The third meeting of the Emergency Committee convened by the WHO Director-General under the IHR 2005 regarding the 2014 Ebola virus disease (EVD, or “Ebola”) outbreak in West Africa was conducted with members and advisors of the Emergency Committee on Wednesday, 22 October 2014, from 1300 to 1710 CET.
This meeting was convened in advance of the 3-month date of the expiration of the temporary recommendations issued on 8 August 2014 and their extension on 22 September 2014, owing to the increase in numbers of cases in Guinea, Liberia, and Sierra Leone, and the new exportation of cases resulting in limited transmission in Spain and United States of America.

The current situation was reviewed. As of 22 October 2014, the number of total cases stands at 9936 total cases, with 4877 deaths. Cases continue to increase exponentially in Guinea, Liberia, and Sierra Leone; the situation in these countries remains of great concern. The key lessons learned to control the outbreak include the importance of leadership, community engagement, bringing in more partners, paying staff on time, and accountability. WHO, UN partners and the international community have scaled up their support in these three countries.

The outbreaks in Nigeria and Senegal were declared over as of 20 October and 17 October, respectively. The Committee welcomed this development and commended those involved in this achievement.

Cases have recently occurred in Spain and United States of America. The index cases in both of these countries originated in West Africa.

After the overview summary, the following IHR States Parties provided an update on and assessment of the Ebola situation in their countries, including progress towards implementation of the Emergency Committee’s Temporary Recommendations: Guinea, Liberia, Sierra Leone, Spain, and United States of America.

It was the unanimous view of the Committee that the event continues to constitute a Public Health Emergency of International Concern (PHEIC).

In light of States Parties’ presentations and subsequent Committee discussions, several points and challenges were noted for the affected countries and other countries. The primary emphasis must continue to be stopping the transmission of Ebola within the three affected countries with intense transmission. This action is the most important step for preventing international spread. Specific attention, including through appropriate monitoring and follow-up of their health, should be paid to
the needs of health care workers. This will also encourage more health care staff to assist in this outbreak.

The Committee reviewed the recommendations issued on 8 August and the comments published on 22 September, and provided the following additional advice to the Director-General for her consideration in addressing the Ebola outbreak in accordance with IHR (2005). All previous temporary recommendations remain in effect. Even though a few cases have occurred outside the three countries with intense transmission, the measures recommended appear to have been helpful in limiting further international spread. Additional recommendations follow below.

States with intense Ebola transmission (Guinea, Liberia, Sierra Leone) Exit screening in Guinea, Liberia and Sierra Leone remains critical for reducing the exportation of Ebola cases. States should maintain and reinforce high-quality exit screening of all persons at international airports, seaport, and major land crossings, for unexplained febrile illness consistent with potential Ebola infection. The exit screening should consist of, at a minimum, a questionnaire, a temperature measurement and, if fever is discovered, an assessment of the risk that the fever is caused by Ebola Virus Disease (EVD). States should collect data from their exit screening processes, monitor their results, and share these with WHO on a regular basis and in a timely fashion. This will increase public confidence and provide important information to other States.

WHO and partners should provide additional support needed by States to further strengthen exit screening processes in a sustainable way.

All States

The Committee reiterated its recommendation that there should be no general ban on international travel or trade. A general travel ban is likely to cause economic hardship, and could consequently increase the uncontrolled migration of people from affected countries, raising the risk of international spread of Ebola. The Committee emphasized the importance of normalizing air travel and the movement of ships, including the handling of cargo and goods, to and from the affected areas, to reduce the isolation and economic hardship of the affected countries. Any necessary medical treatment should be available ashore for seafarers and passengers. Previous recommendations regarding the travel of EVD cases and contacts should continue to be implemented.

A number of States have recently introduced entry screening measures. WHO encourages countries implementing such measures to share their experiences and lessons learned. Entry screening may have a limited effect in reducing international spread when added to exit screening, and its advantages and disadvantages should be carefully considered.

If entry screening is implemented, States should take into account the following considerations: it offers an opportunity for individual sensitization, but the resource demands may be significant, even if screening is targeted; and management systems must be in place to care for travellers and suspected cases in compliance with International Health Regulations (IHR) requirements.

A number of States without Ebola transmission have decided to or are considering cancelling international meetings and mass gatherings. Although the Committee does not recommend such cancellations, it recognizes that these are complex decisions that must be decided on a case-by-case basis. The Committee encourages States to use a risk-based approach to make these decisions. WHO has issued advice for countries hosting international meetings or mass gatherings, and will continue to provide guidance and support on this issue. The Committee agreed that there should not be a general ban on participation of competitors or delegations from countries with transmission of Ebola wishing to attend international events and mass gatherings but that the decision of participation must be made on a case by case basis by the hosting country. The temporary recommendations relating to travel should apply; additional health monitoring may be requested.

All countries should strengthen education and communication efforts to combat stigma, disproportionate fear, and inappropriate measures and reactions associated with Ebola. Such efforts may also encourage self-reporting and early presentation for diagnosis and care.

The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of these recommendations.

Based on this advice and the information considered by the Committee, the Director-General accepted the Committee’s assessment, and declared that the 2014 Ebola outbreak in Guinea, Liberia and Sierra Leone continued to constitute a Public Health Emergency of International Concern. The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005). The Director-General thanked the Committee members and advisors for their advice and requested their reassessment of this situation within three months or earlier should circumstances require.