On March 29, WHO Director-General Margaret Chan announced that the outbreak of Ebola virus disease in countries of west Africa was no longer a Public Health Emergency of International Concern (PHEIC). This decision was taken because, in the opinion of the International Health Regulations Emergency Committee on Ebola, the outbreak is no longer an extraordinary event, there is little risk of international spread, and affected countries have the capacity to rapidly respond to new cases. The Emergency Committee acknowledged that new clusters will continue to occur, but that they are happening at a decreasing frequency.

Paradoxically, although the outbreak is no longer characterised by WHO as an international concern it was still highlighted that there is an urgent need for continued and full international and technical support to prevent, detect, and respond to new outbreaks in the region. Also emphasised was the need for affected countries to maintain their capacity to respond to ongoing or new clusters. A potential danger is that the termination of the PHEIC will be perceived by some parties as a signal that their work is done, particularly given the announcement suggested that the existing capacity to respond is strong.

Central to any declaration of a PHEIC is that the outbreak represents a potential risk to other nations. So the termination of the emergency does not mean that the outbreak is over, just that there is confidence it can be confined within its original borders—it says nothing about the status of currently affected patients. The termination announcement did make a passing reference to the ongoing needs of Ebola survivors, but this did not give a true sense of the scale of the problem of sequelae of Ebola virus disease. Pauline Vetter and colleagues discuss this issue at length in a recent Review in The Lancet Infectious Diseases, describing it as an emergency within the emergency and they point out that the capacity to help these patients is not readily available. They cite the example of Sierra Leone, which has only two practising ophthalmologists and one practising psychiatrist, specialists who are crucially needed to deal with the sequelae; the situation is similar in both Guinea and Liberia. The Review concludes with a warning about international donors turning their attention and funding elsewhere. Does this recent announcement send the wrong message?

It is no exaggeration to say the international community was unprepared for the scale of the outbreak of Ebola virus disease in west Africa. Similarly there was little expectation that the aftermath of the outbreak would present a potentially greater challenge. The scale of this challenge is not directly attributable to the outbreak itself, but instead is due to the inability to provide the resources to help patients who are no longer seen as being in immediate danger and no longer seen, by health authorities, as representing a particular danger to others.

A further warning against complacency came from Ebola Vaccine Team B —an expert panel convened by the Wellcome Trust and the Center for Infectious Disease Research and Policy at the University of Minnesota to discuss vaccine developments and map out strategy. The panel said it would be a tragedy if there was an easing of efforts to fully realise the development of Ebola vaccines and prepare for the next outbreak. Despite the stockpiling of one vaccine by Gavi, no vaccine has yet been approved by any regulatory body. However, vaccination of contacts is being used to tackle the latest cluster in Guinea.

One issue which has not been at the forefront of the discussions is that the Ebola virus was not the sole driver of the outbreak. The root of the outbreak was inadequate investment in health systems . It is no coincidence that the three countries most significantly affected by the Ebola outbreak (Liberia, Guinea, and Sierra Leone) are among the poorest in the world. Highlighted by the low number of ophthalmologists and psychiatrists in Sierra Leone, it is clear that the strengthening of health systems in these countries is no trivial task and current efforts have not come close to truly addressing the needs.

As the end of the outbreak approached a year ago it was clear that complacency and a premature declaration of victory was a danger. Worryingly the declaration that the PHEIC is over might be misinterpreted by donors, leading them to focus their energies elsewhere. So, although there are technical grounds to terminate the PHEIC—a diminished international threat—it must be made abundantly clear that there is still a long way to go before the real emergency is over.

Copyright © 2016 Salvatore Di Nolfi/AP/Press Association Images

Article Info Publication History Identification DOI: https://doi.org/10.1016/S1473-3099(16)30013-5 Copyright © 2016 Elsevier Ltd. All rights reserved. ScienceDirect Access this article on ScienceDirect