H5N1

DRC: 11 NGOs warn of 'catastrophic' situation of hundreds of thousands of displaced people in Ituri

Via Actualite.cd: DRC: 11 NGOs warn of "catastrophic" situation of hundreds of thousands of displaced people in Ituri. The Google translation:

Humanitarian Action Against Hunger, AVSI, Danish Refugee Council, Intersos, Mercy Corps, Norwegian Refugee Council, Oxfam, Solidarity International, Tearfund, Trócaire and Welthungerhilfe have issued an alert on the need for funding to meet the needs of many hundreds of thousands of people affected by the resurgence of violence in the Djugu and Mahagi territories in Ituri province.

These 11 organizations report that most people who have fled the violence live in appalling conditions lacking clean water, medicines and sanitation.   

Others spend the night cramped in public places, such as churches and schools, or try to survive in overcrowded makeshift camps exposed to heavy rains and life-threatening diseases.  

In some cases, 500 people have to share a single toilet.   

These living conditions also increase the risk of sexual violence against women and girls.    

"The situation is catastrophic. Many children are malnourished. Most people lost everything and witnessed the worst atrocities. Now they are facing a terrible dilemma: finding themselves with nothing to eat or risking their lives by returning to their fields," confirms Corinne N'Daw, country director Oxfam in the DRC.    

According to Benjamin Vienot, Country Director of Action Against Hunger in the DRC, humanitarian organizations have not had sufficient funding to cover needs and they still face insecurity in this part of the country.   

"Humanitarian organizations have not been able to reach all those who needed help during the last crisis in 2018 due to lack of funding and insecurity, which made access to the people extremely difficult. We are now faced with an equally dark picture," he added.   

Ten months after the beginning of 2019, DR Congo received only 35% of the necessary funds, in a country where 15.6 million people are affected by severe food insecurity.   

Other parts of the country are also beset by the humanitarian crisis. These are the provinces of South Kivu, Tanganyika and Kasai.  

DRC Ebola: 'New vaccine grants stronger immunity than former' (MSF)

Via 7sur7.cd: DRC-Ebola: "New vaccine grants strong immunity than former", (MSF). The Google translation:

Médecins Sans Frontières, (MSF), supports the introduction of the second vaccine to eradicate Ebola virus, mainly in the provinces of North Kivu and Ituri, in eastern Democratic Republic of Congo.  

According to Tristan Le Lonquer, head of mission in charge of emergencies within this international body, the new vaccine Johnson & Johnson grants a stronger immunity than the former (Merck, Editor's note). 

"The two-shot Johnson & Johnson vaccine offers a broader immunity than the Merck, that is, Johnson & Johnson protects against other strains of the Ebola virus disease," he said Tuesday, October 15, in Beni-city in a scrum.  

Positive Ebola cases are down in North Kivu province. MSF also calls on the inhabitants of the areas affected by this lethal epidemic not to proclaim victory quickly, but rather to ensure sanitary rules including hand washing. 

Dr. Jean-Jacques Muyembe, principal investigator of the said vaccine recently said that it has no side effects.

Northeast Syria: MSF forced to evacuate staff due to extreme volatility in the region

Via MSF.org: Northeast Syria: MSF forced to evacuate staff due to extreme volatility in the region. 

AMSTERDAM/NORTHEAST SYRIA - Following the launch of Turkish military operations and the extremely volatile situation in northeast Syria, Médecins Sans Frontières (MSF) has taken the difficult decision to suspend the majority of our activities and evacuate all our international staff from northeast Syria. 

Since Wednesday 9 October, the extreme volatile situation in northeast Syria has forced MSF international staff to evacuate from our projects in Ain Issa, Al Hol, Tal Abyad, Tal Tamer, Tal Kocher/ Yaroubiyah, Kobane/ Ain Al Arab and Raqqa city. These have been extremely difficult decisions, as MSF is very aware of the needs of fleeing and vulnerable people in the region. 

However, the highly unpredictable and fast-changing situation at present has made it impossible for MSF to negotiate safe access to deliver healthcare and provide humanitarian assistance to people in distress. Given the numerous groups fighting on different sides of the conflict, we can no longer guarantee the safety of our Syrian and international staff.   

“The people in northeast Syria have already endured years of conflict and uncertainty. The latest developments have only increased the need for humanitarian assistance, yet it is impossible to deliver it with the current insecurity,” says Robert Onus, MSF emergency manager for Syria.  

