From Science Mag with a running commentary inserted.
By Jon CohenMay. 15, 2018 , 3:30 PM
The first ever effort to use a vaccine to stop an Ebola outbreak in its initial stages is taking shape in the Democratic Republic of the Congo (DRC).
Virologist Yap Boum, who works with Doctors Without Borders (MSF) began planning his trip to the DRC as soon as it confirmed on 8 May that two Ebola cases had occurred in the remote Bikoro health district in the Équateur province.
THERE WERE ONLY TWO CASES OF EBOLA CONFIRMED WHEN WHO DECLARED AN EBOLA OUTBREAK ON MAY 9TH. BBC REPORTS SAME
As Science went to press, a total of 25 other probable cases and 14 suspected ones had been identified in Bikoro and two adjacent health districts. Nineteen of these people have died.
THERE HAVE NO MORE CONFIRMED CASES SINCE MAY 8TH
ALSO, WHO DID THE DIAGNOSIS?
Boum says the most alarming news from the DRC so far is that two of the probable cases are in Mbandaka, a port city of 1.2 million people. “The possibility of the virus spreading is huge,” adds Boum, noting that while Ebola is incubating undetected—which can take several weeks—the victim is already infectious.
MEDIA NARRATIVE PUSHES IDEA EBOLA ABOUT TO EXPLODE IN POPULOUS CITY AND SPREAD AROUND THE WORLD.
CLAIM NOW THAT EBOLA CAN TAKE SEVERAL WEEKS TO INCUBATE UNDETECTED, MUCH LONGER THAN OFFICIAL EBOLA INCUBATION PERIOD IN 2014 OUTBREAK
DRC President Joseph Kabila has authorized MOPH to use every tool at its disposal, including the experimental vaccine against Ebola, which worked spectacularly well in a clinical trial that Boum helped run in Guinea in 2015 at the tail end of the recent West African epidemic.
THE MERCK VACCINE WAS REFUSED FDA APPROVAL BECAUSE ITS IRREGULAR TRIAL DESIGN WITH NO CONTROL GROUP YIELDED DATA NOT DEEMED STRONG ENOUGH.
The World Health Organization (WHO) also acted quickly, immediately sending a team to the DRC to coordinate the response, which includes improved surveillance, introduction of safe medical and burial techniques, and the establishment of quarantine units operated by MSF and others.
QUARANTINE UNITS AND MARTIAL LAW MEASURES ARE BEING PUT IN PLACE.
WHO Director-General Tedros Adhanom Ghebreyesus even visited Bikoro last week.
WHY THE HYSTERIA WHEN ONLY TWO EBOLA CASES WERE CONFIRMED?
WHO has been heavily criticized for its slow response to the West African epidemic, the worst Ebola outbreak on record, which sickened more than 28,000 people and killed an estimated 11,310 before traditional containment efforts ended it.
The DRC considered using the vaccine for an Ebola outbreak last year, but it met with hurdles including importing the vaccine and uncertainty about whether the virus had moved beyond remote villages. “This time they’re much better prepared,” says Seth Berkley, who heads Gavi, the Vaccine Alliance, a nonprofit based in Geneva, Switzerland, that purchased a stockpile of the experimental vaccine and is providing financial assistance to the DRC.
BILL GATES’ GAVI IS PAYING FOR THE VACCINE.
The vaccine consists of a harmless livestock virus genetically engineered to display Ebola surface proteins.
VIRUS IS GENETICALLY ENGINEERED
It is made by Merck and not yet licensed for use by any country, but can be given as part of a trial under what are known as compassionate use regulations.
IT HAS NOT YET BEEN LICENSED FOR USE BY ANY COUNTRY BECAUSE THERE IS NO DATA SHOWING IT IS SAFE OR EFFECTIVE.
THE RULES HAVE BEEN RELAXED EVEN MORE THIS TIME ROUND.
The trial protocol, approved by DRC last year, relies on a “ring” strategy in which only people who have come in contact with cases, their contacts, health care workers, and other front-line responders are vaccinated.
HEALTH CARE WORKERS TO BE VACCINATED.
At press time, surveillance teams had identified 393 contacts. Some 8000 doses are being shipped to the DRC from WHO’s Geneva headquarters and Merck’s U.S. storage site. Special Arktek containers have already arrived that can maintain the vaccine at below freezing temperatures for travel to remote locations.
WHERE IS MERCK’S US STORAGE SITE WITH THE 300,000 PLUS VACCINES?
MSF will sponsor the trial in collaboration with investigators from the DRC’s health ministry. The team will follow vaccinated people for 84 days to assess whether any develop Ebola and to evaluate side effects.
The vaccine is but one of many tools being wielded to stop the outbreak as quickly as possible. All told, Gavi, WHO, the United Nations, and the Wellcome Trust have committed about $8 million to the DRC response, which includes sending mobile laboratories and equipment to the affected region, parts of which cannot be reached by car.