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NEW YORK / PARIS / GOMA, 23 SEPTEMBER 2019-The World Health Organization (WHO) is rationing Ebola vaccines in the Democratic Republic of Congo (DRC) and hampers efforts to make them readily available to all those at risk of infection. declared the international medical organization Doctors Without Borders / Doctors Without Borders. (MSF) Monday.
According to the experts' recommendations, 450,000 to 600,000 people in the DRC should have already received the vaccine, but only 225,000 people, WHO controlling the supply, imposing strict limits on the number of doses administered to people who have it. need, said MSF. As a result, the epidemic continues to "come back" to areas supposedly covered by vaccination and some areas have remained active hot spots for most of the epidemic.
"WHO restricts the availability of the vaccine in the field and the eligibility criteria and their application for obscure reasons," said Dr. Isabelle Defourny, MSF's director of operations. "We believe that increasing the pace of vaccination is necessary and achievable. At least 2,000 to 2,500 people could be vaccinated each day, instead of 500 to 1,000 as is currently the case. "
The organization calls for the creation of an independent international coordinating committee to facilitate more transparent management of the Ebola vaccination program in the DRC. This would help increase the number of people protected against the disease that has killed more than 2,100 people since the declaration of the outbreak last year.
Even with a highly effective vaccine that can help prevent the spread of the Ebola virus and therapeutic treatments that can improve a patient's chances of survival, the Ebola epidemic in the DRC has a death rate of 67%. This is comparable to the Ebola outbreak in West Africa 2014-2016 that killed more than 11,000 people.
The WHO said that there were enough vaccines to meet the needs. The vaccine, rVSV-ZEBOV, is produced by Merck and has shown very high levels of efficacy.
Although known contacts – and contact contacts – of people with Ebola are expected to be vaccinated as part of the outbreak response (as part of the "ring" vaccination strategy), MSF in the DRC regularly reports that the majority of new Ebola cases are known contacts of previously confirmed cases that had not been vaccinated. It has been difficult to effectively use the "ring" approach for this outbreak, as only about half of the new reported Ebola cases have been identified as contacts of previous confirmed cases before getting sick and seeking a cure. treatment.
"Even when there are front-line health workers – a well-known and easily accessible population – in an outbreak of the epidemic such as that of Beni in the North-West Province. Kivu, nearly a third of them said that they had not been vaccinated, said Dr. Defourny.
Expanding immunization coverage beyond the ring approach and allowing some flexibility in eligibility criteria would allow a much higher number of people to be vaccinated and protected from the disease in transmission areas. active and in communities where people have been tested positive for the virus.
An expanded approach should be feasible as there is now a vaccine that has proven safe and effective; there are medical teams ready to be deployed; there is no problem with the cold chain [that keeps vaccines cold so they don’t become less effective]; there are enough doses to cover current needs and allow an extension of vaccination coverage; and when awareness is sufficient, the vast majority of the population wants to be vaccinated, said MSF.
"Community mistrust and resistance have often been reported as major obstacles in the fight against the Ebola virus," said Dr. Natalie Roberts, MSF Emergency Coordinator. "In reality, people would seek medical care as soon as possible. the onset of symptoms if we told them loud and clear and it is clear that they can be cured with recently proven treatments to significantly increase their chances of survival. They would also be more likely to be vaccinated if more people knew they could be protected from the virus with a highly effective vaccine against the Ebola virus. We must stop blaming communities for their own deaths and ensure that more people have access to treatment and vaccines. "
However, it will not be possible to increase the number of people vaccinated until WHO continues to tightly control the criteria of supply and eligibility. This lack of transparency has directly affected MSF's efforts to increase access to vaccination as MSF vaccination teams have often been forced to wait in North Kivu, one of the three provinces. affected in the DRC, waiting to receive a handful of doses reserved for people only. on a predefined list. MSF has collaborated with the DRC Ministry of Health to vaccinate more than 5,000 front-line workers at various times during the epidemic and is currently contributing to immunization activities in some health zones in Beni, the Philippines. main epicenter of the epidemic.
"Time is running out in an epidemic. Medical teams should be able to quickly provide treatments or vaccines based on what they see on the ground, "said Dr. Roberts. "If a mother cares for her ill child, diagnosed and infected with the Ebola virus, we not only wish to diagnose and treat the child, but also offer her mother post-exposure prophylaxis that could possibly be the only way to help her." prevent her from developing the disease and vaccinating her entire community so that if she gets sick, she will already have developed immunity. But our ability to perform real-time assessments and react accordingly is severely compromised by a rigid, hard-to-understand system. It's like giving firefighters a bucket of water to put out a fire, but only allow them to use a cup of water a day. Every day we see known contacts from confirmed Ebola patients who have not received their dose while they were eligible for vaccination. "
Such restrictions seem unjustified. A Phase III clinical trial in Guinea in 2015 determined that the vaccine was safe and effective. In the absence of regulatory approval, the DRC Ministry of Health and WHO have authorized the use of the vaccine as part of wider access during the course of the year. Hatching in progress. in the DRC. The manufacturer recently said that in addition to the 245,000 doses already delivered to WHO, they were ready to send 190,000 if needed and that an additional 650,000 doses would be available in the next 6 to 18 months.
However, more people will not be vaccinated until WHO clarifies the number of doses available and ensures that those available are rapidly provided to the communities in need. "To enable the optimal use of new tools in an epidemic context, transparency is essential," Dr. Roberts said. "How can we support the Congolese authorities in deploying these tools? How can we expect the Congolese population to trust a system that is not even transparent to front-line health workers such as MSF?
The independent international coordinating committee requested by MSF should build on the model of the international coordination group established in 1997 and composed of MSF, the International Federation of the Red Cross, UNICEF and WHO, which has effectively managed massive meningitis, cholera, and yellow fever outbreaks with limited vaccine stocks. The committee would bring partners together to improve immunization coordination, transparency of inventory management, share data, foster an open dialogue with the pharmaceutical company that makes the vaccine and ensure that the vaccine is provided to all most at risk. exposed to the virus.
In collaboration with the DRC Ministry of Health, MSF has been actively involved in the Ebola response in the north-east of the DRC since its statement of 1 August 2018. MSF teams have been providing care to the people of the DRC. confirmed or suspected Ebola patients, vaccinated front-line workers, enhanced infection prevention and control measures. conducted outreach activities in the community. They have also worked with many health facilities in the provinces of North Kivu and Ituri to support access to general health care for the population during the epidemic. Ebola and truly address the health issues of the population.
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