Following a new Ebola outbreak in the Democratic Republic of Congo in early May, the World Health Organisation (WHO) has decided it is not yet an international public health emergency but is deploying an action plan to contain the disease, a move which proves particularly challenging this time.
Since the first Ebola outbreak in Equateur province in the Democratic Republic of the Congo on 10 May, 51 cases have been reported (28 confirmed, 21 probable and 2 suspected) including 27 deaths, a WHO spokesperson said.
“We are planning for all scenarios, including the worst-case scenario. It will be tough and costly to contain this outbreak”, the spokesperson said.
“At the moment, the regions of Mbandaka, Bikoro and Iboko are affected by the disease, this is the first time Ebola has appeared along a major river route”, he specified.
The first meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) regarding the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo took place on Friday 18 May.
It decided that the conditions for a Public Health Emergency of International Concern (PHEIC) have not currently been met.
But WHO is working with health authorities and partners to contain a new outbreak of Ebola virus disease in the Democratic Republic of the Congo, the spokesperson specified.
But he stressed that the current outbreak is serious.
“The appearance of six reported cases, including four confirmed, in Mbandaka city is very concerning. Controlling a virus once it has reached a large urban area is particularly challenging,” the spokesperson added.
WHO has deployed experts to conduct surveillance in the city, strengthen IPC and triage, prepare for the ring vaccination, and engage communities on the prevention, treatment and reporting of new cases.
“Surveillance is being heightened along the Congo River, at airports and other points of entry but access is extremely difficult due to the remoteness of the area. Access to Iboko is particularly challenging,” he said.
The World Food Programme (WFP) has assisted WHO in putting in place an air-bridge between Kinshasa, Mbandaka and other affected areas – with flights operating six days a week to deliver supplies and personnel.
The health ministry of the Democratic Republic of Congo is leading the response in affected health zones with support from WHO and partners.
“The DRC ministry of health is working with the United Nations Organization Stabilization Mission in the Democratic Republic of the Congo (MONUSCO), the International Organization for Migration (IOM) and WHO to increase surveillance along the Congo River, at airports, bus stations and other points of entry. IOM will deploy an additional 16 epidemiologists to support surveillance measures at points of entry”, the spokesperson said.
Priorities include strengthening not only surveillance and contact tracing but also increasing laboratory capacity, infection prevention and control, case management, community engagement, safe and dignified burials, response and coordination, and vaccination.
Together with the health ministry, WHO is setting up community-based data collection to complement the information provided by health facilities.
The organisation is also deploying around 30 experts to conduct surveillance in Mbandaka and is working with the health ministry and partners to engage with local communities on the prevention, treatment and reporting of new cases. Mobile laboratories are being set up as well.
The rVsV-ZEBOV vaccine
WHO sent special vaccine carriers, which can keep their contents in sub-zero temperatures for up to a week, and has set up freezers to store the vaccines in Mbandaka and Bikoro, the WHO representative said.
“This is not a general vaccination campaign for the whole population of the affected area. It is a targeted vaccination that protects the affected population by vaccinating people at highest risk of infection”, he specified.
Participation in this ‘expanded access’ or compassionate use of the Ebola vaccine is entirely free and voluntary.
“Everyone receiving the vaccine will be informed about potential risks and benefits of the vaccination and must provide written informed consent. After consent is obtained, everyone is screened by a doctor to assess eligibility using a protocol approved by the National Ethical Review Committee. People who consent and are eligibles are vaccinated”, he also specified.
The vaccine was studied in several trials that involved more than 16,000 volunteers in Europe, Africa and the United States, and has been judged safe for use in humans based on available results. In Guinea, the vaccine was tested on 7,500 adults in 2015 and found safe and protective against Ebola infection.
American pharmaceutical company Merck provided vaccines free of charge, the WHO representative added.
The rVSV-ZEBOV vaccine was developed by the Public Health Agency of Canada, licensed to NewLink Genetics, who in turn licensed it to Merck & Co.