in Pakistan and Afghanistan, in addition to new vaccine-derived cases in Africa and Asia, was reviewed and polio continued to be a PHEIC. As of November 2021, taking into account recent events in Afghanistan, a large number of unvaccinated children, increasing mobile people in Pakistan and the risks associated with the COVID-19 pandemic among others, polio remains a PHEIC. Ebola (2014–16) Confirmed cases of Ebola were being reported in Guinea and Liberia in March 2014 and Sierra Leone by May 2014. On Friday, 8 August 2014, following the occurrence of Ebola in the United States and Europe and with the already intense transmission ongoing in three other countries for months, the WHO declared its third PHEIC in response to the outbreak of Ebola in Western Africa. Later, one review showed that a direct impact of this epidemic on America escalated a PHEIC declaration. It was the first PHEIC in a resource-poor setting. Zika virus (2016) On 1 February 2016, the WHO declared its fourth PHEIC in response to clusters of microcephaly and Guillain–Barré syndrome in the Americas, which at the time were suspected to be associated with the ongoing 2015–16 Zika virus epidemic. Later research and evidence bore out these concerns; in April, the WHO stated that "there is scientific consensus that Zika virus is a cause of microcephaly and Guillain–Barré syndrome." This was the first time a PHEIC was declared for a mosquito‐borne disease. This declaration was lifted on 18 November 2016. Kivu Ebola (2019–20) In October 2018 and then later in April 2019, the WHO did not consider the 2018–20 Kivu Ebola epidemic to be a PHEIC. The decision was controversial, with Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP) responding with disappointment and describing the situation as "an Ebola gas can sitting in DRC that's just waiting for a match to hit it", while the WHO panel were unanimous in their decision that declaring it a PHEIC would not give any added benefit. The advice against declaring a PHEIC in October 2018 and April 2019, despite the criteria for doing so appearing to be met on both occasions, has led to the transparency of the IHR EC coming into question. The language used in the statements for the Kivu Ebola epidemic has been noted to be different. In October 2018, the EC stated "a PHEIC should not be declared at this time".