“It is with a heavy heart that MSF has taken the difficult decision to suspend the majority of its activities and evacuate its international staff out of northeast Syria. We cannot operate at scale until we can gain the assurances and acceptance of all parties to the conflict that we can operate safely.  

“We are extremely worried about the safety of our Syrian colleagues and their families who remain in northeast Syria in these troubled times. We will continue to support our Syrian colleagues remotely and explore all possible options to deliver assistance to the people in northeast Syria, despite the constraint,” says Onus. 

The decision to suspend the majority of MSF’s activities comes as the humanitarian situation spirals further out of control and needs are likely to increase. 

In Tal Tamar town, MSF teams were providing blankets, emergency food rations, bottles of water, and soap to the thousands of displaced people who were arriving in the town daily after having fled from their homes with little more than the clothes on their backs.  

Until October 13, MSF was supplying water to several villages in the area to overome water shortages after an airstrike reportedly damaged the water pumping station, cutting off the water supply to whole towns.  

Airstrikes, shelling, and armed clashes have had a grave impacts on the civilian population and on the ability of humanitarian organisations to deliver aid safely.  

On 13 October, dozens of people wounded by an airstrike were brought into Tal Tamer hospital. In Ain Issa town, MSF teams witnessed the population fleeing their homes on foot and seeking safety away from the ongoing conflict. Health workers were evacuated and relocated from the Ain Issa hospital, which had been one of the main hospitals treating wounded people over the past five days.    

Today, as MSF teams depart, we have heard from our staff that the people in Ain Issa camp are severely lacking food, water and medical assistance. Just last week, MSF teams were providing healthcare and, supplying water and mental health support to people living in the camp. Now they are left in a very precarious situation and we are extremely worried for their wellbeing. 

MSF calls on all parties to the conflict to ensure the protection of civilians. We further call on them to provide humanitarian organisations with safe and unhindered access to the civilian population so they can deliver assistance, at a time when it is urgently needed. 

Note: MSF remains present in northwest Syria, providing health care in various facilities and via mobile clinics, as well as supporting health structures in the area.

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 Ebola: CMRE update, October 6

CMRE has published Situation épidémiologique du 06 Octobre 2019. In addition to zero new cases on October 5, we also learn that the response shutdown in Lwemba seems to have been resolved. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI OCTOBER 05, 2019   

Sunday, October 06, 2019   

Since the beginning of the epidemic, the cumulative number of cases is 3,204, of which 3,090 are confirmed and 114 are probable. In total, there were 2,142 deaths (2028 confirmed and 114 probable) and 1004 people healed. 

• 414 suspected cases under investigation; 

• No new cases confirmed; 

• 1 new confirmed death at CTE in Ituri in Komanda; 

• No one healed out of ETCs; 

• No health workers are among the newly confirmed cases. The cumulative number of confirmed / probable cases among health workers is 161 (5% of all confirmed / probable cases), including 41 deaths. 

• 19th day without response activities in Lwemba to Mandima health area in Ituri, where dialogue is ongoing in the community.

   

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  

Reconciliation between displaced people from Lwemba to Biakato and communities left in Lwemba in Mandima in Ituri   

The Lwemba communities who moved to Biakato in Mandima in Ituri reconciled on Sunday, October 06, 2019 with the communities that remained in Lwemba in the presence of the response team led by the Deputy General Coordinator, Dr. Justus Nsio Mbeta, Chief of Cheffery and the MCZ of Mandima, Coordinator of the Mangina Response Subordinate Coordination, as well as some partners the Ministry of Health, including WHO, MSF, UNICEF and the United Nations; 

- From this meeting, follows the following recommendations: setting up a community committee to support the response, the local recruitment of sensitizers in the monitoring of community-based surveillance, decontamination and the workforce in the community; burning houses. The Ministry of Health has promised the next supply of drugs to Lwemba; 

- The Deputy General Coordinator for the Ebola Response to the Epidemic, representing the Ministry of Health and the Technical Secretariat of the CMRE, Dr. Justus Nsio Mbeta, took this opportunity to recall the regulatory role of the Ministry Health and the role of each partner involved in the response; 

