The Post-COVID Law of Speed: An Analysis of The Declaration of Ebola as a Public Health Emergency of International Concern

Newsletter Edition #163 [Treaty Talks]

Dear Readers,

In this edition, we bring you an analysis that interprets WHO's recent decision to declare the Ebola-Bundibugyo outbreak as a Public Health Emergency of International Concern.

My colleague Anjan Rosario, who has worked on this story, argues that the decision to declare Ebola a PHEIC before convening the Emergency Committee, may be legally defensible and operationally necessary. We do a close reading of the International Health Regulations and try to understand the latitude that the DG of the WHO has, in making such a determination. Rosario is a part of our annual fellowship program this year.

The house view is that man-made rules must serve people, and not the other way round. Laws are crucial, but must be used with common sense and humanity, more so when lives are at stake. We hope you find this analysis enlightening.

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Before you get to this analysis, we also present a quick update from the institutional communications presented last week from the WHO and Africa CDC on the Ebola emergency.

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PART I : EBOLA UPDATE

WHO DG Update: Remarks from Tedros Adhanom Ghebreyesus

Excerpts:

"In DRC, 344 cases have been confirmed, including 60 deaths, in 24 health zones across three different provinces: Ituri, North Kivu and South Kivu
The number of suspected cases has now been reduced to 116 from over 1000 last week, as we work through the backlog, either confirming them or ruling them out.
In Uganda, there is one confirmed death and 15 confirmed cases, including a Congolese resident who travelled to the United Arab Emirates, and then to Uganda.
WHO’s risk assessment remains unchanged: very high at the national level, high at the regional level, and low at the global level.
The outbreak had a big head start, and we’re still behind, but under the leadership of the Government of DRC, we are catching up.
Contact tracing in the DRC is not yet where it needs to be. Only about 45% of contacts have been followed up, and to get ahead of the outbreak we need to get that number up to above 90%.
WHO recommends exit screening at airports, ports and border crossings to prevent the exportation of cases and contacts.
We ask countries that have imposed blanket travel restrictions to lift them."
Convened for the second time the principals of the interim Medical Countermeasures Network to align on three priorities: First, increasing support for decentralized diagnostics; Second, mobilizing immediate support for the affected countries to lead clinical trials, in cooperation with communities; And third, accelerating the investments to support all pillars of the response.

Jean Kaseya (Director General of Africa CDC)

• Stated the total funding requirement for the response plan is $517 million.
• Noted a case fatality rate of approximately 15.9% among confirmed cases.Identified 5,009 people currently listed as contacts for monitoring.
• Highlighted that 11 countries have been identified as being at risk.
• Tracked the outbreak's expansion from one province and three health zones on May 15 to three provinces and 26 health zones in the DRC currently.
• Identified Ituri as the epicenter, accounting for over 90% of all cases and 70% of deaths.
• Explained that the rise in confirmed cases was due to enhanced diagnostic capacity allowing for the testing of 1,000 previously stored samples in Ituri.
• Classified the current event as the most serious Bundibugyo Ebola virus outbreak recorded to date. Stated that this outbreak already ranks as the fourth most serious Ebola outbreak in history.

Also see:

PART II: EXCLUSIVE

The Post-COVID Law of Speed: An Analysis of The Declaration of Ebola as a Public Health Emergency of International Concern

By Anjan Rosario

Rosario is a Philippine-qualified lawyer, Joint LL.M. candidate in Global Health Law and Governance at Georgetown Law and the Geneva Graduate Institute, and Geneva Health Files Fellow focused on WHO governance, pandemic law, global health security, regulatory policy, and international institutional processes. anjan.rosario@graduateinstitute.ch

The decision by the Director General of the WHO Tedros Adhanom Ghebreyesus, to declare a Public Health Emergency of International Concern (PHEIC) before convening an Emergency Committee was unprecedented. But it may also reveal a post-COVID reading of Article 12 of the International Health Regulations (IHR): procedure should safeguard emergency power, not slow the alarm.

When the WHO DG declared the Bundibugyo Ebola outbreak in the Democratic Republic of the Congo and Uganda a Public Health Emergency of International Concern, he did more than activate the world’s highest formal public health alert.

He tested the emergency architecture of the International Health Regulations.