BRIEFING NOTE TO THE DIRECTDR-GENERAL

 

 

From: Assistant Director-General, 
To: Director-General

cc: DDG

Topic: Ebola outbreak in Guinea

Date of meeting:
{Driginators}: HQ Director PED autl GER Discussed with HWGD Guinea and 
Dir DEE

 

Key message for DG:

Although the response has been quite in some places, the outbreak of Ebola disease in
Guinea is still evolving, with a number of n?ansmission clraius still not controlled. DG intervention with
the President of Grrirrea might be needed in the near to reaffirm to Guinea and
stress the importance of transparent and proactive communication with the media, the commrurity, and
the private sector, about cases that have not been laboratory confirmed.

DG met with M. Alpha Gonde on 1 ay in Geneva. The proposed intervention could be a follow tip of
the initial meeting. The epidemiological stnration tras changed since the May meeting. The situation was
reassessed on 5-6 June in Conakry when HQ management met with AFRO and for a strategic retreat.
RD APRD is in coutactwidr the President to persuade national authorities to modify the current
communication.

Background

The Ebola outbreak probably began in the region of Grrekedorr in early 2?14. It was notified to WED on
March 2 1 after laboratory confirmation, which was performed by Institut Pasteur, Paris.

its of early June 2U 14, after 3 months of response, the is not control. its of 1D June,
cumulative numbers in Guinea are 3TH cases, with 239 deaths.

Challenges for outbreak control
Eight sites in Guinea have reported cases, including dre capital city Conakry. Three sites are no

longer having, cases [Dabola Eissigorrgon, Diguiraye) a new site [Eankarrji has begun to

report cases since E- Jrute 2314.
There are 2 main issues in Guinea:
the resistance of the population to recommended public health measures, such as

isolation of patients and contact tracing. This resistance is err plained by different cultural
perceptions of the disease and the risk of transmission of the virus. Two main situations
where transmission is likely to occur have been identified: dru'ing patient care and at

funerals.
tit Tire political inclination to mi nimiae the impact of the disease by communicating

only about laboratorycouiirrned cases and deaths. This recent change in 
has been motivated by concerns about the negative economic impact of the outbreak
(trrining industry) and have] restrictions that might be imposed for the ajj pilgrimage.
Note that a British mining company has recently evacuated workers from Sierra Leone

and has restricted non-esse ntial travel to the region.
This be considered as a sub-regional public health issue, as 2 

counn'ies are already affected (Sierra Leone and Liberia). Given the population movements,
especially for attending funerals, cases might soon be notified from Mali, Cote d? Ivoire and
Guinea Bissau.

International support has been very good so far. WHO has deployed 110 experts. However, the
international effort will be difficult to maintain at this level for a long period of time.
Issues being addressed that require close monitoring
 Better risk communication at a high level.
o The government is putting pressure on Ministry of Health to end the outbreak quickly
and avoid creating panic, especially in the expatriate community—hence, the decision to
communicate only about laboratory-confirmed cases and deaths.
o There are currently tensions with WHO because media are quoting WHO numbers that
are publicly posted on the website. The Guinean authorities are perceiving the
discrepancy between MoH numbers and WHO numbers as a threat to their credibility.
o The WHO delegation (HQ/RO/CO) discussed this issue with the MoH last week and
clarified that the WHO approach for surveillance is standardised for all Ebola outbreaks
regardless of the country of origin.
o RD AFRO has sent a letter to the President of Guinea to raise the issue of transparent
risk communication.
 Need to contain the Ebola outbreak in the subregion and IHR
o WHO has intervened in the past to prevent neighbouring countries from closing borders,
which is known to be ineffective at preventing the spread of the disease. This
intervention is acknowledged by Guinean Ministry of Health.
o Thus far, this event has not triggered the convening of an Emergency Committee nor the
declaration of a PHEIC. The use of IHR in this way could be seen as an hostile act in the
current context and may hamper collaboration between WHO and affected countries.
o WHO should anticipate further spread of the disease and enhance readiness in the
sub-region.

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