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The director-general of the WHO has proclaimed the Ebola outbreak in West Africa as a Public Health Emergency of International Concern, triggering an urgent international step-up in the response to the crisis, which it now sees as a serious threat to other countries, too.

The “extraordinary” situation presents a public health risk to other nations, with “serious” potential consequences if it continues to spread, the first meeting on Ebola of the WHO’s Emergency Committee reported today. The director-general accepted its assessment.

It is the largest Ebola outbreak ever, claiming more than 930 deaths among 1,711 reported cases since it began in Guinea in December 2013.

Challenges facing the response to the outbreak include: fragile health systems with inadequate infection control practices in many facilities; inexperience in dealing with Ebola outbreaks; and misperceptions about the disease, the WHO says.

    Key Facts

  • The current Ebola outbreak now affects Guinea, Liberia, Nigeria and Sierra Leone
  • The Ebola virus kills up to 90 per cent of those it infects
  • The last reported outbreak occurred in 2012 in the Democratic Republic of Congo, with 57 cases and 29 deaths
  • Ebola is spread from wild animals and human-to-human contact
  • There is no licensed treatment
    Source: WHO
The committee issued a range of recommendations to step up the response to the outbreak, including for heads of state to set up emergency operation centres and for health ministers to coordinate operations.

States must fully engage local, religious and traditional leaders and healers too, so communities can play a central role in identifying the infection and seeking early treatment, it says.

Healthcare workers should be given sufficient medical supplies, and appropriate education and training, as well as timely payment of salaries and, as appropriate, hazard pay, it says.

The committee says that states should also ensure that treatment centres and reliable diagnostic laboratories are situated close to areas of transmission, and that they are appropriately staffed and equipped.

Travel restrictions, bans on mass gatherings and the quarantine of infected people were also proposed. 

The committee says that unaffected countries bordering those with Ebola cases should: urgently establish surveillance for clusters of unexplained fever or deaths; establish access to a qualified diagnostic laboratory for Ebola virus disease; ensure that health workers are aware of and trained in appropriate infection prevention and control procedures; and establish rapid response teams with the capacity to investigate and manage Ebola cases and the people they have had contact with. 

All states should be prepared to detect, investigate and manage Ebola cases, it adds.

“We need to ask the medical ethicists to give us guidance on what the responsible thing to do is.”

Marie-Paule Kieny, WHO

The WHO committee emphasises the importance of continued support by the WHO and other national and international partners in ensuring the effective implementation and monitoring of these recommendations. 

The director-general requested the committee’s reassessment within three months.

Assessing experimental drugs

Early next week, the WHO plans to convene a panel of medical ethicists to explore the use of experimental treatment in the ongoing outbreak. Although no Ebola drugs have gone through human clinical trials and been approved, several experimental options are under development. But there are questions over whether these should be used in this crisis.

“We are in an unusual situation in this outbreak. We have a disease with a high fatality rate without any proven treatment or vaccine,” said Marie-Paule Kieny, assistant director-general at the WHO, in a press release this week. “We need to ask the medical ethicists to give us guidance on what the responsible thing to do is.”

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