- For the community victim of the fire, she asks for the guarantee of guarantee of their security, the emergency humanitarian aid, the compensation of their destroyed property and the reconstruction of their burned houses, the commitment or the hiring of all victims in the various services at all levels, the immediate arrest of all the alleged perpetrators of these uncivil acts and the care of the children affected; - These fires occurred following the death of a nurse from Lwemba, confirmed with Ebola Virus Disease. His death sparked the uprising of the population to burn down the houses and other property of all the unknowns of Lwemba. This remains the cause, even, the cessation of the activities of the response in this Health Area for more than 15 days; 

- The leaders of the Lwemba community also asked for the construction of the houses for the displaced, the organization of an intercommunal dialogue session by the Administrator of the territory or his delegate and the rehabilitation of the road to Lwemba ; 

- In the response, WHO is responsible for epidemiological surveillance, communication and prevention against infection (IPC) and immunization, UNICEF is in charge of communication, psychosocial care and PCI, MSF and ALIMA take care of the treatment of patients in the Ebola treatment center and the PCI and psychosocial support within CTE, WFP brings food products to contacts, IOM takes care of Entry and Control Points (water supply, soap and chlorine); 

- As for the National Institute for Biomedical Research (INRB), Dr. Nsio stated that he is in charge of the diagnosis and gives MSF and ALIMA the medicines to treat patients with CTE. 

- The World Health Organization has pledged to rebuild houses burned, to provide community surveillance (community watch) and investigations of all suspected cases, as well as to build a transit center in Lwemba, while UNICEF has pledged to improve communication and awareness through the use of space, to support ICH, decontamination and psychosocial, to provide water sources and to build latrines in 5 priority schools; 

- On the other hand, Médecins Sans Frontières intends to help the community of Lwemba to resume primary health care, to organize triage in the Health Zones present in the village and to break the PCI, as well as to train sensitizers; 

- At the end of this Lwemba meeting, all partners, including WHO, UNICEF and MSF, met around the Deputy General Coordinator at the Biakato Reference Health Center to review the joint and shared planning of activities in Lwemba.

VACCINATION

- Since vaccination began on August 8, 2018, 234,108 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.

MONITORING AT ENTRY POINTS

- Three high-risk contacts were intercepted on Saturday 05 October 2019 at Maboya Checkpoint (PoC) in Butembo. They are all from the same family and came from the Kabasha Health Area to Kalunguta for Bunyuka in Vuhovi;

- They are all contacts of a confirmed case, died of the Ebola Virus Disease (EVD) of September 30, 2019 in Kabasha;

- The 1st contact is a little girl of 8 years old, unvaccinated who presented fever at 38 ° C. She was taken to the CTE of Butembo for the care after validation of the alert was validated;

- The 2nd contact is a 24 year old man vaccinated and asymptomatic. This is the biological father of the 1st contact;

- The 3rd contact, grandmother of the 1st contact, 54, unvaccinated and asymptomatic;

- Since the beginning of the epidemic, the cumulative number of travelers checked (temperature measurement ) at the sanitary control points is 102,840,774 ;

- 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.

MSF: Vaccinating against Ebola: The challenges of containing the outbreak in Beni

Via MSF.org: Vaccinating against Ebola: The challenges of containing the outbreak in Beni. Excerpt:

Beni is one of the recurring hotspots of the current Ebola epidemic in North Kivu province of the Democratic Republic of the Congo (DRC). For more than a year, the outbreak response has been in full swing in the city.  

On site since the early days of the epidemic, Médecins Sans Frontières (MSF) has recently started supporting vaccination activities, a promising tool in the fight against the virus disease. Yet reaching the right people in time is a complex endeavour. 

Esther only winces slightly when a doctor from the vaccination team injects the investigational Ebola vaccine called rVSV-ZEBOV into her left upper arm in Kimbangu, a community in the southwest of Beni. Justin[not is real name], her two-and-a-half-year-old son, bursts into tears when he sees a new syringe being filled, and only calms down a few minutes after receiving his shot.   

The vaccine is painful in the arm, but the side effects are mostly mild. Early results show the vaccine provides effective protection for a promising 95 per cent of participants after 10 days.

Contacts are vaccinated in a well-coordinated routine 

Esther and her son came to one of three vaccination sites set up by MSF every day in Beni, as part of our latest efforts to contain Ebola with the response teams of the Ministry of Health and the World Health Organization.   

“There was a confirmed Ebola case in my neighbourhood, and a surveillance team told me that we should get vaccinated as we are likely contacts,” Esther said.   

Setting up the vaccination sites is a well-coordinated routine. A series of plastic tables are lined up next to a waiting area, registration and consent forms are put into place, and the vaccination team don protective gowns.  

