Yesterday the Democratic Republic of the Congo (DRC) said that ministry of health and government officials have agreed that Merck's rVSV-ZEBOV is the only vaccine that will be used during the current, ever-growing Ebola outbreak in North Kivu and Ituri provinces.
"Due to the lack of sufficient scientific evidence on the efficacy and safety of other vaccines as well as the risk of confusion among the population, it was decided that no clinical vaccine trials will be allowed throughout the country," the ministry said in its daily update yesterday.
As of yesterday, a total of 158,830 people have been vaccinated with rVSV-ZEBOV, which clinical data suggest has as high as a 97.5% effectiveness rate against the virus.
The vaccine has been given in a ring vaccination strategy, which follows case contacts in concentric circles. The ring strategy was first used during the 2014-2016 West African outbreak.
Yesterday the ministry said that, since Jun 13, health workers have followed a new vaccine protocol that can be adapted to different security concerns and environments as the situation calls for.
The protocol includes "classic" ring, as well as "enlarged" ring, which looks to vaccinate all inhabitants of houses within 5 meters around the outbreak of a confirmed case. In places where teams safety cannot be guaranteed, workers have used a "geographical" ring, which vaccinates an entire village or neighborhood.
The DRC will likely confirm 11 new cases of Ebola today, which raises outbreak totals to 2,462, according to a dashboard maintained by the World Health Organization (WHO). Yesterday, as it confirmed 14 new cases and 2 new deaths, the ministry reported a total of 1,647 deaths and said 364 suspected cases are still under investigation.
UN chief on surveillance, community engagement
The United Nations (UN) Ebola response coordinator, David Gressly, MBA, gave an extensive interview to The New Humanitarianthis week, in which he identified the biggest challenges facing the outbreak response.
"There are areas where surveillance is weak, mainly because of insecurity. So sometimes the virus gets into a locality relatively undetected. Right now we are chasing the virus as it moves from place to place. What's important is to take a more structured approach that looks at the things that are stopping the public health response from happening," Gressly said.
In addition to surveillance, community engagement—or lack thereof—remains a constant feature of this outbreak.
"As we step up our engagement with communities, including by listening to their needs beyond Ebola and finding ways to meet them, we are seeing some of the reticence to the response ease," he said. "This will take time in some areas that have historically been distrustful of outsiders. We are making progress, but need to do more. The virus will find a way to continue to replicate if we don't have all the holes plugged."
Gressly said the UN is employing a variety of strategies to provide security during the outbreak, from community policing, to hotlines, to as a last resort, armed vehicles.
Jul 11 DRC report
WHO Ebola dashboard
Jul 11 New Humanitarian article
Apr 15 CIDRAP News story “Ebola cases climb by 44 as vaccine trial affirms high efficacy”