WHO to convene emergency committee to decide if outbreak now constitutes an international health emergency.

Vaccinations against Ebola have started in the Democratic Republic of the Congo’s (DRC) Goma after the first case of the virus was identified in the eastern city, sparking alert among health officials and raising the spectre of a rapid increase in transmission rates.

Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization (WHO), said in a statement on Monday that the case threatened to be a “game-changer” in the ongoing epidemic, which has killed more than 1,600 people so far and had not previously reached a major urban hub.

Tedros pointed to Goma’s sizeable population of some two million people and its proximity to neighbouring Rwanda as being of particular concern.

“It is a gateway to the region and the world,” he told a meeting of the United Nations officials and donors gathered in the Swiss city of Geneva.

“Although this is a very concerning development, it’s one that we and the government have expected and prepared for,” he added.

Goma had been preparing for the arrival of Ebola for months by setting up hand-washing stations, making sure moto-taxi drivers do not share helmets, vaccinating 3,000 health care workers and running an operational treatment centre since February.

Tedros’ comments came as WHO said health workers had started vaccinating people who had come in contact with the individual in Goma, the capital of North Kivu province, after the DRC’s Health Ministry confirmed on Sunday he had contracted Ebola.

The victim had arrived in the city earlier on Sunday by bus alongside several other people from Butembo, a town 300km to the north and at the centre of the DRC’s nearly yearlong Ebola outbreak. He was taken back to a treatment facility in Butembo on Monday.

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“Due to the speed with which the patient has been identified and isolated, as well as the identification of all bus passengers from Butembo, the risk of spreading to the rest of the city of Goma remains low,” the Health Ministry said in a statement.

WHO emergencies chief Mike Ryan said health workers had identified 60 contacts, including 18 who were on the bus with the individual, and half of them have been vaccinated.

“Goma is a warning,” Ryan told reporters in Geneva.

“It is a warning because every time the disease moves, it can re-establish itself somewhere else,” he later told AFP news agency.

Two fatal cases were reported in Uganda last month, marking the first confirmed cross-border cases of the virus in the current epidemic and prompting the WHO’s emergency committee to weigh for a third time whether to declare the outbreak an international health emergency.

Plea for increased aid

Tedros said on Monday that WHO’s emergency committee would be convened once again to consider raising the global alarm over the outbreak after officials at all three previous such meetings – including the one last month – decided against doing so despite registering “deep concern”.

International health emergency declarations almost always boost global attention and lead to an increase in aid.

Mark Lowcock, the UN humanitarian chief, said without increased resources it would not be possible to bring the epidemic “under control”.

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“The need is for money, not next week, or next month or later in the year. The need is for money now,” Lowcock told the Reuters news agency on Monday.

His comments came as the United States‘ top diplomat in Geneva said Washington would “provide more [aid] in the coming months” and the European Union‘s ambassador said the bloc would examine possibilities to scale up its response.

Rory Stewart, the United Kingdom‘s international development secretary, meanwhile, pledged an additional $63m of aid from Britain, while chastising existing donors who appeared reluctant to offer additional support.

“What I’ve noticed going around the world trying to get people in this room to contribute is there are a lot of very intellectual, sophisticated reasons that international donors give on why they don’t want to give any more money,” Stewart said.

“Yes, it’s complex, yes it’s very difficult … but we are in a very, very fragile situation,” he added. “We are going to need considerably more investment if we are to get down to zero [cases] in eastern DRC.”

‘Keep calm’

Amid the calls for more international support, local officials appealed for calm.

“I call on the population of the city of Goma and its outskirts to keep calm … [and] cooperate with response teams by observing hygiene and prevention measures and notifying any suspected case of Ebola,” North Kivu Governor Carly Nzanzu Kasivita said.

Prior to the confirmed case in Goma and the earlier cases in Uganda, the Ebola outbreak was previously confined to more rural regions of North Kivu and neighbouring Ituri province after emerging last August.

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Combined, the two provinces border Rwanda, Uganda and South Sudan.

A toxic mix of active armed groups and deep-rooted mistrust of health officials among local communities have hampered efforts to halt the virus there with nearly 2,500 cases registered so far, according to DRC’s Health Ministry.

Unidentified attackers killed two Ebola health workers near Mukulia in North Kivu over the weekend, the latest in a string of assaults this year that have killed or injured dozens of responders.

Amid the unrest, health workers have vaccinated some 160,000 people. The vaccine is experimental but is estimated to be 97.5 percent effective and, according to WHO, may protect a person for up to 12 months.

The world’s worst epidemic of Ebola, a haemorrhagic fever that can spread through bodily fluids, killed about 11,300 people in West Africa as it surged through Guinea, Sierra Leone and Liberia from 2013 to 2016.