August 8, 2014

expert reaction to WHO decision that current Ebola outbreak is a Public Health Emergency of International Concern (PHEIC)

The World Health Organisation’s (WHO) Emergency Committee declared that the Ebola outbreak in West Africa meets the conditions for a Public Health Emergency of International Concern (PHEIC) and made recommendations for stopping further spread of the disease.

Dr Ben Neuman, Virologist, University of Reading, said:

“The WHO’s declaring a public health emergency of international concern is a big forward step in the fight against this dangerous disease. It is a rare event, something only done in the past for H1N1 ‘swine’ flu in 2008 and the ongoing polio outbreak.

“This will make the vast resources of the United Nations such as funds, experts and equipment, available to help stop Ebola.   This should bring the outbreak under control although it’s likely it won’t be stopped completely until after Christmas.

“The WHO also recommended common sense procedures to stop the spread of infection, such as taking temperatures of outgoing passengers from airports in the affected region.”

Prof Tom Solomon, University of Liverpool’s Head of Institute of Infection and Global Health, and Director of the UK’s NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, said:

“These are sensible and proportionate measures to help try and bring this outbreak under control, without causing unnecessary disruption and panic. Especially welcome is the emphasis on outbreak control locally in the countries through better use of the standard measures which we know work, such as correctly using full personal protective equipment (gowns, masks, gloves, goggles) with proper training. Plus full engagement of the local community through the people they respect and listen to, i.e. religious leaders and traditional healers.

“In terms of international travel, it is reassuring that there is NO general travel ban, which would not have been sensible at this stage. The WHO advice is that in countries with Ebola, passengers leaving for international travel should have a questionnaire and temperature measurement to identify if they may be at risk; and then further more detailed questioning and investigation as necessary.”

Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:

“This seems a sensible measured response that focusses on the real problems of the current outbreak.

“Fighting chains of transmission, through public engagement, education, increased surveillance, diagnosis and contact tracing are the only ways this outbreak is going to be snuffed out.

“Keeping these countries open for travel and business makes sense; the virus doesn’t spread very easily – it’s not like influenza which is easily spread from one person to another; you have to have direct contact with body fluids. The extra measures to prevent export of the virus should greatly reduce the risk of global spread.

“Here in the UK our surveillance systems are well set-up to identify imported infections, as the early detection and management of the recent imported case of a similar exotic virus, called Crimean Haemorhagic Fever virus, testifies. No doubt the ongoing West African outbreak will have the necessary people here on high alert.”

Dr Jeremy Farrar, Director of the Wellcome Trust, said:

“The WHO’s recommendations today will help provide the global leadership which we very much welcome. Ebola continues to pose a very serious health threat for people in West Africa, but it remains very unlikely that the outbreak will turn into a global pandemic. However, even though the epidemic is currently ‘regional’, Ebola is still of global concern and there remains a possibility that imported cases of Ebola will reach countries outside of West Africa and also that the health care system, economies and stability of the countries involved will be affected. Outbreaks such as this affect us all, even if the virus itself does not reach the UK.”

Prof David Heymann, Head and Senior Fellow, Chatham House Centre on Global Health Security, and Professor of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, said:

“The major message of the Emergency Committee is that the three known measures that stop outbreaks – hospital infection control including protection of health workers, community understanding of risks of infection and how to prevent infection including during burial practices, and contact tracing of known cases with fever surveillance and isolation of those with fever until diagnosis is known – appear not to have been robustly enough applied earlier in the outbreak and governments appear to not have been engaged as necessary. Hopefully these recommendations will address these issues, and ensure stronger international coordination.

“The WHO recommendations are comprehensive and evidence-based recommendations based on current information, and clearly demonstrate the importance of the International Health Regulations and its emergency committees that can be called on virtually to make recommendations to the Director General based on available information at the time of international spread of infections such as Ebola.”

Declared interests

Prof Tom Solomon works on emerging and zoonotic infections, and has had grant funding from MRC, NIHR, Gates Foundation and the Wellcome Trust, plus other smaller charities. He sits on various bodies, including the Department of Health Committee on the Safety of Blood Tissues and Organs (SABTO).

Prof David Heymann was assistant director at WHO when the revised IHR (International Health Regulations) came into effect and were initially implemented.