World Health Assembly: Ebola Outbreak In DRC Remains A Challenge

At the World Health Assembly yesterday, the World Health Organization (WHO) highlighted challenges and concerns around the current outbreak of Ebola in the Democratic Republic of Congo (DRC).

The 71st World Health Assembly is taking place from 19-26 May.

WHO Director General Tedros Adhanom Ghebreyesus told a briefing: “There is already commitment by the government but coordination of all the ministers and the president had already instructed all ministers to work together, then the other important element is the coordination of the partners and we have seen that already, that will make a difference.”

According to Peter Salama, WHO deputy director-general, Emergency Preparedness and Response, as of 23 May, there were “58 cases including confirmed, suspected and probable, and 27 deaths and we are now following actively with the government more than 600 contacts.”

Salama went on to highlight the current concerns about the outbreak and pointed out that the outbreak has a potential to expand. “The involvement of a town, Mbandaka, which is the capital of the equatorial province in that region with a population of more than one million people” is a concern, he said.

Other concerns have to do with fact that Mbandaka is on the Congo River, which is linked to Kinshasa and hence connected to surrounding countries like the Republic of Congo, and the Central African Republic, putting these places at risk of spread of the outbreak, he said. He also mentioned that five healthcare workers have been infected.

“That’s a tragedy in its own right, but it also signals a potential for further amplification,” he said, adding that dealing with three or four separate focal points of the outbreak is also challenging logistically.

However, he also highlighted the support and partnerships that have made progress possible in combating the spread of the outbreak so far. Starting from the government leadership by the WHO, support from Médecins Sans Frontières (MSF), UNICEF, World Food Programme, International Federation of the Red Cross and Red Crescent, Centre for Disease Control, UN Mission in the DRC (MONUSCO), International Organization for Migration (IOM), African CDC, Chinese CDC, and others, he stated.

The detective work of epidemiology according to Salama is what will “make or break the response to this outbreak.” This process involves the documentation of how people are getting infected and hence how to manage and control the transmission, he added.

A ring vaccination programme against the outbreak has started in the DRC, according to Salama. He also pointed out the challenges in carrying out the vaccination programme as a result of the remoteness of location of the site of the outbreak as well as lack of constant electricity. He clarified that the vaccination programme is not mass immunisation.

“This is a highly targeted ring vaccination where confirmed or probable cases are identified and each and every contact is traced and vaccinated and then the contacts of those contacts are then traced and vaccinated, forming protective rings around that case to protect the people themselves, the contacts, but also to prevent further community transmission,” he said. This was the same approach that was used for the elimination of smallpox disease in the 1970s, he added.

Gavi Support

Earlier this week (21 May), Gavi released a statement which highlighted how the vaccine will be deployed in the DRC. According to the statement, “[t]he vaccine has gone through Phase 3 trials but has not yet been licensed by relevant regulatory authorities.” It added that “[w]hile the vaccine goes through the licensing process, an agreement between Gavi and Merck, the developer of rVSV-ZEBOV [Ebola vaccine], ensures that 300,000 investigational doses of the vaccine are available in case of an outbreak,” and that “[i]t is these doses that will be used in the DRC.”

The statement further mentioned that Seth Berkley, CEO of Gavi the Vaccine Alliance, said that health workers will be the first to receive the vaccine. It also pointed out that towards the vaccination, Gavi is providing US$1 million and that the funding will support the “deployment of health workers, transport, critical supplies and other operations.”

In another statement released this week, Gavi mentioned that the ring vaccination programme began on Monday in the DRC due to “a very prompt reaction from the government,” and Gavi’s role in “making 300,000 investigational doses of the rVSV-ZEBOV Ebola vaccine available, some of which will be used in the current Ebola response.”

 

Image Credits: DFID .

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