The World Health Organization issued a extraordinary declaration on Saturday expressing concern over possible unreported Ebola cases in Tanzania and asking the country to provide patient samples for testing in an external laboratory.
The statement refers to a Tanzanian doctor who died on 8 September after returning from Uganda. She was reported to have Ebola-like symptoms. Several of the woman's contacts became ill, although the Tanzanian authorities insisted that they tested Ebola negative.
However, the country has not released the tests so they can be validated by an external laboratory, as proposed by the International Health Regulations, an agreement to protect the world from the spread of infectious diseases.
It is highly unusual for WHO, which is normally diplomatic, to inform the public that a Member State is obstructing an important disease investigation.
"The assumption is that if all the tests were really negative, there is no reason for Tanzania not to submit these samples for secondary testing and verification," Dr. Ashish Jha, director of the Harvard Global Health Institute STAT.
"It's only an advantage for them to do this to solve one of these problems. And the fact that they do not do that gives cause for concern and … whatever they do next, people will have less faith in them, "Jha said.
In addition, the Tanzanian authorities waited four days to respond to the first urgent request for information from the WHO ̵
The delay of the country's first reaction exacerbates the discomfort over this case. "There is really no reason to take four days to respond to an urgent WHO request," Jha said.
The concern is compounded by the fact that throughout East Africa the danger of a possible spread of Ebola due to the protracted eruption exists in the eastern part of the Democratic Republic of the Congo. The eruption, the second largest in a long time, is in its 14th month. By Friday, 3,160 cases and 2,114 deaths had been reported.
The woman had studied in Uganda. She reportedly returned to Tanzania on August 22 and traveled to fieldwork in various parts of the country. On August 29, she got Ebola-like symptoms, including fever and bloody diarrhea. She died in the Tanzanian capital Dar es Salaam and was immediately buried. Dar es Salaam has a population of 6 million people.
Two days later, WHO received information from unofficial channels that a person suspected of Ebola had died. The information showing that the woman was tested positive for Ebola, but the Tanzanian authorities have not provided any information on the cause of death. They also did not reveal what hurts two of their later contracted contacts, but only that their research was negative for Ebola.
On Thursday, WHO received another informal notice that another contact was ill and hospitalized. When the country asked Tanzania for information on this last possible case, it responded that it had no "EVD case" and no "suspected case" anywhere.
There is currently no information to suggest that the dead woman had traveled to the Democratic Republic of the Congo. However, this does not rule out that it could be infected. She may have been in contact with an unreported case in Uganda or was infected with a new, undiscovered Ebola occurrence.
Tanzania has never had an Ebola outbreak. In cases where there is a suspicion of Ebola in a country where the disease has not been treated in the past, the International Health Regulations recommend validating the efforts for early testing by a laboratory with Ebola experience, a so-called reference laboratory , The Tanzanian authorities told WHO on Monday that they would not agree to an external investigation of their samples.
The WHO Declaration progresses step by step in attempts to obtain information about the country The case involved sending a mission to Tanzania to meet with authorities and offer assistance.
The situation was also worrying for the United States. On Saturday, the CDC said she was aware of the situation and worked with the WHO to get more information.  On Tuesday, East African Minister of Health and Human Services Alex Azar announced a review of the Ebola response in the Democratic Republic of the Congo. Tanzania urged to be more open.
"We urge the Tanzanian Government to comply promptly with its obligations under the International Health Regulations and to disclose information in a transparent manner and to fully cooperate with the international health community to enable an independent review of the circumstances surrounding the death of that individual" Azar told reporters during a meeting.
Later he asked Dr. Robert Redfield, Director of Centers for Disease Control and Prevention, to travel to Tanzania. Redfield was with Azar on the mission to East Africa.