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DRC Ebola Outbreak 2019 Blog 8 Ebola virus Vaccination Programs: A Tool to End Ebola virus and EID Epidemics?
EID vaccination programs are a new promising tool in the arsenal to end EID outbreaks. The new Ebola virus vaccine used in this 2019 DRC outbreak was tested in smaller outbreaks, including one in the western region of the DRC in the summer of 2018 (16, 17). The success of the Ebola virus vaccination program in earlier outbreaks gave hope that EID and Ebola virus outbreaks would be more easily controlled using this instrument. In December 2018 and again in January 2019, the WHO warned that the outbreak would last another 6 months. By mid-April 2019, about one-third of the original vaccine supply of 300,000 doses was already spent. At this rate the vaccine stockpile would be severely depleted within another 6 months, giving another explosive boost to this epidemic battle (23).
In fighting EIDs, vaccination programs require some cautionary strategies to achieve success. Vaccination campaigns can be a very effective tool in small locally contained outbreaks with a ‘few’ cases. Alone, ring vaccination (vaccinating close contacts of known infected cases) campaigns are not a solution to eliminating EID outbreaks. Several reasons why this Ebola vaccination program is less successful in the northeastern provinces of DRC have been discussed. They include: the size of the population to immunize, the larger urban environments in which vaccinations ‘chase’ new outbreaks, and the violence of rebel and local groups in the region forcing the movement of populations in this unstable environment. The vaccine program is one arm of a multi-pronged approach to break this epidemic. Aggressively pinpointing carriers, testing, isolating infected carriers and educating the public are also among the required strategies to contain outbreaks (3, 21, 57-58).
The following analogy should clarify how vaccinations control outbreaks and pandemics. Ebola virus vaccination gives an individual armor (immunity) that protects them from Ebola virus infection. An armored (vaccinated) person does not stop guns (infected people) from firing bullets (Ebola virus) at hundreds to thousands of rounds per day. Some of these bullets “hit” (infect) anyone who does not have armor. Those people who are struck by bullets later become guns that fire more bullets, affecting more people without armor. In this analogy to break the infection cycle means putting guns, infected people, into isolation clinics until they recover.
North Kivu and Ituri provinces have populations of about 8.5 million people and 3.5 million people, respectively. While prior regional migration of people took place for commerce and familial visits, the violent militias now play a role in the mobility of populations in this region. The total available Ebola vaccine stockpile is 300,000 units or about 2.5% of this regional population of 12 million people. It is not possible to vaccinate (supply armor to) each person in the region. While the Ebola virus vaccination program continues to play a major role in controlling this outbreak, it cannot be the major tool to end this outbreak with a large regional population and the northeastern provinces where infected people are increasingly found scattered across a region twice the size of Croatia (or the US’s state of West Virginia).
Copyright © 2019 Na’eem A. Abdullah All Rights Reserved
Morning fog on the African river Sangha. Congo. Sergey Uryadnikov Photographer/ Shutterstock Photos.
Many emerging infectious diseases originate in tropical ecosystems. See About Page - Sangha River.
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