By Sharon Atieno
The slow pace of Ebola vaccination activities has led the Médecins Sans Frontières (MSF) to call for an urgent formation of an independent, international coordination committee to facilitate a more transparent management of the Ebola vaccination programme.
MSF, which has been in the frontline of Ebola intervention in the north-eastern Democratic Republic of Congo (DRC) since the outbreak in 2018, notes that only a fraction of the eligible population is benefiting from this critical tool.
“One reason is the lack of transparency concerning vaccine supply chains by the World Health Organisation (WHO), who imposes strict limits on the number of doses deployed in the field,” MSF says in a press statement.
Statistics reveal that in less than two years into the ongoing Ebola outbreak in north-eastern DRC, the disease has killed over 2,100 people, a mortality rate which is 67 percent comparable to the 2014-2016 West Africa outbreak, when neither therapeutic treatments nor a highly effective vaccine were available, unlike today. As many as 40 percent of the deaths are represented by people who died at home before they could even be identified as patients.
Though efforts by the Ministry of Health and WHO have resulted in vaccination of 225,000 persons with rVSV-ZEBOV, an investigational vaccine produced by Merck, the number remains largely insufficient as the outbreak keeps resurging in areas that have been supposedly covered by vaccination.
“We think that upping the pace of vaccination is necessary and feasible: at least 2,000-2,500 people could be vaccinated each day, instead of 500-1,000 as is currently the case” says Dr Isabelle Defourny, MSF director of operations. “We have a vaccine that is proven to be safe and effective; we have teams ready to be deployed; there is no problem with the cold chain; there are enough doses to cover the current needs and to allow for an extension of vaccination coverage, as recently confirmed by Merck, the vaccine manufacturer; and when there is enough awareness, the vast majority of the population wants to be vaccinated.”
“Yet WHO is restricting the availability of the vaccine in the field and the eligibility criteria and their application for reasons that are unclear,” Dr Defourny continues. “Even when it comes to frontline health workers (a known, easily reachable population), in a hotspot of the outbreak such as Beni, almost a third of them reported they have not been vaccinated.”
MSF notes that its efforts to expand access to vaccination, in collaboration with the Ministry of Health and according to the recommendations of the Strategic Advisory Group of Experts (SAGE) in May 2019, have been frustrated by the tight controls on supply and eligibility criteria imposed by WHO.
It further notes that, MSF vaccination teams have often been forced to remain on standby in North Kivu, waiting to receive a handful of doses reserved to people on a pre-defined list.
“Time is of the essence in an outbreak: medical teams should be able to rapidly provide treatments or vaccines based on what they see on the ground,” says Natalie Roberts, MSF Emergency Coordinator.
“If a mother has been caring for her sick child who is then diagnosed with Ebola, not only do we want to diagnose and treat the child, but we also want to provide the mother with post-exposure prophylaxis that could potentially prevent her from developing the disease, and vaccinate her whole community so that if she does get sick, they will have already developed immunity. But our capacity to carry out real-time assessments and react accordingly is severely undermined by a rigid system which is hard to comprehend. It’s like giving fire fighters a bucket of water to put out a fire, but only allowing them to use one cup of water a day. Every day we see known contacts of confirmed Ebola patients who have not received their dose despite being eligible for vaccination.”
Merck had earlier on stated that in addition to the 245,000 doses already delivered to WHO, they are ready to ship another 190,000 doses if required and that 650,000 additional doses will be available over the next 6-18 months.
“To allow for the best possible use of experimental tools in an outbreak context, transparency is key,” continues Dr Roberts. “How can we support the Congolese authorities in using these tools, how can we expect the Congolese people to trust a system that is not even transparent to front-line health workers like MSF?”
MSF recommends that the committee should be based on the model of the International Coordination Group created in 1997 composed of MSF, the International Federation of Red Cross, the United Nations Children’s Fund (UNICEF) and WHO to bring partners together to improve coordination on vaccination, increase transparency in stock management, share data, foster an open dialogue with the manufacturers and ultimately ensure that the vaccine is provided to all those most at risk of being exposed to the virus.