H5N1

More than 18 million children in Uganda to be immunized against measles, rubella and polio in mass campaign

Via WHO AFRO: More than 18 million children in Uganda to be immunized against measles, rubella and polio in mass campaign.

Kampala, 15 October 2019 – Uganda is set to immunize more than 18 million children against measles and rubella, which amounts to 43% of the country’s population. Among them, 8.2 million children younger than 9 months, or 20.5% of the population, will also receive the oral polio vaccine. 

Uganda has experienced measles outbreaks across numerous districts in the past three years. At the same time, polio remains a daunting threat, given evidence of vaccine-derived strains circulating in neighbouring countries. 

The five-day mass immunization campaign, funded by the Government of Uganda; GAVI, the Vaccine Alliance; the United Nations Children’s Fund; and the World Health Organization (WHO); intends to tackle these three public health challenges. 

The campaign, to be conducted in schools for the first three days and in communities for the last two days, targets all children younger than 15 years, whether previously immunized or not, in order to interrupt circulation of these diseases. The campaign will be a launch pad to introduce the measles-rubella vaccine into the country’s routine immunization schedule. 

“This campaign does NOT replace the routine immunization schedule. Parents, caregivers and all concerned must ensure that all children receive and complete all the vaccines specified on our immunization schedule after the campaign,” said Dr Jane Ruth Aceng, Uganda Minister of Health.  

The mass campaign provides opportunity to intensify sensitization of communities on measles, rubella and polio as well as disease surveillance and to investigate any unreported but suspected cases of these diseases. This is particularly important because of the declining trend in routine immunization coverage in the country.  

“This is an extremely important exercise,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “It represents an impressive level of commitment to health care that we need more than ever across the African Region to prevent deaths, disease and suffering and to avoid unnecessary expenditure when caring for people who are sick.” 

The Government of Uganda acknowledges the importance of immunization against various diseases to attain Sustainable Development Goal 3, which underlines the need for good health and well-being.  

“We appeal to all parents, caregivers and guardians to take your children younger than 15 years for immunization against measles, rubella and polio during this mass exercise. The Ministry of Health has approved the vaccines to be used, and they are safe, free and effective,” said Dr Yonas Tegegn Woldermariam, WHO Representative in Uganda.  

During the campaign, teams of health workers will set up vaccination service delivery posts across the country, with the objective of attaining more than 95% immunization coverage, which is needed to interrupt the transmission of measles, rubella and polio.

WHO gravely concerned about humanitarian situation in northeast Syria

By email, a statement from WHO:

13 October, Cairo, Egypt — WHO is gravely concerned about the humanitarian health situation in northeast Syria, where up to 200,000 people have been displaced as a result of increased military operations since 9 October, and almost 1.5 million people are in need of health aid. Many of those affected by the recent hostilities have already experienced immense physical and mental stress as a result of years of conflict and repeated displacement.

People in need of essential health care services face challenges related to insecurity and limited access to health care. Already weakened health services in northeast Syria have been severely impacted by the latest security developments. The national hospital in Ras Al-Ain is currently out of service, and the national hospital and two health centers in Tel Abyad are also currently non-functional. The three field hospitals in Al-Hol camp have limited their services since 12 October as a result of the escalation of hostilities which has impeded access of health staff to the camp. All health facilities in camps hosting displaced people in Ain Issa and Ras al Ain have also been evacuated, with additional facilities under threat as the conflict rapidly escalates.

A number of health partners have already suspended services due to insecurity, further disrupting access to essential health care services. On 12 October, a trauma stabilization point located south of Ras Al Ain was evacuated after being reportedly attacked, resulting in two health staff injured and two ambulances destroyed. On the same day, the hospital in Ras Al-Ain was also reportedly attacked. There were no casualties as the facility had already been evacuated.

Across northeast Syria, shortages of health workers is widespread as they too have been among those displaced by the ongoing insecurity, aggravating an already critical situation and further depriving underserved populations of access to medical care.

