26 May 2019

East Africa: High-Risk EA Weighs Using Trial Ebola Vaccine to Avert DRC Spread

Even as Ebola response teams struggle to contain the disease outbreak in the Democratic Republic of Congo, East African Community ministers of health say they are alive to the risks, and are now considering using an experimental Ebola vaccine.

In the recent past, Ebola treatment centres in DRC have come under repeated attack while response workers have been unable to move about in outbreak hotspots.

Now the six countries, especially those bordering DRC's North Kivu and Ituri Provinces, where the Ebola outbreaks have escalated, are pulling out all stops to ensure that they are able to respond effectively should there be a confirmed case.

Uganda, Burundi and Rwanda are at high risk, while parts of South Sudan and Tanzania that are close to border towns are considered to be at medium risk.

Explaining the decision to use the vaccine, Acting Head of the Health Department at the East African Community Secretariat in Arusha, Dr Michael Katende said using Ebola vaccine is good for frontline districts and workers.

"Since it is the most promising candidate, it is better to have something that is giving you some protection than have nothing at all," he said.

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Ebola is a virus that causes severe bleeding and organ failure and can lead to death. The disease is primarily spread by animal or insect bites or stings.

Humans may spread the virus to other humans through contact with bodily fluids such as blood.

Initial symptoms include fever, headache, muscle pain and chills. Later, a person may experience internal bleeding resulting in vomiting or coughing blood.

With more than 1,100 dead, Congo's Ebola outbreak is only getting worse.

The World Health Organisation has recommended "compassionate" use of the vaccine known as rVSV-ZEBOV, which scientists say has proven to be safe and well tolerated.

The vaccine, however, is still under trial and is currently not in the market.

Expanded access

Compassionate use (also called expanded access) provides a pathway for patients with life-threatening conditions to gain access to unapproved investigational drugs, biologics and medical devices.

As the Ebola outbreak rages on in the DRC and the WHO and other organisations face increasing pressure to respond, there are questions over whether it is time to declare a public health emergency of international concern.

Dr Katende said that in the region, the drug will be given to frontline districts and people at high risk of contracting the virus, like healthcare workers.

But Dr Katende said that not all countries will have access to the drug currently given out in quotas, as it is not only costly and will need a donor partner, but also because the available doses have been prioritised based on the country's risk of an outbreak.

"Because it is a trial vaccine and the number of doses produced are limited, the quota system is being used. In DRC, the vaccine is being dispersed in quotas. Over and above these doses, countries have to pay or find a donor partner to help them pay for the dose," said Dr Katende.

He added that interested countries will have to submit and follow the ethical approval and requirements for using a trial drug.

This is because in the first few days after vaccination, many vaccines experience a mild acute-phase reaction fever, headache, muscle and joint pains for a short duration.

DRC epidemic

However, Dr Katende said the benefits outweigh the risks, especially at a time when the ongoing Ebola outbreak in DRC is considered the second deadliest in history, after the haemorrhagic fever killed 11,310 people across three countries in West Africa from 2013 to 2016.

The epidemic attracted worldwide attention. Since no specific drugs or treatments were available at the time, vaccination was considered the most promising and effective method of controlling the epidemic.

rVSV-ZEBOV was used in the DR Congo in the 2018 outbreak and has since been used extensively, particularly for people who are most likely to be infected in order to inhibit the spread of the disease.

Currently there is no licensed vaccine against Ebola.

Early this month, the WHO issued new recommendations to control the spread of the Ebola outbreak in the DRC.

Through its strategic advisory group of experts -- Sage -- WHO endorsed the expansion of the population eligible for vaccination with the Merck vaccine and introduced an additional experimental one developed by Johnson & Johnson.

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