The Ebola epidemic wreaking havoc in the Democratic Republic of Congo (DRC) was declared a global health emergency by the World Health Organization (W.H.O.) this month. The current outbreak is deadliest so far, after the 2014 outbreak in West Africa that killed 11,310 people. The DRC outbreak started in August last year and by now it has killed more than 1750 people. The epidemic hot zone of the disease is no more limited to DRC. It has expanded into northeastern Congo near Rwanda and also in Uganda.
There are undertones of internal struggle inside the DRC government ranks that have made availability of new vaccines difficult and safety of health workers at risk. A vaccine by Merck, rVSV-ZEBOV, has been deployed in the affected areas. Nearly 200,000 doses of this vaccine has been donated by Merck and distributed in DRC and an additional 245,000 are ready to ship. Merck plans to make 800,000 doses more, but it takes 18 months to manufacture the vaccine. Health experts are worried that if the disease spreads into eastern Congo and South Sudan, both politically disrupted areas, there will be widespread shortages of the vaccine even with increased production.
rVSV-ZEBOV is a single-dose vaccine. It is being used to 'ring-vaccinate' immediate circle of affected individuals. With a concern of severe vaccine shortage at the current rate of disease spread, W.H.O. wanted to immunize everyone in the area, and not just immediate contacts of patients. There are ongoing talks about reducing the vaccine dose to half its current dose for those at highest risk and one-fifth of the current dose for everyone else at risk.
W.H.O. and several aid-donors have endorsed a new vaccine manufactured by Johnson & Johnson in May. Right now its name is Ad26.ZEBOV/MVA-BN. This is a double-dose vaccine requiring administration 56 days apart. The ministry of health, lead until recently by Dr. Oly Ilunga, did not agree to use the new vaccine stating concerns about difficulty in building trust among the locals. Ilunga recently resigned from his post, possibly over this disagreement.
Johnson & Johnson has offered to donate 500,000 doses. To avoid confusion among individuals getting the vaccine and among health care professionals, the new vaccine will be distinguished from the old one by not adopting ring-vaccination. Instead, the new vaccine will be used even in areas further away from the disease hostspots to immunize a broader geographic populace which is likely to be hit by the disease in near future.
DRC has seen not just seen this outbreak but also local mistrust and tensions at grass-root levels. Rebel groups in the area have attacked several healthcare facilities prompting aid-workers to flee the region. Driving into Ebola-stricken heartlands is very risky, let alone the risks of setting up makeshift clinics there.
It is likely that W.H.O. will go ahead with the new vaccine, a decision which is now to be taken by the President in the absence of the Health Minister. But until the authorities come to a decision of using this vaccine, it sits idle in a Dutch facitily far away from Africa.
Discovered in 1976 near the Ebola River in DRC, the virus has infected swathes of Africa repeatedly. It is still not clear how the virus entered human population, but on the basis of studies using related viruses, it is likely to have infected humans through bats. It spreads in humans through contact with contaminated body fluids.
Suggested links:
https://www.bloomberg.com/news/articles/2019-07-21/johnson-johnson-shot-languishes-amid-deadly-ebola-outbreak
https://www.latimes.com/science/story/2019-07-25/panic-lurking-why-the-long-awaited-ebola-vaccine-wont-end-the-congo-outbreak