Damages to the pumping station in Ras Al Ain, the main water source for most of Al Hassakeh governorate, has increased the risk of outbreaks of infectious diseases. Even before the current escalation in conflict, acute diarreah and typhoid were two of the most reported diseases among people in northeast Syria in August 2019. Ongoing displacements, overcrowded living conditions, and limited access to safe water and sanitation services, will likely lead to an increase in the number of people affected by water-borne diseases.

Amid this chaotic and fast-moving situation, WHO and health partners are working hard to respond to urgent health needs. Almost 314,000 medical treatments, vaccines, in addition to trauma medicines for 500 trauma patients have already been prepositioned in Qamishly hub. An additional shipment of more than 100,000 treatments and medicines for 640 trauma patients will be airlifted to Qamishly in the coming week. Medicines for diarrheal diseases, have also been prepositioned for delivery to health facilities as needed. Despite the challenges, many health NGOs continue to operate or shift to new locations. Some casualty cases requiring hospitalization are referred to a WHO-supported facility in Al-Hassakeh, and WHO is in the process of contracting two additional hospitals in Al-Hassakeh and Al-Raqqa to support referral services.

As the situation evolves, WHO and partners will continue to assess health needs and scale up their response as needed.

WHO calls on all parties to the conflict to preserve the right to health for hundreds of thousands of innocent civilians in northeast Syria, and comply with International Humanitarian Law to protect all civilians, including health care workers and patients, as well as health facilities.

California power shutoff: How PG&E's actions hit the medically vulnerable the hardest

This is where the climate crisis hits public health, and public health loses. Via The Guardian: California power shutoff: how PG&E's actions hit the medically vulnerable the hardest. Excerpt:

Deanne Mediati learned of northern California’s massive power shutoff when her husband shook her awake at 3.30 in the morning on Wednesday. “Honey, the power is out,” he told her. “You’re not breathing.”  

Mediati, 59, has hypoxia and requires an oxygen concentrator to breathe when she sleeps. Like everything else running on electricity in 600,000 California homes and businesses this week, her oxygen concentrator stopped working when the country’s largest utility company cut power to an unprecedented swath of the state as a preventive measure against wildfires. 

In a state gripped by climate crisis, where the biggest utility was found at fault in two of the deadliest wildfires in recent history, these preventive shutoffs are set to become the new normal. But the impacts of these power cuts are being disproportionately borne by the physically vulnerable, disability rights advocates said.

And for Californians like Mediati who rely on electronic medical devices, access to electricity is a matter of life or death. A 67-year-old man, in a small community east of Sacramento, may be the first fatality in the shutoff. Few details were yet available on the case, but the man depended on an oxygen device and died 12 minutes after losing electricity. 

“I had to be woken up because I stopped breathing,” Mediati said. “I could have died.”  

In the latest shutoff in northern California, Pacific Gas and Electric (PG&E) cut the power to portions of 34 of the state’s 58 counties on Wednesday, a move that affects more than 1.5 million people. Of those affected, more than 30,000 are part of a medical baseline program, meaning they have special energy needs due to qualifying medical conditions.  

These energy needs range from motorized wheelchairs, ventilators, dialysis machines, apnea monitors, electrostatic nebulizers to respirators – all of which require power to operate. In the aftermath of the shutdown, people dependent on these devices were scrambling to find alternative power sources, places to charge them or other ways to get through what was originally slated to be up to five to seven days of no electricity. 

Beyond medical baseline customers, an unknown number of other affected Californians may be medically fragile and dependent on electricity in other ways. Rebecca Fortelka, who has cerebral palsy and a connective tissue disorder, is “heavily reliant” on electricity, not just because of her power wheelchair, but because of the air cleaning system she has to run continuously to keep her environmental allergies from flaring up. 

