenging, DRC has previously trained members of the armed group to conduct surveillance activities. The current focus is to find the source of the outbreak and potential links to the previous cases or survivors.  Case validation is conducted when alerts are reported to confirm that the case meets the case definition. However, for a community death that occurred on 30 March, the first and second alerts were not validated. This community death is currently being
investigated. 
In response to the Committee’s question on available resources for this EVD response, WHO highlighted the diminishing resources to address the outbreak and the recent departure of NGO partners who had been providing support for the EVD response
in the area. WHO has not received adequate EVD funding since the start of 2020 and is currently using its emergency funds to support the epidemiological and public health interventions. Financial and human resources of DRC, WHO, and partners are challenged
by the ongoing COVID-19 outbreak.  The Committee expressed concern regarding infection prevention and control in the health facilities. Assessment of health facilities are being conducted to identify the risk of nosocomial infections. <h2>Conclusions and Advice</h2>The Committee discussed the progress in addressing the Ebola outbreak on 10 April. Following the announcement of new Ebola cases in Beni, the Director-General asked the Emergency Committee to reconvene on 14 April to study the information provided by
DRC on the recent resurgence of cases. The Committee agreed that while there is a low risk of international spread, they consider this event to still constitute a public health emergency of international concern (PHEIC) under the IHR (2005), requiring international coordination and support.The Committee emphasized the need for sufficient global funding for WHO as well as national and international partners to effectively implement and monitor these recommendations.The Committee provided the following advice to the Director-General for his issuance as revised Temporary Recommendations under the IHR (2005).For DRC:<ul style="margin-left:30px;"><li>Intensify surveillance activities and investigation of recently reported cases including potential nosocomial infections.  </li><li>Expand use of vaccine in high risk populations, as vaccination is the best public health tool to prevent and control the spread of EVD. </li><li>Continue to strengthen the EVD infrastructure (i.e. primary health care, risk communications and community engagement systems such as community action cells, surveillance systems including at points of entry, and alert management levels).</li><li>Reinforce messaging with communities regarding the potential for resurgence and the need for sustained community engagement in reporting of alerts. </li><li>Remain vigilant against EVD while strengthening the focus on routine immunization programmes as well as other vaccine preventable diseases (i.e. measles and polio).</li></ul>For countries at risk:<ul style="margin-left:30px;"><li>At-risk countries should remain prepared to cope with future outbreaks of EVD and continue to utilize and strengthen their preparedness capacities for other health emergencies (i.e. COVID-19). </li></ul>For WHO: <ul style="margin-left:30px;"><li>Sustain support for investigation of and response to this EVD outbreak. </li><li>Continue engagement with countries and partners, including industry, to establish and maintain a global stockpile for EVD vaccines. </li><li>Conduct evaluations and encourage development of future vaccine candidates that can protect health workers and populations at risk. </li></ul>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 14 April 2020 maintained the EVD 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 EVD, effective 14 April 2020. The Director-General thanked the Committee Members and Advisors
for their advice and requested their reassessment as soon as the situation requires.