Ebola vaccine launch in North Kivu highlights urgency of seizing opportunities, closing health security gaps

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Ebola vaccine deployment reflects progress, need for ongoing strides in surveillance, laboratory resources, training

Research toward the development of an Ebola vaccine had languished for more than a decade when the gravity of the outbreak in West Africa was recognized in 2014. Although the virus, and its potential to spread quickly and devastatingly in remote areas had been recognized nearly 40 years earlier, as crisis escalated to eventually take the lives of more than 11,000 people — more than 500 of them health workers —  only two Ebola vaccine candidates had ever been tested on humans, neither yielding signs they would work. While the tragedy in West Africa spurred renewed and accelerated testing, they came too late to complete trials in Sierra Leone and Liberia, where by then the spread had been controlled by other means, and too late for the vast majority of people who had been exposed to the virus.

The announcement then, by the World Health Organization on Wednesday, that the vaccine that played a role in controlling the just-ended outbreak in the Democratic of Congo’s Equateur province has been deployed again, just one week into a confirmed outbreak on the other side of that country represents enormous progress. That the first recipients of the vaccine were health workers offers promise, also, that the devastating and compounding toll on front line care providers will not be repeated.

But the obstacles facing the ring vaccination campaign go well beyond those of meeting government protocols, securing the needed supplies, and keeping the vaccines cold across long and rough terrains with little reliable power. Now they include armed conflict that will necessitate military escorts for contact tracing and vaccine administration and that has caused the displacement of an estimated million people, against the added urgency of near and porous borders. About 3,000 people were vaccinated during the Equateur outbreak, and WHO has said another 3200 doses stand ready for the current outbreak. With 43 confirmed or probable Ebola cases one week into recognition of the latest outbreak, nearly 900 people have been identified as contacts so far.

The recognition and response to the last three Ebola outbreaks in the Democratic Republic of Congo, which have occurred in the last 17 months alone, demonstrate improvements in surveillance and laboratory capacities over the years since the virus was first identified in what was then Zaire, that for a time far outpaced vaccine development. Now, with the setting of a new outbreak demonstrating challenges that can evolve faster than responses, those efforts should accelerate as well.

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