“I also have medication that needs to be refrigerated at all times due to DVT and blood clots,” said Fortelka, 30. “I also am on a special diet because of food allergies and autoimmune conditions so that food is expensive, and if it spoils due to a power outage that is a huge blow to me financially.”  

Fortelka, who lives in Livermore, an inland city east of San Francisco, had been without power for 48 hours. Though PG&E sent an email to medical baseline customers stating that it “will be calling, texting and emailing you” to alert about power shutdowns, both Fortelka and Mediati said they didn’t get any prior warning. 

“My mom went to our local PG&E office and was told we have to fend for ourselves because medical baseline doesn’t count in this situation,” she said.

MSF: Ebola response overshadows DRC's fragile health system

Thanks to Mary Marshall for sending the link to this important report from MSF.org: Ebola response overshadows DRC's fragile health system. Excerpt (but read the whole story):

For health centres and hospitals in the region, the scale-up of the internationally funded Ebola response can be a blessing or a curse. 

Where Ebola response teams and international organisations set up isolation and treatment facilities, they often improve infrastructure, pay extra staff, and support primary healthcare services. 

But the health workers needed in the response are almost exclusively hired from other health centres and hospitals in the area, which are now facing critical staff shortages.  

At the General Hospital in the main village of Mabalako, these gaps are strikingly evident. Over half of the doctors and nursing staff are missing, and no one has sufficient time to watch over patients in the four wards around the big courtyard.

As extra wages with the Ebola response tend to be higher and more reliable, many of the remaining staff are disappointed that they were not selected, and moral and motivation are low. 

In the hospital, the staff shortages, unavailable treatments, and missing salaries are a deadly mix.  

“We lost children in the paediatric ward because they were not put on the correct malaria treatment straight away – an error that could have been avoided with the right human resources and more vigilance,” said MSF doctor Brian Da Cruz, who is supporting the two remaining doctors in charge of an operating theatre, maternity department, paediatric clinic, and a regular ward with more than 40 beds. 

The hospital also has a basic isolation zone for patients with infectious diseases, but the small structure has no changing rooms, no decontamination zone, and there is no safe access for families to visit patients.  

As suspect Ebola patients are taken to another, better equipped structure, its rooms are currently used to observe four children with measles, a vaccine-preventable, but highly infectious disease leading to regular epidemics in the DRC. 

On the opposite side of the courtyard, MSF drilled a borehole and installed a water point, which is in permanent use by people living in the neighbourhood for clean drinking water.

While MSF’s support was mostly focused on improving infrastructure and working alongside the remaining staff in health centres and the regional hospital, the team is currently evaluating a different model, including a regular payment scheme to supplement staff salaries and offer bedside training. 

“We are discussing playing a stronger role in the hospital and the three health centres we support, by taking supervisory responsibility, offering training on the job, and ensuring patients have access to free care while staff are getting paid,” explained MSF project coordinator Amandine Colin. 

Back in Metale, MSF community outreach specialist Wivine Bokotogi hands a set of flashcards on malaria prevention and treatment to two local health promoters. 

Malaria is another major health burden at risk of being neglected as the attention and resources chase after the Ebola epidemic. In the DRC, malaria accounted for 13 per cent of deaths in children under five years old in 2016, and up to half of the people screened in Ebola treatment centres last year tested positive for malaria alone. 

“We train the local health promoters on key messages to prevent malaria, including instructions to cover stagnant water sources, use mosquito nets, and take children to the nearest health centres so they can be treated in time,” said Wivine.

DRC Equateur: Nearly 250 children dead of measles in one month

Via provinces26rdc.net: DRC Equateur: Nearly 250 children dead of measles in one month. The Google translation:

Measles killed 246 children in one month in the Basankusu Health Zone. The epidemic is currently raging in twelve health zones in Equateur. Civil society organizations are launching an SOS in the face of the scale of this epidemic.  

