World Health Organization officials on Wednesday defended their response to an alarming new Ebola outbreak centered in the Democratic Republic of Congo, after U.S. Secretary of State Marco Rubio said the agency was “a little slow” in determining the extent of the outbreak.
WHO authorities emphasized that their role is to provide technical and operational support to national health authorities, which have the primary responsibility for detecting the spread of the disease under international rules.
“We are not replacing national efforts,” WHO Director-General Tedros Adhanom Ghebreyesus said at a press conference. “We just support them.”
Referring to the International Health Regulations, which set out the obligations of countries in health emergencies, Tedros said Rubio’s comments “may result from a lack of understanding of how the IHR works and the responsibilities of the WHO and other bodies.”
Rubio’s comments Tuesday were just the latest criticism from the Trump administration and its ally the World Health Organization. President Trump also withdrew the United States from the WHO and forced significant budget cuts.
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WHO experts said the scale of the outbreak, with nearly 600 suspected cases and 139 suspected deaths, and signs that many infections are not being counted, shows the virus has been circulating for months, even though African health authorities declared it only on Friday.
Mr. Rubio’s criticism of the WHO clearly struck a nerve with the agency. When reporters asked about the statement, four different WHO officials, including the director-general, took turns speaking. At WHO press conferences, one or two officials often answer each question based on the subject matter and expertise.
“Surveillance starts within the community and starts with national health authorities,” said Anais Legan, a WHO expert on viral hemorrhagic fevers.
The WHO previously said it was alerted to a possible Ebola outbreak on May 5 and immediately sent a team to Ituri province to assist national health authorities. However, initial tests came back negative, possibly because the infection is caused by a rare Ebola strain called Bundibugyo, which has only been recorded twice so far. Testing in the region was designed to test for the more common Ebola Zaire virus.
Instead, the samples had to be sent to a laboratory in the capital Kinshasa, about 1,700 kilometers away, for more advanced diagnostic tests. Bundibugyo virus was identified as the cause on May 14th.
While defending their work, WHO officials pointed to multiple challenges that complicate identifying and responding to the outbreak, and were careful not to directly criticize the DRC.
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Beyond the fact that this is a Bundibugyo outbreak, it is occurring in a remote region in eastern Democratic Republic of the Congo, where many migrants gather, and is home to a long-standing conflict that has only escalated in recent months, further restricting access to health care. WHO experts also said the early symptoms of Ebola are similar to those of many other infectious diseases, from malaria to typhoid fever, that health workers are much more likely to encounter in the region, and they may not immediately recognize Ebola when treating patients.
Mohamed Yaqub Janabi, WHO’s regional director for Africa, said the situation was “inherently difficult”, saying “in remote and insecure areas, cases may take longer to be identified”.
Tedros said the current outbreak is “more complex” than previous Ebola outbreaks that the Democratic Republic of Congo has responded to. “That’s something we need to understand, whether it’s the secretary or anyone else,” he added, referring to Rubio.
Abdirahman Mahmoud, the WHO’s health emergency official, said experts were still investigating the timing and location of the outbreak and working to identify all possible transmission routes, but officials in the Democratic Republic of the Congo said the first known death occurred on April 20. Then, a few days later, there was what appeared to be a superspreader incident at a funeral or medical facility. In early May, health officials saw social media posts about deaths in the community, Mahmud said.
