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War zone complicates roll-out of Ebola vaccine in latest outbreak

Two Congolese Government troops reach the top of a green hill overlooking Lake Kivu. Buildings can be seen by the lake shore

Ebola vaccines will be difficult to dispense in the North Kivu province owing to conflict zones in some areas.Credit: Dai Kurokawa/EPA/Shutterstock

Aid workers in the Democratic Republic of the Congo began giving an experimental Ebola vaccine to health workers on 8 August — one week after the World Health Organization declared an outbreak of the virus. First responders and public-health staff are scrambling to contain the outbreak while planning how to roll out the vaccine to communities in the middle of a conflict zone.

The virus is spreading in North Kivu and Ituri, in the east of the Democratic Republic of the Congo (DRC). As of 7 August, 44 people had shown symptoms of Ebola — including 36 who had died. But violence perpetuated by more than 100 armed groups fighting over resources and power in those lush, green provinces has escalated this year in advance of the country’s presidential election scheduled for December. This is the nation’s tenth Ebola outbreak since 1976, but it is the first in this tumultuous eastern region.

“The situation is volatile,” says Ibrahima Socé-Fall, director of the World Health Organization’s (WHO’s) emergency operations in Africa, based in Brazzaville in the neighbouring Republic of Congo.

Even so, researchers are also gearing up to give people with Ebola experimental antibody and antiviral drugs in addition to the vaccine.

Making contacts

Socé-Fall says that at least 2,000 doses of the experimental vaccine, called rVSV-ZEBOV, remain in the country from the most recent Ebola outbreak, which ended in July, and more doses are on the way. The DRC will need a larger vaccine supply now because the strategy deployed during the previous outbreak will not work for the current one. That last outbreak, which hit western DRC, lasted three months.

During the previous outbreak, officials vaccinated health workers, people who had direct contact with someone with Ebola and the contacts of those contacts. But the instability in North Kivu and Ituri has made tracking such connections difficult. In towns where people have been infected but officials can’t track down their contacts, workers might vaccinate the entire community instead, says Socé-Fall.

An inability to track these connections worries epidemiologists because the virus spreads through people on the move. Humanitarian groups estimate that this year, nearly 750,000 people in North Kivu and Ituri have fled from militia fighters who maim and rape people and burn villages to the ground. And about one million refugees who have been displaced from their homes by fighting over at least the past decade continue to travel frequently between cities in the region. Some refugees migrate through the porous borders of neighbouring countries such as Uganda, Rwanda and Burundi.

A WHO mobilizer faces a room full of people sat on wooden chairs. A women in pink at right speaks animatedly with his colleague

Workers with the World Health Organization speak during a community engagement training in the North Kivu city of Beni.Credit: Eugene Kabambi/WHO

Armed escorts

Aid agencies must now figure out how to get into these conflict zones to fight Ebola without endangering their staff. Workers might travel with armed security escorts provided by the DRC government for their protection, said Peter Salama, WHO’s head of emergency preparedness and response, at a press briefing on 3 August.

But a key organization fighting Ebola in the area, Médecins Sans Frontières (MSF, also known as Doctors Without Borders), hesitates to use that approach. The group feels that travelling with armed escorts hinders their ability to help people of various political affiliations, says Salha Issoufou, the head of MSF’s operation in DRC. So MSF will forgo the escorts.

The next phase of the response by the WHO, the DRC government and aid groups will be to use experimental drugs to treat people who have Ebola. That could begin later this week, says Steve Ahuka, a virologist at the National Institute for Biomedical Research based in Kinshasa. A national review board that evaluates research ethics has approved the use of these treatments, and Ahuka says that a few therapeutics have just arrived in the region.

One treatment is an antibody called mAb114, a drug derived from an antibody found in a survivor of the 1995 Ebola outbreak in the DRC and manufactured by the US government. Others include the antiviral drugs Favipiravir (T-705), made by Japanese company Toyama Chemical, and Remdesivir (GS-5734), produced by Gilead, based in Foster City, California.

“Thanks to our experience from the previous outbreak, we are prepared,” says Ahuka.

Nature 560, 289-290 (2018)


Updates & Corrections

  • Correction 09 August 2018: This story has been corrected to reflect the fact that the US government manufactured the antibody treatment mAb114, not Mapp Biopharmaceutical.


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