The coordinator of the citizen movement ECCHA / Basankusu, Christian Boketsu, says that after his visit Monday, October 7, 2019 through hospitals and health institutions, he noted "a total of 246 deaths in this territory. Patients are abandoned because of lack of medication."  

Provincial health minister / Equateur, Bruno Efoloko, confirms that this measles outbreak has been reported since the 36th week in twelve health zones in the province. He said that as far as Basankusu was concerned, "WHO is planning to go down there soon in its second phase of intervention." This includes "free measles care, but also the strengthening of routine immunization with a double dose of vaccine."  

Dr. Bruno Efoloko lamented the fact that "many parents were hiding their children, saying that measles can not be cured in the hospital. This caused this high mortality. "

Critical WHO supplies arrive in Sudan to manage cholera outbreak

WHO EMRO has published Critical WHO supplies arrive in Sudan to manage cholera outbreak.

25 September, 2019 – A shipment of 36 tons of cholera treatment medicines and supplies have arrived in Khartoum and are being prepared for distribution as part of the World Health Organization’s response activities supporting the Federal Ministry of Health in Sudan to contain and halt a cholera outbreak.  

The shipment includes 5000 rapid diagnostic tests (RDTs) for immediate detection and screening of cholera patients at health facilities and high-risk areas. RDTs are an essential part of early detection and response activities as their use ensures timely management and reporting of cholera cases.  

The shipment also contains medicines that can treat 2500 severely dehydrated patients, and which will be distributed to cholera treatment centres in Blue Nile and Sinnar states, where cases have been confirmed, as well as in the neighbouring at-risk states of White Nile, Kassala, Gedaref and Khartoum.  

“Even with the rapid depletion of our resources, we are accelerating our coordinated response, including delivering more medicines and supplies,” said Dr Naeema Al Gasseer, WHO Representative in Sudan. “We are working around the clock with the Federal Ministry of Health, state authorities and partners to control the outbreak and prevent more deaths.”  

As of 24 September, a total of 184 cholera cases have been reported, including 128 cases from Blue Nile State and 56 cases in Sinnar state. Eight cholera-related deaths have been recorded by the Federal Ministry of Health, including 6 in Blue Nile State and 2 in Sinnar State.  

Open defecation, lack of clean water outside the capital city and a dilapidated health sector are serious threats in a country of about 40 million people. Cholera, a bacterial disease usually contracted from contaminated water supplies, can be fatal if not treated early. 

As part of an overall integrated cholera response plan, WHO is working with the Ministry, state-level health ministries, United Nations agencies and nongovernmental organizations on surveillance of cases to monitor and control spread of the disease; maintain clean water, sanitation and nutrition; and raise awareness among at-risk communities. 

To date, WHO has deployed international experts to support the ongoing response activities and has trained and deployed 9 rapid response teams, each consisting of at least 3 members, for assessment and surveillance of high-risk areas. 18 health volunteers have also been trained and deployed to conduct water quality assessments in the 2 affected States. 

WHO is also actively disseminating awareness messages on health and sanitation through focus group discussions with community leaders, especially women, and training workshops are ongoing for volunteers on conducting house-to-house and community visits to deliver relevant health messages.

WHO AFRO: Situation report 60, Ebola virus disease outbreak in DRC

WHO AFRO has published Situation Report - Ebola Virus Disease Outbreak in DRC - Sitrep 60 (2019). Excerpt:

In the past week, from 16 to 22 September, 39 new confirmed Ebola virus disease (EVD) cases, with an additional 22 deaths, have been reported from nine health zones in three affected provinces in the Democratic Republic of the Congo. 

 Pockets of insecurity in the affected areas, along with localised security incidents, continue to hinder response activities, including safe and dignified burials (SDB), vaccination, contact tracing and case reporting. For instance, a recent major security incident in Lwemba, within Mandima health zone is still preventing response activities in this area. Overall, these incidents underscore the need for continued and proactive engagement and sensitizing of local communities, especially in the high risk areas that may not currently be affected.

