Jun 22, 2019 Volume 393Number 10190p2469-2562, e44
The politics of PHEIC
An emergency committee decided on June 14 that the current Ebola virus disease outbreak in the Democratic Republic of the Congo did not warrant a Public Health Emergency of International Concern (PHEIC). It was the third time the committee has decided against a PHEIC declaration since this Ebola outbreak began in August, 2018, which has now affected over 2100 people. WHO Director-General Tedros Adhanom Ghebreyesus agreed with the committee’s advice but asserted the outbreak remains an emergency.
The decision has been met mostly with surprise, in light of two Ebola-related deaths in neighbouring Uganda. Global health leaders reacted with disappointment, saying that a PHEIC would have raised the levels of international support, enhanced diplomatic efforts and security, and released more financial resources to support the response teams in the region. The emergency committee acknowledged the cross-border spread and commended Uganda for its response. They decided the economic harms associated with a PHEIC declaration would outweigh the benefits.
We disagree. The decision appears more political than technical and that is a mistake. The committee seems to have favoured local protectiveness over global galvanising. Yes, Uganda deserves visible credit for its preparedness, collaboration, and transparency. Yes, nearby countries should feel bolstered by the confidence of WHO and its Director-General. And yes, recalcitrant donors should be reassured of the ability of African countries to prepare for and contain infectious disease outbreaks, and thus be deserving of investment. But calling a PHEIC would not distract from any of these local interests, and the decision might backfire in terms of not inciting a sense of urgency from the international community.
PHEIC could be a force for good, mobilising global resources and communities to build solidarity, preparedness, trust, and resolution of conflict. The concerns about trade and tourism restrictions with PHEIC are valid but not inevitable. Global financial and political support is badly needed, and a PHEIC declaration would have produced that.