The World Health Organization declared on Saturday that the spread of the Ebola virus in the Democratic Republic of Congo and Uganda was a global health emergency.
The announcement was made a day after Africa’s leading public health authority reported that an outbreak in a province in the northeast of the country was linked to dozens of suspected deaths.
By Saturday, cases had also been confirmed in Kinshasa, Congo, and in Kampala, Uganda, the capital cities of each country, the W.H.O. said.
In Congo’s Ituri province, where the outbreak was first identified, 246 suspected cases and 80 deaths attributed to the virus had been reported, although only eight cases had been definitively linked to the virus through laboratory testing. There is no approved vaccine or therapeutics for the Bundibugyo species of Ebola behind the outbreak, according to the W.H.O.
The scale of the outbreak could be far larger than has been detected and reported, the W.H.O. said in declaring a “public health emergency of international concern.” It added that there were “significant uncertainties” about the precise number of people infected and the “geographic spread.”
The W.H.O.’s declaration signals a public health risk requiring a coordinated international response, and is intended to prompt member countries to prepare for the virus to spread and to share vaccines, treatments and other resources needed to contain the outbreak.
The U.S. Agency for International Development has played a major role in containing previous outbreaks, but last year it was shuttered by the Trump administration. It is unclear how that might have affected the response to this outbreak. The administration also cut funding for the U.S. Centers for Disease Control and Prevention, the leading public health agency in the country. It also withdrew in January from the W.H.O.
The outbreak does not meet the criteria of a pandemic emergency, the highest level of alert, that was applied to the Covid pandemic, the W.H.O. said.
Some global health experts were alarmed that the first reports of the outbreak emerged so late in its development. A surge in cases is typically picked up much earlier by the W.H.O., other health organizations or by news reports, said Jennifer Nuzzo, the director of the Pandemic Center at the Brown University School of Public Health.
In Kampala, two confirmed cases, including one death, were not apparently linked, but they were identified within 24 hours of one another in people who had traveled from Congo, the agency said. The Ugandan authorities had earlier said they had identified a single case of a 59-year-old Congolese man who was admitted to a hospital in Kampala on May 11 and died three days later. A confirmed case in Kinshasa involved a person returning from Ituri, the agency said.
In Ituri, the 246 suspected cases have been reported across at least three health zones, including Rwampara, Mongbwalu and Bunia, the province’s main city, the W.H.O. said. The agency added that unusual clusters of community deaths had been reported across several health zones, and that suspected cases had also been reported in neighboring North-Kivu province.
The risk of the outbreak spreading is exacerbated by a humanitarian crisis, high population mobility and a large network of informal health care facilities in the area, the agency said.
Containing an Ebola outbreak depends on the speed and scale of the public health response. The virus is transmitted through direct contact with the bodily fluids of an infected person, putting family members and caregivers at particular risk. Tracing people who may have come into contact with sufferers, isolating and treating victims promptly and safely, and burying the dead properly are all viewed as critical steps.
The political context in Ituri makes all of those things harder, according to experts. President Félix Tshisekedi of Congo declared a state of siege in the province in 2021 following attacks by insurgent groups, including the Allied Democratic Forces, an organization that has pledged allegiance to the Islamic State, and the Cooperative for the Development of Congo, a militia group.
The state of siege amounts effectively to martial law, which limits fundamental freedoms. In addition, the armed groups have committed massacres in recent months that have not been stopped by the government or by U.N. peacekeepers, according to Clémentine de Montjoye, a senior researcher at Human Rights Watch.
The effect has been reduced public trust in the authorities in terms of health and basic rights, she said.
“Civilians have already been exposed to extreme violence and the failure of the state to protect them and to provide them with access to basic services,” she said. “This has been compounded by U.S.A.I.D. cuts and a reduction of international aid that has affected health care providers and forced certain clinics to close.” Ituri borders Uganda and South Sudan, making frequent cross-border movement another challenge. In one example, Uganda is set to hold an annual Catholic festival on June 3 which typically attracts worshipers from across the border.
Uganda’s health minister, Jane Ocero, said on NTV Uganda, a commercial broadcaster, on Saturday that the country had a well-developed system of community health workers who go door to door, acting as surveillance officers, who then report through an electronic health system to emergency operation centers in every region.
“We have built up a very strong system of identification, detection and response to these outbreaks and the systems start from the grass roots,” she said.
Guinea, Sierra Leone and Liberia were hit by an Ebola epidemic in 2014 and 2015 that killed more than 11,000 people and sickened more than 28,000 across 10 countries, according to estimates by the W.H.O. Responders initially failed to recognize the extent of the outbreak and did not take sufficient steps to prevent its spread.
Since then, there has been a string of outbreaks, mainly in Congo and Uganda. But they have been contained, largely because public health officials have reacted quickly, drawing on knowledge and experience gained during previous outbreaks.
Tedros Adhanom Ghebreyesus, the director general of the W.H.O., said in a briefing on Friday that the organization was notified about suspected Ebola cases on May 5 and had sent a team to Ituri to investigate. Initial samples tested negative for the virus because field equipment could detect only the Zaire species of Ebola, the only species for which a licensed vaccine exists, he said.
Samples were later sent to the National Institute of Biomedical Research in Kinshasa, which confirmed on Thursday that some had tested positive for Ebola, Dr. Tedros said.
The Doctors Without Borders charity said on Sunday that it was preparing to rapidly scale up its medical response in Ituri.
“The number of cases and deaths we are seeing in such a short time frame, combined with the spread across several health zones and now across the border, is extremely concerning,” said Trish Newport, an emergency program manager for the charity.
The spread of the outbreak to the capitals of Congo and Uganda could pose an added challenge for public health workers because infectious diseases can spread more rapidly in dense urban settings.
Musinguzi Blanshe contributed reporting from Kampala, Uganda.
