In a development that global health officials say is a turning point in how the world fights Ebola, vaccinators today began immunizing health workers in the Democratic Republic of Congo (DRC), the first stage of a ring vaccination strategy.
In other developments, four more illnesses were reported, along with another healthcare worker death, and more countries signaled financial support to help with the international response to the outbreak.
The launch of the vaccine campaign comes at the start of the World Health Assembly, the World Health Organization's (WHO's) decision-making body made up of delegates from 194 countries. WHO Director-General Tedros Adhanom Ghebreyesus, PhD, in his opening speech today. spoke of his visit last week to the DRC's outbreak hot spot. He said he was proud of the WHO's response so far and thanked the WHO's global health partners for their quick actions.
"The outbreak in Bikoro illustrates again that health security and universal health coverage are two sides of the same coin. The best thing we can do to prevent future outbreaks is to strengthen health systems everywhere," Tedros said.
Vaccination begins with health providers
In an update today, the WHO said healthcare worker and ring vaccination began in the country's two Ebola hot spots, Mbandaka and Bikoro, both located in Equateur Province. It said Merck has provided the WHO with 8,640 doses of VSV-EBOV, the experimental vaccine furthest along in clinical trials that was shown to be highly effective in a phase 3 trial in Guinea at the end of West Africa's outbreak.
The unlicensed vaccine is being deployed on a compassionate use basis along with a clinical trial. Merck has donated the vaccine doses, and Gavi, the Vaccine Alliance has contributed $1 million toward the vaccine campaign's operational costs.
On Twitter today, Peter Salama, MD, the WHO's deputy director-general for emergency preparedness and response, said, "Today marks a turning point in how we deal with Ebola—we are moving from a strategy of containment to one of offering communities protection and care."
Seth Berkley, MD, Gavi's chief executive officer, in the DRC today to see the launch of the campaign, said in a statement, "The DRC government, alongside the WHO, MSF [Doctors Without Borders] and others, are working hard to slow the spread of Ebola. We now hope that deploying the vaccine will give a vital boost to these efforts, helping to defeat this outbreak."
Of the WHO vaccine stock, 7,540 doses are slated for the DRC, enough for 50 rings of 150 people. Contacts and contacts of contacts are slated for voluntary vaccine, and health workers will regularly monitor those who are vaccinated. Frontline response workers will also be offered the vaccine, as will be health workers and responder in countries at risk for spread of the disease. An extra 8,000 doses will be available in the coming days.
Health teams with experience in Ebola vaccination from Guinea arrived in the DRC over the weekend to help with the DRC's campaign. The WHO said the ring vaccination strategy depends on tracing all contact and contacts of contacts as soon as possible after a case is confirmed. So far, more than 600 contacts have been identified, the WHO said.
The Africa Centers for Disease Control and Prevention (Africa CDC) said yesterday that it has recruited 25 epidemiologists to support teams working in the affected areas of the DRC.
The WHO said each vaccination team has one or two social mobilizers who will visit the community and explain the process to people who are eligible for vaccination. It also emphasized that although the use of the vaccine marks a milestone for controlling the disease, it is just one of several outbreak control steps, such as case finding, contact tracing, isolating sick patients, lab testing, infection control, and safe burials.
New cases lift outbreak total to 49
Salama today said the Ebola case total has grown by 4 more cases over the weekend, to 49 cases, reflecting 22 confirmed, 21 probable, and 6 suspected cases.
One more death has been reported in the outbreak, involving a nurse in Bikoro where the outbreak is centered, the Associated Press (AP) reported today, citing the DRC's health minister, Oly Ilunga, MD.
So far it's not clear where the new cases are from, but health officials are worried about spread in Mbandaka, which has a population of 1.2 million, where four cases had been reported by the end of last week. Salama said in a May 19 tweet that three cases from Wangata health zone in Mbandaka were confirmed and that the fourth is a new suspected case that's not linked to the others.
A report from The Atlantic said inaccurate maps are stirring some confusion about the boundaries of the Wangata health zone where the Mbandaka patients are from.
So far, there's no evidence that the map problems are hurting the response, Cyrus Cinai, a cartographer from the University of California at Los Angeles who is working with the health ministry to improve map accuracy, told The Atlantic. Health officials in the DRC, however, said it's important to have good visualizations to communicate conditions on the ground to international partners who don't know the area and to get a clear grasp on where the outbreak is and how it's moving.
Support grows for outbreak response
Canada's government on May 19 announced that it will provide an additional $2.5 million in emergency humanitarian assistance to help support organizations responding to the outbreak.
Marie-Claude Bibeau, minister of international development, said in a statement, "Preventing further transmission of the Ebola virus is essential to controlling the current outbreak. This emergency funding will go directly to trusted humanitarian partners and enable health care workers and response teams to continue to quickly manage this outbreak."
Meanwhile, the Washington Post reported on May 18 that the United States is planning to provide several million dollars to support the DRC's Ebola outbreak, with details being finalized and an announcement expected early this week.
The WHO has said it and its partners need $26 million for the Ebola response over the next 3 months.
May 21 WHO statement
May 21 WHO update on ring vaccination
May 21 Gavi statement
May 20 Africa CDC statement
Peter Salama Twitter feed
May 21 AP story
May 21 Atlantic story
May 19 Canadian government statement
May 18 Washington Post story