Health workers in the Democratic Republic of Congo began vaccinating people Monday against an outbreak of Ebola that's killed at least 26 people. The experimental drug was tested in Guinea two years ago with a 100 percent success rate, but this is the first time a vaccine will be used to control an Ebola outbreak.
Here & Now's Peter O'Dowd speaks with Dr. Seth Berkley (@GaviSeth), an infectious disease epidemiologist and CEO of Gavi, the Vaccine Alliance, which is providing money and logistical support to get the vaccine distributed.
"I'm confident that the vaccine itself is effective — we've seen that in clinical trials and in animal studies — and will do what it needs to do," Berkley says. "Of course, it only can work if you can track the cases and then the contacts with them. So that is always the complicated picture."
On the Democratic Republic of Congo's past outbreaks of Ebola
"The good news is that DRC is a country that has experience with Ebola. It is the country where Ebola was first seen, and so over this last 40 years they've had nine outbreaks. Obviously they've been of varying intensity, but they've been able to control them using public health measures. Now, the last outbreak was a smaller outbreak. It was able to be controlled completely using public health means and didn't require a use of a vaccine. We now have a vaccine, and that is what is exciting and additional that can be done here. But of course, the fact that this has now moved into the provincial capital, where there's a large number of people, does raise a significant level of concern."
On the logistical challenges of distributing the vaccine
"This is one of the most difficult places on earth. This is in a heavy tropical rainforest without good infrastructure. ... The temperature stability issue is a challenge. The good news on that is that there are special carriers that can be used to transport the vaccine out to the emergency site and keep it at that temperature. And then you can take it out of that temperature and keep it in a fridge, a normal fridge, from 2 to 8 degrees, for a period of time as you are going ahead to use the vaccine. Now, once you take it out of that condition, once you've had it in the fridge, then if you don't use it in a period of time, you have to dispose of it. So we have to be very careful to try to keep it in that cold chain. But there is some flexibility in doing that. But it is going to be a very different task indeed."
"This is the first time that we're systematically going to be doing vaccination for an outbreak, other than the clinical trial in Guinea. So it is a new experience."Dr. Seth Berkley
On the "ring fencing" vaccination technique
"The ring vaccination idea really came from work by Dr. William Foege, former head of CDC, when he worked around smallpox. The original way people worked to try to get rid of smallpox was, you'd have an outbreak and they would try to cover the entire district, community, country. And what he came up with, the idea was, if you didn't have enough vaccine you could go to the case that had it, and then you could say, 'Who did the case have contact with?' And even extending it out further to people that, you know, the contacts had contacts with. Family members, friends, you know, if you've traveled outside, you've taken a taxi, if you've been to a funeral, all the people you've met. So the idea is to create a ring of protection around the cases to slow down transmission. That was what was done in Guinea. It was somewhere between 100 and 150 contacts per case. And that is the strategy that's going to be used here. Of course, on top of that, we will want to vaccinate the health care workers and burial workers, or others that are directly involved with the cases."
On the availability of the vaccine
"When Gavi originally made the commitment to work with the Merck Corporation, one of the agreements was that they would put aside 300,000 doses of vaccine, which is a substantial number. Now the idea behind that is some of those doses are available immediately, but also, in that process, if it looks like we need more doses, they can go ahead and turn on their manufacturing and produce more doses. So, I would say, at the moment, I'm not worried about those number of doses. The more important issue is moving as quickly as possible to get this vaccination started and to make sure that we are reaching the contacts and then doing this ring vaccination around them."
This article was originally published on May 21, 2018.
This segment aired on May 21, 2018.