In the 21 days from 2 to 22 September 2019, 45 health areas in 13 health zones reported new cases. During this period, a total of 129 confirmed cases were reported, with the majority coming from the health zones of Mambasa (25%, n=32 cases), Mandima (19%, n=25 cases), Kalunguta (17%, n=22 cases) and Beni (11%, n=14 cases). 

As of 22 September 2019, a total of 3168 EVD cases were reported, including 3057 confirmed and 111 probable cases, of which 2118 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases with reported sex and age data, 56% (1772) were female, 28% (900) were children aged less than 18 years, and 5% (160) were healthcare workers. 

The Democratic Republic of the Congo health authorities have endorsed the use of a second investigational Ebola vaccine with at-risk populations in areas that do not have active EVD transmission. Regular vaccination activities in EVD-affected areas will continue. See the full update here (https://www.who.int/news-room/detail/23-09-2019-second-ebola-vaccine-to-complement-ring-vaccination-given-green-light-in-drc). 

Under Pillar 1 of the current Strategic Response Plan, the estimated funding requirement for all partners for the period July to December 2019 is US$ 287 million, including US$ 120-140 million for WHO. As of 24 September 2019, close to US$ 60 million have been received by WHO, with further funds committed or pledged. Currently available funds will close the financing gap up until the end of October 2019. Further resources are needed to fund the response through to December 2019, and WHO is appealing to donors to provide generous support.

DRC Ebola: CMRE update, September 23

CMRE now publishes its daily updates in web-accessible format: Situation épidémiologique au 23 septembre 2019. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AS AT SEPTEMBER 22, 2019   

The Epidemiological Status of Ebola Virus Disease on September 22, 2019/Monday, September 23, 2019    

Since the beginning of the epidemic, the cumulative number of cases is 3,168, of which 3,057 are confirmed and 111 are probable. In total, there were 2.118 deaths (2007 confirmed and 111 probable) and 975 people healed. 

• 343 suspected cases under investigation; 

• 4 new confirmed cases, including: 

• 1 in North Kivu in Butembo; 

• 3 in Ituri, including 2 in Mandima and 1 in Mambasa. 

• 3 new confirmed deaths, including: 

• 2 community deaths, including 1 in North Kivu in Butembo and 1 in Ituri in Mambasa; 

• 1 confirmed death in Ituri in Mandima.  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 160 (5% of all confirmed / probable cases), including 41 deaths.

  

The data presented in this table are subject to change after extensive investigation and after redistribution of cases and deaths in their respective health areas.   

NEWS  

Start of training of trainers in Goma on good clinical practices related to the second Ebola vaccine 

• The Ebola Virus Disease Response Information Management Coordinator, representing the Technical Secretariat, Mathias Mossoko, launched Monday in Goma training of trainers that runs from 23 to 28 September 2019 on good clinical practices (GCP) related to the second vaccine against the Ebola virus. 

• This training benefits from the expertise of CVD's Malians on the transmission of notions about good clinical practice. It aims to provide participants with the standards applicable to the design, conduct, monitoring and stopping of studies, to teach them the activities of audit, analysis, reporting and documentation with the guarantee that these studies rely on sound scientific and ethical principles. It is also intended to introduce participants to the correct documentation of the clinical properties of the vaccine tested or evaluated. 

• The Response Information Management Coordinator called the attendance participants to demonstrate better actors for the implementation of good practice in this second vaccine. 

• For its part, the chairman of the Immunization Committee, Stéphane Hans, said that this five-day training announces the forthcoming launch of the second vaccine that will come at any time in the targeted health zones. "We welcome this supplementary vaccine very positively compared to the first vaccine. This second vaccine has the advantage of preventing all strains of the Ebola virus. It is therefore positive for the population that will receive it," he said while inviting all communities targeted by this vaccination to take ownership of this activity, once launched. 

