As Ebola vaccinations begin in South Sudan, DRC officials highlight challenges, perceptions

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Vaccinations against Ebola in a South Sudan city close to the border of the Democratic Republic of Congo where the virus continues to spread, began today, the latest recognition of the potential for the ongoing war-zone outbreak still not officially deemed a Public Health Emergency of International Concern — or PHEIC — to become one.

The vaccinations of health workers in Yambio, a state capital in southwestern South Sudan, already challenged by outbreaks of other infectious diseases, limited health resources, wide-spread poverty, and populations displaced by political instability, follows the start of health worker vaccinations in Uganda by two months, and will be followed by vaccinations in other South Sudan areas bordering the DRC outbreak. Rwanda also has announced plans to vaccinate health workers positioned to be front-line responders in the event of cross-border spread.

Announced by the World Health Organization today, the South Sudan vaccination campaign is being supported by WHO, Gavi, the Vaccine Alliance, UNICEF, the U.S. Centers for Disease Control and Prevention and local partners, and accompanied by ongoing border screening, health worker training, surveillance capacity strengthening and community education.

More than 67,654 people in the DRC have received the Merck rVSV-ZEBOV vaccine, which, while still experimental, has been deemed “highly” protective against the Zaire Ebola strain now circulating in the DRC. It was previously used in the waning days of the West Africa outbreak, as well as during the previous, ninth DRC outbreak in the country’s northeastern region, that was contained within three months. The current outbreak, however, is now in its sixth month, and the most optimistic projections see it continuing for at least another six months. Less optimistic have been projections, including by CDC Director Robert Redfield, that the outbreak could continue, surfacing sporadically,  indefinitely. As of Saturday, according to the DRC Health Ministry, 675 people are confirmed to have fallen ill with the virus during the current outbreak, with an additional 49 cases yet to be confirmed, and  451 people have died as a result, with an additional 49 deaths possibly caused by the virus. So far, according to the ministry, 255 of those who fell sick have survived.

While providing essential protection for health workers and other known or likely contacts of infected individuals, the vaccine is still but one component of a larger strategy, reliant on comprehensive contact training, added health resources for diagnosis as well as treatment, community awareness, cooperation and participation, all challenged in areas where distrust has been fueled by political turmoil and violence.

The “majority of assaults and physical threats” against Ebola responders carrying out contact tracing and attempting community engagement, has come from “Ebola-affected communities themselves,” the DRC health ministry reported in its Saturday update. Some armed groups are cooperating with health responders, the report continue, easing the way to controlling the outbreak “as quickly as possible in their areas of influence.” The Ministry was taking exception to a report from Pulitzer-prize winning global health writer and former Council on Foreign Relations fellow Laurie Garrett that quoted a former UN representative on sexual violence calling the region the “rape capital of the world,” and discussing the risks of sexual spread of the virus in conflict zones. No cases of rape, or transmission caused by rape have been reported, the ministry stated.

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