Then an MSF vehicle delivers the first vials of the vaccine in a cooling container and a member of the surveillance team starts identifying eligible people. 

While Ebola cases have been on the decline in Beni since late August 2019, new suspected and confirmed cases are still being admitted to isolation zones in local healthcare facilities or the MSF-operated Ebola Treatment Centre (ETC) every day. Twice already, in December 2018 and June 2019, the outbreak seemed contained, only to flare up again  with even higher numbers.

Beni: 'Attack did not target an Ebola treatment centre'

Via 7sur7.cd: Beni/Ebola: 'Attack did not target an Ebola treatment centre'. The Google translation:

On the morning of Wednesday, October 2, 2019, armed men stormed the Masimbembe district, located in the rural commune of Mangina, in the territory of Beni (North Kivu). They were armed with guns but their target was not the Ebola treatment center, says local civil society. 

Immediately aware, the Congolese national police launched an offensive against these attackers. 

"The security forces fired several shots, and the police officers who are in charge of the MSF NGO also fired shots, which is why the attackers were not against the CTE. There are no major incidents, the patients are still there," Muhindo Rangi Jupson, chairman of Mangina's civil society, told 7SUR7.CD.  

The information is also confirmed by the Chief Senior Commissioner of the Congolese National Police of Beni. Safari Kazingufu Jean Felix reassures 7SUR7.CD that the situation was quickly mastered. 

Signs DR Congo Ebola outbreak finally ‘on the retreat’ but risk of international spread, ‘still high’

Via UN News: Signs DR Congo Ebola outbreak finally ‘on the retreat’ but risk of international spread, ‘still high’.

The second worst Ebola outbreak in history is “on the retreat” said the UN’s health agency chief on Wednesday, warning however that there is no room for complacency, with dozens of new cases each week still being recorded in eastern Democratic Republic of the Congo (DRC).  

“It’s not over, until it’s over” said Tedros Adhanom Gheybreyesus, speaking to reporters at UN Headquarters in New York, after a meeting co-hosted by WHO and the DRC Government, on the margins of the UN General Assembly, bringing together regional ministers for health, on Ebola preparedness and response. 

Latest figures show that more than 2,100 lives have been lost to the haemorrhagic fever since August last year, with 57 new cases recorded in the week up to 19 September; although around 1,000 have recovered from the disease, with more than 3,150 cases overall.  

“The outbreak is happening in a complex situation where there is political instability and also insecurity”, said Mr. Tedros. “While fighting Ebola in DRC we have to strengthen our preparedness in neighbouring countries, because the risk of spread is still high”. 

He said the meeting had agreed to invest in neighbouring nations not only to end the current outbreak, but also help prevent epidemics in the future. Within DRC, “we will strengthen the health system, because that’s what will give us better outcomes for the future too…that’s the commitment that was shown” during the meeting with ministers and partners, he added. 

Responding to criticism reportedly levelled at the WHO vaccination strategy by partner NGO in the DRC, Médecins Sans Frontières (MSF), that it had been too limited and selective in scope so far, Mr. Tedros told reporters that “we learn almost every day, and adjust our response accordingly”, adding that “be it on use of vaccines, on other strategies that we follow, we try and learn every day, and recalibrate our response on a regular basis.”    

The Health and Human Services Secretary of the United States, Alex Azar, was first to speak to reporters at the stakeout, and described the outbreak as “the most complex Ebola outbreak in history” and said stopping it, was one of President Donald Trump’s top priorities.  

Speaking alongside the DRC’s health minister, the top US health official thanked President, Félix Tshisekedi for attending the meeting, saying the “unique” circumstances of the outbreak meant it could not be stopped “without close and committed cooperation among all stakeholders”. 

“Thankfully, today’s meeting underscored that we do have that kind of on-going cooperation…Today’s meeting should send a powerful message that the ministers of health here today, will work together closely and relentlessly until this outbreak is over.”

Health experts fight Ebola in DR Congo, and each other

Via The New York Times: Health Experts Fight Ebola in Congo, and Each Other. Excerpt and then a comment:

In the urgent struggle to stop the Ebola epidemic in the Democratic Republic of Congo, doctors are rolling out powerful vaccines and lifesaving antiviral drugs, but the year-old outbreak, mired in violence among warring militias, is now caught between expert groups feuding over the best strategy to stamp out the disease. 

