Congo Begins Ebola Vaccinations as Bundibugyo Protection Remains Uncertain
The Democratic Republic of the Congo began vaccinating frontline and health workers against Ebola in Kisangani on Thursday, August 27, as authorities confront an expanding outbreak caused by Bundibugyo virus.
The campaign is using Ervebo, a vaccine licensed and recommended for Ebola virus disease caused by the Zaire ebolavirus. It is not licensed for Bundibugyo virus disease, and the World Health Organization says its protection against the current outbreak strain has not been established in humans.
That makes the rollout both an emergency measure and a test of public-health policy. Responders are being prioritized because they face high exposure risks, while a separate Phase 3 clinical trial will collect evidence on whether Ervebo can protect people against Bundibugyo Ebola.
Frontline workers first
The vaccination campaign was launched in Kisangani, the capital of Tshopo province. Authorities expect it to cover 14 health zones across Tshopo, Bas-Uele and Haut-Uele provinces.
Health Minister Roger Kamba said at the launch that the immediate priority was protecting people working on the front lines of the response, according to the Associated Press. The campaign is not a general-population vaccination program, and authorities have not established that it will stop community transmission.
People offered the vaccine are to receive information about its risks, possible benefits and limitations in the Bundibugyo outbreak and provide informed consent, WHO and the Africa Centres for Disease Control and Prevention said.
Why Ervebo is being used
On August 20, WHO and the International Coordinating Group on Vaccine Provision announced an initial allocation of 70,000 Ervebo doses to the DRC. The allocation divides the doses between responder protection and research: 50,000 are intended for frontline and health workers, while 20,000 are reserved for a Phase 3 clinical trial.
WHO said early laboratory and animal data suggest Ervebo may offer some protection against Bundibugyo virus because the viruses are related. But that possibility remains unconfirmed in people. The trial is intended to produce evidence that could guide future decisions during Bundibugyo outbreaks.
The distinction matters because Ervebo’s licensed indication covers Ebola virus disease caused by the Zaire ebolavirus, not Bundibugyo virus disease. Using the vaccine in this setting therefore does not amount to a finding that it works against the strain driving the outbreak.
An outbreak under pressure
WHO reported in an August 14 Disease Outbreak News update that the outbreak had reached 54 health zones across six provinces: Ituri, North Kivu, South Kivu, Haut-Uele, Tshopo and Bas-Uele. Ituri remained the epicenter.
In that update, WHO listed 4,665 confirmed cases and 2,184 reported deaths as of August 12. Separately, Congolese government figures cited by AP listed 5,713 confirmed cases and 2,744 deaths as of Tuesday, August 25. The figures use different reporting dates and should not be combined into a single total.
The response is also operating amid insecurity, displacement, population movement and constrained access to health care. WHO said at least 155 health workers had confirmed infections as of August 9, including 45 deaths. The agency also reported attacks on health care that have disrupted surveillance, response work and access to treatment.
A separate WHO Regional Office for Africa update on August 24 described the outbreak as the country’s fastest-growing and said transmission was outpacing control efforts. AP reported that WHO officials assessed the outbreak as capable of surpassing the 2014–2016 West Africa Ebola outbreak, the deadliest on record. Those are attributed assessments, not final historical conclusions.
What comes next
The next important indicators will be vaccination coverage among responders, enrollment and monitoring in the Phase 3 trial, additional outbreak data and any evidence that vaccination reduces illness among people exposed to Bundibugyo virus.
For now, Ervebo offers a potential layer of protection for workers confronting a dangerous outbreak, but it is not proven protection against the strain driving the emergency. The decision to use it reflects the pressure of a rapidly spreading epidemic and the need to generate evidence while the response is still underway.
Sources
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