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Final Statement on the 8th meeting of the International Health Regulations (2005).

Emergency Committee for Ebola Virus Disease in Democratic Republic of Congo (Ituri, North Kivu, and South Kivu) on 26 June 2020

The 8Th Emergency Committee Meeting convened by the Director General of WHO under the International Health Regulations (IHR) (2005) to review the outbreak of Ebola Virus Disease (EVD) in Ituri, North Kivu, and South Kivu Ebola, Democratic Democratic Republic of Congo. (DRC), on Friday 26 June 2020 from 13:00 to 15:50 at Geneva Time (CEST). The role of the committee is to advise the Director-General, who takes the final decision on the determination of the International Determination of Public Health Emergencies (PHEIC) and considers the temporary recommendations appropriate.

Meeting proceedings

Emergency committee members and advisors were called by teleconference.

The Secretariat welcomed the committee and thanked them for their support. The Director General welcomed the committee and expressed gratitude to all those who have responded to the outbreak.

Representatives of WHO's Legal Department and Compliance, Risk Management and Ethics Department briefed the committee members about their roles and responsibilities. Committee members were reminded of their duty of confidentiality and their responsibility to disclose personal, financial, or professional connections, which may lead to conflict of interest. Each member who was present was surveyed and no conflict of interest was considered relevant to the meeting.

The meeting was chaired by Dr. Preben handed over to Avitsland. Dr. Avitsland also welcomed the committee, outlined the objectives of the meeting and introduced the presenters.

Presentations were made by a representative of the DRC and WHO Secretariat Ministry of Health to update the committee on the situation.

The DRC Ministry of Health provided an update on the status of epidemiology. As of 23 June 2020, a total of 3 470 EVD cases were reported from 29 health sectors, including 3 317 confirmed and 153 probable cases, of which 2 287 cases died (CFR 66%). Since the last reported case on 27 April 2020, there have been no new confirmed or potential cases of EVD. On 25 June 2020, the DRC Ministry of Health announced that human-to-human transmission of the Ebola virus had ended in Ituri, North Kivu and South Kivu provinces. The DRC's Ministry of Health notes that a separate EVD outbreak is occurring in Equatorial Province, not related to the epidemic that spreads in Iduri, North Kivu and South Kivu provinces.

The DRC Ministry of Health to strengthen its national response plan to strengthen operational capabilities of surveillance, laboratory diagnostic capability, infection prevention and control (IPC), risk communication and community mobilization (RCCE), EVD survivor care programs and the provincial health department Is implementing

The WHO Secretariat presented the WHO risk assessment and reference. Based on the outbreak, current epidemiology, and response development in Ituri, North Kivu, and South Kivu provinces, overall national and regional risk levels remain moderate. Global risk levels remain low.

The WHO noted that the regional readiness capability built for the EVD response, such as coordination mechanisms; Response plans; Laboratory diagnostic capability; Rapid response teams; And community-based surveillance systems, are also being used to facilitate a strong COVID-19 response.

Remaining challenges include the need for continued human and financial resources to sustain EVD survivor care programs such as prevention, preparedness, response and control activities; Unstable security situation; New EVD outbreak in Ecuador province; And concurrent burden of COVID-19, cholera and measles.

Although its outbreak in Ituri, North Kivu and South Kivu provinces has been officially declared to have ended, the detection of a new EVD outbreak in Equator Province highlights the possibility of reintroduction from animal reservoirs. DRC and at-risk countries need to maintain vigilance to reduce the risk of EVD re-emergence as well as to rapidly detect and respond to any new clusters.

Context and discussion

The committee congratulated the Ministry of Health on the conclusion of the outbreak of EVD in ETD, North Kivu, and South Kivu provinces. The committee conveyed its strong appreciation to the World Health Organization for their support in ending this challenging outbreak. The committee also thanked health workers, donors, and all partners, who have supported the successful response and recognized international cooperation and strong solidarity between the DRC, neighboring countries, WHO and partners.

The committee noted that genetic sequencing confirmed that EVD outbreaks in Ituri, North Kivu, and South Kivu provinces and in the province of Ecuador are epidemiologically specific events.

The committee highlighted the importance of the 90-day National Response Plan which includes intensive monitoring, response capability and follow-up action with EVD survivors. The DRC and partners engage in all measures to reduce resurgence capacity in Ituri, North Kivu and South Kivu Provinces. The committee noted the importance of the EVD survivor care program and continued RCEC activities, which would be continued by locally trained staff in each province, in collaboration with national staff as needed.

The committee expressed concern over the lack of priority resources to conduct a 90-day national response plan and to maintain long-term local capacity for prevention and response. The financial and human resources of the DRC, WHO and partners are challenged by concurrent COVID-19, cholera and measles outbreaks. The committee encouraged DRC, WHO and partners to harmonize EVD, cholera, measles and COVID-19 prevention and control activities.

Conclusions and advice

The committee agreed that the current situation in Ituri, North Kivu and South Kivu provinces is no longer a public health emergency of international concern.

The committee emphasized the importance of continued donor funding and human resources to conduct the 90-day National Response Plan.

The Committee provided the following advice to the Director-General for their issuance, as per the amended provisional recommendations, Article 15 (1) of the IHR (2005)…Temporary recommendations may be revised or extended as appropriate, stipulating that a public health emergency of international concern has ended, preventing other temporary recommendations at the time or immediately addressing its recurrence Required can be issued for the purpose of planting. (…) TTheir provisional recommendations will expire three months after their release.. "

The Committee provided the following advice to the Director-General for issuing the revised recommendations under the IHR (2005) to the Director General.

For DRC:

  • Conduct their 90-day National Response Plan and ensure that appropriate human and financial resources are available for implementation throughout the period.
  • Continue your EVD survivor care program that 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 potential EVD flare-ups and spillover events. Leverage resources as needed by integrating EVD RCCE activities with concurrent response efforts related to measles, cholera, and COVID-19 outbreaks.
  • Keep in mind the experts of the upcoming Strategic Advisory Group on vaccination (SAGE) recommendations on the use of EVD vaccines.
  • Develop an EVD prevention and control plan to maintain preparedness and response capacity beyond the initial 90-day national response plan.

Neighboring Countries:

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

For whom:

  • Continue to encourage research on the potential of animal reservoirs and spillover incidents.
  • Continue engagement with countries and partners, including industry, to establish and maintain strategic global reserves for EVD vaccines.
  • Collect and publish lessons learned with the DRC and partners on this EVD outbreak, including the effectiveness of vaccination and other interventions and challenges related to emergency response in the context of civil unrest and insecurity.

Based on this advice, on the basis of the report of the affected state party and the information currently available, the Director General accepted the committee's assessment and concluded the Public Health Emergency of Public Health Emergency (PHEIC) for the event on 26 June 2020 declare.

The Director-General accepted the committee's advice and issued them as provisional recommendations under the IHR (2005), effective 26 June 2020. The Director General thanked the members and advisors of the committee for their advice during the outbreak.

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