• The training on good clinical practice will revolve around several presentations on different topics, among others, the Ebola virus disease, the responsibilities of the INRB for the QA system, study vaccines (storage, management, chain cold and accounting), inclusion and follow-up of pregnant women, community involvement and informed consent, etc. 

• This training was organized for the different actors involved in this project, including doctors, epidemiologists, clinicians and pharmacists. A total of 25 people from Kinshasa, including the INRB, UNIKIN, CUK and specialized programs and North Kivu, including the Provincial Health Inspectorate (IPS), the Provincial Division of health (DPS) and the health zones coordination Offices (BCZS) participate in these foundations.

VACCINATION

Opening of an enlarged ring of vaccination around two confirmed cases of 19 and 21 September 2019 in the health area of ​​Madidi in Mambasa in Ituri Another satellite ring was opened at the Kitatumba General Referral Hospital in Butembo health zone in North Kivu around the case notified on 22 09 2019. This case started the illness in the Kasindi health area in Mutwanga, North Kivu.

• The Expanded Program of Vaccines has received 4320 doses of vaccine at the national level;

• Since vaccination began on August 8, 2018, 226,722 people have been vaccinated;

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 20 May 2018. 

ENTRY MONITORING

• High-risk contact was intercepted at Kangote PoC in Butembo, North Kivu. This is a 28-year-old unvaccinated woman on the 14th day (D14) follow-up who was listed around a confirmed case in the Katwa Health Zone. During her interception, this woman presented some signs related to the #Ebola Virus Disease. She was sent to the Butembo CTE for treatment.

• Kituku PoC providers in Goma, North Kivu, were assaulted by about 20 onlookers called "Maibobo" who were avenging one of their drowned during the night of 20 to 21 September 2019. These providers feel insecure and ask to be supported by officers of the National Police (PNC) or FARDC.

• Since the beginning of the epidemic, the total number of travelers checked (temperature measurement) at the sanitary control points up to 22 September 2019 is 96,998,860;

• To date, a total of 111 entry points (PoE) and sanitary control points (PoCs) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries.

Maxmen: Aid group says Ebola vaccine is not reaching enough people

Via Nature News & Comment, Amy Maxmen writes about today brouhaha: Aid group says Ebola vaccine is not reaching enough people. Excerpt:

The aid organization Médecins sans Frontiéres says that the World Health Organization (WHO) is not distributing Ebola vaccine widely enough in the Democratic Republic of the Congo (DRC). 

An epidemic of the virus in the DRC has sickened more than 3,100 people and killed roughly 2,100 since August 2018, according to the WHO. The agency, an arm of the United Nations, has been distributing the rVSV-ZEBOV vaccine in areas of the DRC where Ebola is spreading. 

The vaccine, made by Merck, is more than 97% effective, according to a preliminary analysis published in April by the WHO and DRC government researchers. Yet Médecins sans Frontiéres (MSF, also known as Doctors without Borders) says that “only a fraction of the eligible population” in the DRC has received the vaccine — roughly 225,000 of the 600,000 people that the group estimates should have received the shot. 

Health workers are among those who have been under-vaccinated, MSF says, noting that 160 have been infected with the virus. “In a hotspot of the outbreak such as Beni, almost a third of [health workers] reported they have not been vaccinated,” said Isabelle Defourny, MSF’s director of operations, who is based in Paris, in a statement on 23 September. Beni is a city in the eastern DRC and a hotspot of the epidemic.

The MSF’s criticisms came as the WHO said it will roll out a second Ebola vaccine in the DRC to combat the outbreak beginning in October. The WHO plans to give the vaccine, made by Johnson & Johnson, to people in the eastern DRC who live in areas free of Ebola. 

Ibrahima Socé Fall, the assistant director of WHO’s emergency response, rejects many of MSF’s claims — beginning with the group’s estimate that 600,000 people should have received the Merck vaccine. 

