Last week, Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization (WHO), declined to declare the ongoing outbreak of Ebola a global emergency. His decision came on the advice of an expert scientific panel; it was dubious nevertheless. Whatever the world chooses to call it, the disease is now on the edge of catastrophe that requires an urgent response.
The most urgent of all is also among the least direct. It doesn’t involve Ebola at all but rather the inside of our cell phones.
As of April 13, the outbreak in the Democratic Republic of the Congo has sickened 1,251 people, killing 803, or 64 percent, of the infected. (This is well past the threshold of the 2014 Ebola outbreak, which was formally declared a global health emergency by WHO on Aug. 8, 2014.) Despite the fact that nearly 100,000 people have been immunized with a vaccine that is 97.5 percent effective, infections are soaring, spread over a wide geography that is constantly catching international epidemic control experts by surprise. Many of the Ebola dead never sought care, remaining unknown to authorities until their demise and dying in their homes surrounded by virally exposed friends and family, risking further expansion of the epidemic.
This is occurring in an atmosphere of anger, warfare, distrust, and violence that increasingly targets the international health care response. North Kivu, the main area of infection, has been a war zone since 1994, when hundreds of thousands of ethnic Hutus fled there from Rwanda, fearing reprisal attacks from Tutsis after 75 percent of the Tutsi population was slaughtered in a mass genocide. The Rwandan army swept into the region in 1996, spawning a massive war involving multiple African nations that eventually claimed more than 6 million lives. Though that war officially ended in 2003, fighting never stopped in North Kivu and today involves an estimated 120 groups that range from sophisticated, well-armed armies to ragtag bands of self-proclaimed “liberators” that operate as criminal gangs (for which the international health care responders’ foreign funds are a lucrative target).
Although Americans have played a minor role in this epidemic, because the U.S. State Department forbids federal employees from venturing into the dangerous North Kivu area, the global response has been aggressive and smart. Past mistakes in epidemic responses have largely been corrected, WHO has executed bold leadership, there is an effective vaccine, and despite the constant threat of violence, hundreds of health responders from all over the world are on the scene. Yet the epidemic continues to expand, and in late-night conversations with WHO’s Tedros, I have asked why he is reluctant to declare a global emergency. The audibly exhausted director-general quizzed back, “What is to be gained by doing so?”
He has a point. Other than perhaps loosening U.S. Secretary of State Mike Pompeo’s restrictions limiting scientists at the U.S. Centers for Disease Control and Prevention from joining the response, and putting an enormous guilt trip on the World Bank to offer a few million dollars, it’s hard to identify what a heightened state of urgency might offer. Any enhancement in military presence—increasing the numbers of United Nations peacekeepers over the roughly 20,000 now in North Kivu or expanding the size of the Congolese national army presence—would invite counteraction from rebel forces, likely escalating warfare. Moreover, many local citizens are already convinced that the entire Ebola crisis was concocted by corrupt officials in Congo’s faraway capital, Kinshasa, for a variety of nefarious purposes; a military escalation would only appear to validate their conspiracy theories.