What Happens if the WHO Declares Ebola an ‘Emergency of International Concern’?

Some of the ultrastructural morphology displayed by an Ebola virus virion is revealed in this undated handout colorized transmission electron micrograph (TEM) obtained by Reuters August 1, 2014. Cynthia Goldsmith/CDC/Reuters

A committee of the United Nations World Health Organization (WHO) is set to announce Friday its decision on what, if anything, the international community should do about the unprecedented Ebola outbreak that has killed upwards of 900 people in Central and Western Africa and continues to spread.

The first decision on the table at the emergency meeting currently underway is whether or not to place the Ebola outbreak in the officially-designated category of “public health emergencies of international concern” (PHEIC). If the UN Director-General agrees with the committee, that designation could trigger an immediate “internationally coordinated response” to contain and control the outbreak. That could mean anything from mobilizing NATO military assets, to restricting travel in and out of countries where Ebola is present, according to Stephen Morrison, the director of the Global Health Policy Center at the Center for Strategic and International Studies.

“You’re facing the fundamental challenge of how to create order and separate populations, and it is becoming rapidly impossible for these governments to handle it themselves,” Morrison tells Newsweek. Liberia declared a state of emergency over the outbreak on Wednesday, suspending some civil liberties, and Sierra Leone has deployed troops to blockade rural regions hit by the virus.

Restricting travel for certain people based on geography, Morrison says, would be “a big step, and a very powerful and potent step,” which may create a need for on-the-ground international support, potentially in the form of troops and equipment for distributing goods like medical supplies.

Morrison says he thinks international intervention is inevitable, and that the U.S. and other NATO countries are well-equipped to provide on-the-ground support. “The U.S. military knows how to operate in these environments in terms of ground transport, supply chain, and distribution of commodities. If we’re saying these need to be put in place, you have ready-made tools to do that.”

In 2009, the WHO classified the outbreak of H1N1 swine influenza a public health emergency of international concern, putting several countries, including the U.S., on high alert for the disease. The same day, cases of H1N1 were identified in New York City and Kansas, and shortly after, the U.S. began releasing stockpiles of antiviral drugs, and certain drugs were authorized for emergency off-label use by the FDA. As the pandemic spread, the WHO used the PHEIC designation to request that all countries activate their emergency pandemic preparedness plans.

The WHO is convening an additional panel of medical ethicists next week to address the question of whether or not experimental drugs should be used during the current outbreak. The experimental serum ZMapp appears to have significantly improved the conditions of two American health care workers who contracted Ebola in Liberia. But ZMapp is unlikely to be deployed on a wide scale in Africa. The small, obscure firm that produced the serum had only previously tested it on monkeys, and does not currently have a means to scale up production, though it is scrambling to find a way.

“It’s absolutely overwhelming,” Larry Zeitlin, the president of Mapp, said in an interview with the New York Times Wednesday. “We are discussing with the FDA the right path to make the drug available to people as quickly and safely as possible,” he added, referring to the Food and Drug Administration.

The next test subjects for ZMapp are likely to be Ebola patients, rather than healthy volunteers, according to the Times. But who would get to take the drug (or other experimental therapies, all of which would likely be in very limited supply) presents a major ethical dilemma.

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