As Ebola Cases Rise in Congo, the W.H.O. Declines to Issue Emergency Declaration

Despite a worsening Ebola epidemic in the Democratic Republic of Congo, the World Health Organization on Friday again decided not to declare the outbreak a global health emergency.

While expressing “deep concern” about the number of increasing cases in parts of Congo, and the potential risk of the disease spreading to neighboring countries, the W.H.O. said the epidemic did not meet the criteria for declaring an international public health emergency.

This is the second time since the outbreak began last year that the W.H.O. has declined to issue such a declaration. The first was in October. Some researchers have urged the organization to do so for months; such pronouncements are reserved for epidemics that pose a serious threat to public health and could spread internationally. A global health emergency, they argue, would bring more money and international help to stamp out the disease.

The epidemic does not meet the global emergency criteria because it has remained limited to two northeastern provinces and has not reached other countries, the W.H.O. said, even though the affected areas share borders with Rwanda, South Sudan and Uganda.

Now in its eighth month, the outbreak has sickened 1,206 people and killed 764 as of Wednesday, the W.H.O. reports. The affected provinces, North Kivu and Ituri, are a conflict zone, rife with armed militias. There have been multiple attacks on treatment centers by unknown assailants.

Case counts have jumped recently, with 20 new cases on Wednesday, the highest number in any one day since the outbreak began in August, according to the International Rescue Committee.

“The situation is bad and it’s getting worse,” said Tariq Roland Riebl, the emergency response director for the I.R.C.

Responding to the W.H.O. decision, Doctors Without Borders, which has been working in the region, issued a statement saying, “More than eight months into the outbreak, the situation is alarming. The number of new reported cases has significantly increased over the past few weeks, reaching its highest levels since the declaration of the epidemic. Last week, 40 percent of the newly reported cases are people who died in the community before they could be identified as Ebola patients and offered care.”

During a news briefing about the decision, Dr. Michael J. Ryan, deputy director of W.H.O.’s health emergency program, said that the recent increase in cases actually reflected a positive development: By earning the trust of some communities, medical teams have gained access to areas they had been unable to enter before, and are finding more patients.

Fear and distrust of the government run deep in the region, and extend to the Ministry of Health and organizations thought to be associated with it, including aid groups and the W.H.O. Suspicion has led some people to avoid testing and treatment altogether, or to postpone it until they are too sick to be saved.

A particular concern is that many deaths have occurred in the community, rather than in treatment centers. Keeping the sick at home helps spread the virus, because the disease becomes more contagious as it progresses. It is spread by bodily fluids, so caregivers who lack protective gear are almost certain to become infected, as are those who prepare corpses for burial.

Some of the anger and distrust stem from the way aid groups have operated, said Dr. Natalie Roberts, the emergency operations director for Doctors Without Borders. She said people in the communities did not understand why those with potential Ebola symptoms like fever, even children, would be isolated for up to 48 hours while waiting for test results, and why those who tested negative might be released without a diagnosis or treatment for their fever, which might well be malaria.

Dr. Roberts said the group was changing the way it deals with patients, letting them wait at home for test results, and making sure to address their other health concerns and provide needed information. Her organization is also trying to give patients choices, and allow them to be treated in local health centers rather than Ebola treatment centers if that is their preference.

Other groups are also changing their approaches to bring them more into line with what communities need, Dr. Ryan said, though he added, “We evolve the response, we don’t change it.”

An emergency declaration could be unfairly interpreted as criticism and a move to take control away from Congo’s Ministry of Health, which has been taking the lead in the Ebola response, Dr. Roberts said. “It would be a bit of a blow to the ministry.”

Dr. Robert Steffen, from the University of Zurich, chairman of W.H.O.’s emergency committee, said, “We are moderately optimistic that this outbreak can be brought into control, not immediately, but still in a foreseeable time.”

Earlier declarations for a “public health emergency of international concern,” the official title, were issued for swine flu in 2009, polio in 2014, Ebola in West Africa in 2014 and Zika virus in 2016.

Experts from Johns Hopkins University called for a declaration back in November, in an article in The New England Journal of Medicine, saying that the move “would increase both political attention and the financial resources flowing to the control effort.”

In an interview before Friday’s decision, an author of the journal article, Jennifer B. Nuzzo of the Johns Hopkins Center for Health Security, said: “I think it’s absolutely essential that they do declare it now. They need to make clear for countries the urgency of the situation and to increase pressure on W.H.O. member states to do more to bring this outbreak under control.”

Later, Dr. Nuzzo called the W.H.O.’s decision “unfathomable.” She said using the lack of international spread as a rationale for not declaring an emergency made little sense, because the goal should be to prevent spread.

“All the data shows that efforts to contain it have not worked,” she said. “You can’t conclude that international spread is not a possibility. Why would we wait for international spread?”

Dr. Nuzzo said there is sometimes hesitation about declaring emergencies, out of concern that the declarations will prompt other nations to impose needless bans on travel or trade that would further stigmatize countries with outbreaks and batter their economies. But she said that there were ways to discourage such bans, and that an emergency declaration should be made strictly on the basis of health concerns, not politics.

The outbreak is the second largest ever. The deadliest Ebola epidemic occurred from 2014 to 2016, in Guinea, Liberia and Sierra Leone; it sickened 28,610 people and killed 11,308. The W.H.O. faced sharp criticism for its slow response in the early phases of that outbreak..