At the same time, there are disturbing suggestions that the virus may have spread to Tanzania and that the government there is withholding information about possible cases from the World Health Organization.  

The outbreak in Congo continues unabated, with 3,157 cases and 2,108 deaths as of Sept. 19, when the W.H.O. reported that disease transmission had worsened, with 57 new cases that week, versus 40 the week before. The affected region includes the provinces of North Kivu and Ituri, in the northeastern part of the country, near the borders of Uganda, Rwanda and South Sudan.  

Efforts to contain the disease in one hot spot, Lwemba, had to be suspended because of violence from Sept. 14 to Sept. 17, “a community response to the death of a local health worker” from Ebola, the W.H.O. reported, adding that the suspension “has a serious impact on the response activities on the ground.”

 A dispute between two major players in the epidemic response — Doctors Without Borders and the W.H.O. — erupted on Monday, just as the W.H.O. announced that a new vaccine, the second to be deployed, would be introduced into the region.  

On Monday, Doctors Without Borders accused the World Health Organization of “rationing Ebola vaccines and hampering efforts to make them quickly available to all who are at risk of infection.”  

The W.H.O. quickly fired back, saying it was “not limiting access to vaccine but rather implementing a strategy recommended by an independent advisory body of experts and as agreed with the government of the D.R.C. and partners.”  

The statement, from Dr. Mike Ryan, executive director of the W.H.O.’s health emergencies program, also said that the organization had deployed more experts to the region than any other group, and added, “Along with the D.R.C. government, no one wants to bring this epidemic to an end more than W.H.O.” 

The approach so far has relied on a traditional strategy called ring vaccination that has been used successfully against other diseases. It involves vaccinating everyone who has had contact with an infected person, and all the contacts of those people, as well. 

Officials from Doctors Without Borders say the strategy has not worked in Congo, in part because it has not been possible to track down every person who has come into contact with someone infected with Ebola, and because some contacts have refused to cooperate. The group has urged more widespread vaccination in regions where the disease is spreading, whether people are known contacts or not. 

But it says that instead the W.H.O. has doled out limited amounts of vaccine. About 225,000 people have been vaccinated, but Doctors Without Borders says 450,000 to 600,000 should have received the vaccine by now. 

The vaccine that has been used so far, made by Merck, takes effect after one dose. 

On Monday, the W.H.O. announced that the health authorities in Congo had decided to allow use of a second vaccine, made by Johnson & Johnson. That vaccine requires two doses, about two months apart, and will be used only in areas that are at risk but where the need is not urgent because the disease is not being actively transmitted. 

People at high risk, including contacts of cases, and their contacts, will still receive the Merck vaccine.  

Congo’s previous minister of health, Dr. Oly Ilunga, vehemently opposed using any vaccine but the Merck one, saying people had come to trust it and would be unlikely to accept a new one. He resigned in July after Congo’s president took control of the Ebola response away from him. Dr. Ilunga was arrested on Sept. 14, accused of mismanaging some $4 million meant for the Ebola response, a claim that his lawyers deny. 

Concerns about possible spread of the disease to Tanzania arose on Sept. 10, when the W.H.O. obtained “unofficial reports” of the death in Dar es Salaam, the largest city in Tanzania, of someone suspected to have had Ebola. Further unofficial reports said the person had tested positive for Ebola. Then the W.H.O. heard of two more possible cases. 

The W.H.O. said it requested information from Tanzania, but received none, even though International Health Regulations, agreed on by all W.H.O. member countries, require that suspected cases of Ebola be reported.

It's an old novelist's proverb: "Stress reveals character." DRC's 10th Ebola outbreak has provided over a year's worth of stress, and it's beginning to show in the responders.

So MSF, never known for its reassuring bedside manner, is barking at WHO. The Tshisekedi government in Kinshasa, pulling itself together after months of bargaining with the still-powerful Kabila faction, has tried to show it's in control by ousting Oly Ilunga and adopting the J&J vaccine. 

 

WHO, meanwhile, has lost its cool with Tanzania, where Ebola may or may not be present, and Tanzania has revealed its lack of character by going into sullen silence. 

 

If the late 34-year-old medical researcher did indeed die of Ebola, she didn't pick it up in DR Congo...which implies either a Congolese carrier in Uganda or even a whole new outbreak. (Or a completely different hemorrhagic fever.)

 

So yes, it's a stressful time. We'll learn a lot about the people dealing with Ebola over the next week or two. And about ourselves.

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.