Closing Statement at the 8th Meeting of International Health Regulations (2005)

Ebola Emergency Committee of the Democratic Republic of the Congo (Ituri, North Kivu and South Kivu) on 26 June 2020

8^th a meeting of the Emergency Committee convened by the Director-General of the WHO in accordance with International Health Regulations (IHR) (2005) to review the Ebola virus (EVD) epidemic in Ituri, North Kivu and South Kivu, Democratic Republic of the Congo (DRC), was held on Friday, June 26, 2020, from 1:00 pm to 3:50 pm Geneva Time (CEST). The role of the Board is to advise the Director-General, who makes the final decision on the establishment of an urgent international public health concern (PHEIC) and, if necessary, makes interim recommendations.

Proceedings of the meeting

The members of the Committee for Emergency Situations were convened by teleconference.

The Secretariat welcomed the Committee and thanked them for their support. The Director General welcomed the Board and expressed his gratitude to all those who responded to this epidemic.

Representatives of the WHO Legal Department and the Compliance, Risk Management and Ethics Department briefed Board members on their roles and responsibilities. Board members were reminded of their duty of confidentiality and their responsibility to disclose personal, financial or professional relationships that may be considered to constitute a conflict of interest. Each member present was examined and no conflict of interest was assessed as relevant to the meeting.

The meeting was handed over to the chairman, Dr. Preben Aavitsland. Dr. Aavitsland also welcomed the Committee, presented the objectives of the meeting and introduced those present.

A representative of the LDK Ministry of Health and the WHO Secretariat held presentations to update the Committee on the situation.

The DRC Ministry of Health submitted an update of the epidemiological situation. As of June 23, 2020, a total of 3,470 cases of EVD were reported from 29 health zones, including 3,317 confirmed and 153 probable cases, of which 2,287 deaths (CFR 66%). No new confirmed or probable cases of EVD have been reported since the last reported case on 27 April 2020. On June 25, 2020, the Ministry of Health of the Democratic Army and Democracy declared that human-to-human transmission of the Ebola virus had ended in the provinces of Ituri, North Kivu, and South Kivu. The DRC Ministry of Health notes that a separate EVD epidemic is occurring in Eftyur province, which is not epidemiologically linked to the outbreak in Ituri, North Kivu and South Kivu provinces.

The Ministry of Health for Democratic Protection and Development is implementing its national response plan to strengthen surveillance, laboratory diagnostic capacity, infection prevention and control (IPC), risk communication and community engagement (RCCE), EVR survivors protection program, and operational capacity of provincial health departments.

The WHO Secretariat presented the assessment and context of the WHO. Based on the evolution of the epidemic, the current epidemiology, and the reactions in Ituri, North Kivu, and South Kivu provinces, the overall national and regional level of risk remains moderate. The global level of risk remains low.

The WHO noted that regional preparedness capacities are built for EVD response, such as coordination mechanisms; response plans; laboratory diagnostic ability; rapid response teams; and community-based surveillance systems, are also used to enable a strong COVID-19 response.

Remaining challenges include the need for ongoing human and financial resources to maintain prevention, preparedness, response, and control activities, such as the EVD Survival Care Program; unstable security situation; a new outbreak of EVD in the province of Equestur; and simultaneous load of COVID-19, cholera and measles.

Although outbreaks have been officially declared in Ituri, North Kivu and South Kivu provinces, the discovery of a new EVD epidemic in Equavenur Province highlights the potential for reintroduction from animal reservoirs. DRCs and countries at risk must maintain vigilance to reduce the risk of EVD recurrence as well as rapid detection and response to each new cluster.

Context and discussion

The committee congratulated the Ministry of Health on the end of the EVD epidemic in the provinces of Ituri, North Kivu and South Kivu. The Committee expressed great gratitude to the World Health Organization for their support in ending this challenging epidemic. The Committee also thanked the health workers, donors and all partners who supported the successful response and recognized the international cooperation and strong solidarity between the Democratic Republic of the Congo, neighboring countries, the WHO and partners.

The Committee noted that the genetic sequence confirmed that the outbreaks of EVD in the provinces of Ituri, North Kivu and South Kivu and the province of Ekavatur were epidemiologically different events.

The committee stressed the importance of a 90-day national response plan that includes maintaining intensive surveillance, responsiveness and monitoring of EVD survivors. The DRC and partners are taking all measures to reduce the potential for resuscitation in Ituri, North Kivu and South Kivu provinces. The Committee noted the importance of the EVD Survival Care Program and continued the activities of the RCCE which will continue to be carried out by locally trained staff in each province with the assistance of national staff as needed.

The Committee expressed concern about the lack of priority resources for operationalizing the 90-day national response plan and maintaining long-term local prevention and response capacities. The financial and human resources of the DRC, WHO and partners, are causing parallel epidemics of COVID-19, cholera and measles. The Committee encouraged the DRC, WHO and partners to coordinate the activities of prevention and control of EVD, cholera, measles and COVID-19.

Conclusions and tips

The Committee agreed that the current situation in Ituri, North Kivu and South Kivu is no longer a public health condition of international importance.

The Committee stressed the importance of continuous donor funding and human resources for the operationalization of the 90-day national response plan.

The Committee advised the Director-General to issue it as a revised interim recommendation, in accordance with Article 15 (1) of the IHR (2005).Interim recommendations may be amended or extended as necessary, including after a state of emergency of international importance to public health has been established, at which time other interim recommendations may be issued to prevent or promptly detect its recurrence. […] TInterim recommendations automatically expire three months after their issuance“.

The Board gave the following advice to the Director-General for its issuance as revised interim recommendations in accordance with the IHR (2005).

For DRC:

• Operationalize their 90-day national response plan and ensure that adequate human and financial resources are available for implementation throughout its duration.
• Continue with the EVD Survival Care Program, which provides clinical, biological, and social support to survivors.
• Continue to use community action cells or comparable community-level resources for locally based RCCEs to address possible EVD explosions and spills. Use resources, integrating EVD RCCE activities as needed with concurrent response activities related to measles, cholera, and COVID-19 epidemics.
• Consider the forthcoming recommendations of the Strategic Advisory Group of Immunization Experts (SAGE) on the use of EVD vaccines.
• Develop an EVD prevention and control plan to maintain preparedness and response capabilities beyond the initial 90-day response plan.

Neighbouring Countries:

• Continue to strengthen your oversight of EVD to prevent the risk of potential spread.

For whom:

• Continue to encourage research on animal reservoirs and overflow potentials.

• Continue working with countries and partners, including industry, to establish and maintain a strategic global supply of EVD vaccines.
• Collect and publish lessons learned with the DRC and partners on this EVD epidemic, including the effectiveness of vaccination and other interventions and the challenges associated with responding to emergencies in the context of civil unrest and insecurity.

On the basis of this advice, the reports provided by the State Party concerned and the information currently available, the Director General accepted the Commission’s assessment and on 26 June 2020 declared an end to the International Public Health Concern (PHEIC) for this event.

The Director – General accepted the Board ‘s advice and issued it as interim recommendations in accordance with the IHR (2005), in force 26. June 2020. The Director General thanked board members and advisors for advice during the epidemic.