A tough task 

The WHO’s strategy has been to vaccinate people who have come in contact with a person who has been diagnosed with Ebola, along with the contacts of those contacts and health workers. Socé Fall argues that MSF has overestimated the number of people who should be vaccinated. The aid group based its projection on the average number of contacts per person diagnosed with Ebola — but in many cases, Socé Fall says, the contacts of people with Ebola overlap. This reduces the overall number of people who need to be immunized against the virus.

Socé Fall also disputes MSF’s estimate that a third of health workers haven’t been offered the vaccine. He says that [no] one knows the true number of health workers in the areas where Ebola is spreading, because the term includes traditional healers as well as doctors and nurses offering modern medical treatment — and others that mix both kinds of care. The WHO has struggled to find and vaccinate health workers that operate small, unregistered facilities scattered throughout the forests of the eastern DRC.

Ebola DRC: MSF calls for an international, independent committee for Ebola vaccination

This is an unexpected political development. MSF has been relatively low-profile in this outbreak, compared to West Africa. But now it's challenging the DRC and WHO: Ebola DRC: MSF calls for an international, independent committee for Ebola vaccination.

Monday, September 23, 2019 — Despite the availability of a highly effective Ebola vaccine in north-eastern Democratic Republic of Congo (DRC), only a fraction of the eligible population is receiving it. 

Today, international medical humanitarian organisation Médecins Sans Frontières/Doctors Without Borders (MSF) calls for the establishment of an independent, international coordination committee to improve the transparency of the vaccination programme and increase access for the population.  

The current Ebola outbreak in DRC has killed over 2,000 people with a mortality rate of 67%. This is comparable with the 2014-2016 West Africa outbreak, when tools such as the vaccine and therapeutic treatments were not available. 

“Community mistrust and resistance have often been cited as the major obstacles in the fight against Ebola. However, we need to stop blaming communities for their own deaths and make sure more people have access to treatments and vaccines,” says Dr Natalie Roberts, MSF Emergency Coordinator.  

Thanks to the efforts of the Ministry of Health and the World Health Organization (WHO), approximately 225,000 people have been vaccinated with rVSV-ZEBOV, an investigational vaccine produced by Merck that has shown very high levels of efficacy. However, this number remains largely insufficient. Ebola experts have recommended vaccinating between 150 and 200 contacts for each confirmed Ebola patient. 

With 3,150 total confirmed cases reported so far, between 450,000 and 600,000 people should have been vaccinated - more than double the actual number of 225,000.  

“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. Yet the WHO is restricting the availability of the vaccine in the field, as well as the eligibility criteria and their application for unclear reasons” says Dr Isabelle Defourny, MSF Director of Operations. “Even when it comes to frontline health workers, a known and easily reachable population, in a hotspot of the outbreak such as Beni, almost a third of them reported they have not been vaccinated.” 

MSF’s efforts to expand access to the 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 the WHO. These restrictions are in place despite the rVSV-ZEBOV vaccine demonstrating a good safety profile and a high level of protection against the virus. MSF vaccination teams in North Kivu have often been forced to remain on standby, waiting to receive a handful of doses reserved for people on a pre-defined list.  

“Time is of essence in an outbreak: medical teams should be able to rapidly provide treatments or vaccines based on what they see on the ground. 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 firefighters 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,” says Dr Roberts. 

“To allow for the best possible use of experimental tools in an outbreak context, transparency is key. How can we expect the Congolese population to trust a system that is not even transparent to front-line health workers like MSF?” notes Dr Roberts. 

MSF calls for the urgent creation of an independent, international coordination committee, based on the model of the International Coordination Group created in 1997. This composed of MSF, the International Federation of Red Cross, UNICEF and WHO, and proved successful in managing massive meningitis, cholera and yellow fever outbreaks with limited vaccine supplies. 

The committee would 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.

7sur7.cd also has the story, with emphasis on MSF's criticism of WHO rather than the DRC.