WHO DECLARES EBOLA EPIDEMIC AN INTERNATIONAL HEALTH EMERGENCY

GENEVA, 2014-08-08. — The World Health Organization today declared the Ebola epidemic in West Africa a Public Health Emergency of International Concern, calling for a coordinated international response to a disease that is killing patients, infecting medical workers and stretching national health services beyond their capacity. Director-General Dr Margaret Chan accepted the unanimous advice of an emergency committee convened under the International Health Regulations. The declaration brings the outbreak formally before governments worldwide as an exceptional threat requiring assistance and vigilance beyond the countries already affected. It does not, however, amount to a recommendation that borders be closed or that ordinary trade and travel with the region cease.

The figures placed before the committee record 1,711 cases and 932 deaths in Guinea, Liberia, Sierra Leone and Nigeria as of 4 August. Those totals include suspected, probable and laboratory-confirmed infections; they are a dated accounting of an epidemic still developing, not a complete measure of its present reach. Guinea, Liberia and Sierra Leone bear the principal burden, while the arrival of an infected traveller in Nigeria has demonstrated the danger of transmission through international movement. The committee described the outbreak as an “extraordinary event” and judged the possible consequences of further international spread “particularly serious”, citing the virus's virulence, patterns of transmission and weaknesses in health systems.

The emergency committee met by teleconference on 6 and 7 August, hearing from representatives of the four affected countries before recommending today's declaration. Its findings place particular weight on the difficulty of bringing this outbreak under control where medical services have limited staff, equipment and experience of Ebola. “Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own,” Dr Chan said. “I urge the international community to provide this support on the most urgent basis possible.” The appeal is for practical assistance as well as political attention: trained personnel, supplies, laboratory support and the organisation needed to identify and interrupt chains of infection.

The present epidemic was recognised in Guinea in March and has since developed into the largest Ebola outbreak recorded. Previous outbreaks have occurred principally in Central Africa, often in circumstances where transmission could be confined to a smaller area. Here, movement across neighbouring borders, infections in towns and cities, and difficulties winning public confidence have complicated the response. Families may care for sick relatives without protection, and funeral practices involving contact with bodies can carry infection onward. Fear of treatment centres and distrust of officials can also keep patients out of sight. Effective control therefore requires more than announcing restrictions: health teams must persuade communities that reporting illness and accepting safe care offer protection.

Ebola spreads through direct contact with the blood or other bodily fluids of infected people, and through contaminated materials. The bodies of those who have died remain dangerous to people handling them without appropriate precautions. The disease is not spread through the air in the manner of influenza, but close nursing care can expose relatives and medical workers to considerable risk. Early symptoms, including fever and weakness, may resemble those of other illnesses common in the region, making rapid assessment important. There is no licensed vaccine or proven specific treatment presently available. Supportive care, isolation, protective equipment and careful tracing of contacts remain the central instruments of the public-health response.

For countries with Ebola transmission, WHO recommends that heads of state declare a national emergency and personally address their populations, explaining both the threat and the measures required to contain it. Governments should establish emergency management arrangements capable of coordinating health services, transport, security and public information. The recommendations also recognise the burden placed on affected communities: people confined by control measures must receive essential supplies and assistance. Medical personnel need adequate protection, training and dependable support. Without these provisions, restrictions may deepen hardship while doing little to secure cooperation. The organisation is asking political leaders to treat containment as a responsibility extending across government, rather than leaving it to overstretched health ministries.

International departure points are to receive particular attention. WHO recommends exit screening at international airports, seaports and major land crossings in countries with transmission, including a health questionnaire, temperature measurement and assessment of unexplained fever. People with Ebola should not travel internationally except under arrangements for appropriate medical evacuation; contacts should also be restricted from international travel during the monitoring period. At the same time, the committee advises against a general prohibition on international travel or trade. Countries without cases should prepare to detect, investigate and manage suspected infections, inform travellers about risks and ensure that medical staff know how to recognise a possible case and obtain specialist help.

The declaration comes as West African governments are already adopting exceptional measures. Liberia's President Ellen Johnson Sirleaf has declared a state of emergency, and Sierra Leone has also invoked emergency powers against the epidemic. Nigeria's President Goodluck Jonathan today declared a national emergency as his government confronts infections linked to the imported case. These decisions place the crisis at the centre of national politics, where authorities face demands to protect the public without making daily survival impossible. Quarantine, disrupted movement and fear of health facilities can impose serious costs on households. WHO's recommendations make clear that successful enforcement must be accompanied by communication, medical care and material support.

Transport and business are already feeling the effects of the outbreak. British Airways has suspended its services to Liberia and Sierra Leone until the end of August, reflecting concerns that are spreading beyond hospitals and border posts. Such interruptions threaten to complicate commercial activity and the movement of people at a time when the affected countries need outside assistance. The emergency committee expressly identified the possible international economic consequences among its concerns. Yet its rejection of a blanket travel or trade ban draws an important distinction between targeted precautions and general isolation. The immediate economic question is whether essential links can be maintained while carriers, governments and travellers respond to a rapidly changing risk.

Today's decision supplies an international framework, but its success will depend on what governments and relief organisations can deliver in the coming days. Treatment capacity must expand, laboratories must return reliable results, contacts must be followed and burials must be conducted safely. Countries beyond West Africa must prepare without allowing alarm to displace proportionate public-health measures. For the worst-affected states, the urgent need is to turn promises of solidarity into people and equipment at the bedside and in the community. Geneva has now declared that this is an emergency of international concern. Whether transmission can be checked will be determined by the speed, coordination and public acceptance of the response.