“Pop-up” vaccination sites, widened eligibility for inoculations, reduced doses, and the addition of a new investigational vaccine candidate are among the strategies a panel of World Health Organization experts has recommended to reverse discouraging trends, including increased cases and continuing security threats confronting responses to the ongoing Ebola outbreak in the Democratic Republic of Congo.
While more than 110,000 people, including health workers, contacts of infected people and their contacts, have been vaccinated against Ebola over the slightly more than nine months of the current outbreak, the revised strategy gives a glimpse of challenges facing efforts to contain and quell the spread of the virus. Central to those are security challenges stemming from continued armed conflict, civil unrest, and the distrust of government and outsiders those have fueled. Both interrupting and creating obstacles to the ring vaccination strategy effective in the previous outbreak, those conditions have stalled efforts to reach contacts and break chains of transmission. To streamline the process and improve security, the panel recommends establishing fixed vaccination sites to which contacts will be invited, as an alternative to visiting the homes of contacts.
In the face of challenges interfering with reaching all known contacts, and their contacts, the panel also recommends the additionally proactive approach of expanding the eligibility for vaccination to third-level contacts, and to residents of communities where a case has been confirmed in the preceding three weeks.
At the same time, the revised strategy highlights potential concerns about a continuing and uninterrupted supply of vaccines against the virus, with doses adjusted for the level of risk, and the proposed introduction of an additional investigative vaccine developed by Johnson & Johnson. The one, still investigational vaccine, developed by Merck, tested at toward the end of the West Africa Ebola crisis, and used so far in the current, and immediately preceding DRC Ebola outbreaks, has been demonstrated to be effective at lower dosages, according to the panel. The revised strategy recommends half the current dose be administered to those at highest risk, and less than a quarter of the current dose be administered to those at lower risk, while the newer candidate be rolled out in communities at lower risk.
The updated interim recommendations are here.