On March 29th, an emergency committee of public health experts, officials and scientists convened by the World Health Organization declared that the Ebola situation in West Africa no longer constitutes a “Public Health Emergency of International Concern.” After 25 months, and 11,323 deaths, the World Health Organization has decided to stand down from its emergency footing.
This is a good sign, but it does not mean that Ebola is no longer a threat to global health. In fact, the same press release that includes that declaration mentions that Ebola outbreak clusters have continued to occur and cites a current outbreak going on in Guinea. What the statement does mean is that the committee is recommending that trade and transportation in West Africa go back to normal.
The Committee provided its view that Ebola transmission in West Africa no longer constitutes an extraordinary event, that the risk of international spread is now low, and that countries currently have the capacity to respond rapidly to new virus emergences. Accordingly, in the Committee’s view the Ebola situation in West Africa no longer constitutes a Public Health Emergency of International Concern and the Temporary Recommendations adopted in response should now be terminated. The Committee emphasized that there should be no restrictions on travel and trade with Guinea, Liberia and Sierra Leone, and that any such measures should be lifted immediately. [Emphasis added]
Since August 2014, Guinea, Liberia, and Sierra Leone have been following temporary emergency restrictions on travel and trade. The most visible restriction is the exit screening of all persons at international airports, seaports and major land crossings. The screening must consist of a minimum of a questionnaire, a temperature measurement and, if there is a fever, an assessment of the risk that the fever is caused by EVD. Anyone who seems to be exhibiting the symptoms of Ebola will not be allowed to travel unless the travel is part of an appropriate medical evacuation. They also call for “extraordinary measures such as quarantine,” if needed and recommended that countries most affected by Ebola declare a state of public health emergency.
The WHO Emergency Committee is now formally stating that the public health emergency has passed. Although Ebola cases continue in West Africa – one case was confirmed earlier today, April 1st, in Liberia – WHO feels that they are being correctly addressed. The WHO feels that national surveillance systems are accurately identifying cases of Ebola and then successfully contacting the people that may have been infected. Once identified, people infected with Ebola are receiving treatment for the disease in facilities that can prevent their infection from spreading. Surveillance systems are also able to work with laboratories to identify particular strains of Ebola virus so they can trace the exact path of an outbreak.
Ebola remains a global threat. It has proven itself to be highly contagious and it overwhelmed the weak health systems of West Africa with unprecedented speed. Guinea, Liberia, and Sierra Leone are now able to keep Ebola from spreading when outbreaks occur rarely. However, concern remains widespread about their ability to handle larger outbreaks effectively. Global health experts such as WHO itself and Medicins sans Frontieres feel that Ebola has damaged the already weak health systems of West Africa, if only because of the sheer number of health care professionals who died of the disease.
The pressures that caused the first outbreak of Ebola remain in place. Ebola is a zoonotic disease; it spread from animals to humans. As humans continue to encroach on animal habitats in Africa, their contact with Ebola-carrying fruit bats, apes, or monkeys will only increase. At the same time, human survivors of Ebola continue to carry the virus in their blood and bodily fluids, and we don’t know yet how long they will continue to do so. At least one of the recent Ebola outbreaks in West Africa is thought to have been transmitted sexually by an Ebola survivor.
The WHO has reassured us that, for now, West Africa can keep small Ebola outbreaks from becoming emergencies. We have no real evidence that West Africa – or anywhere else – can face a large one.