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BENI, Congo (AP) – Until his last breath, Salomon Nduhi Kambale insisted that he had been poisoned by someone and that that was the reason he vomited blood. The 30-year-old man did not want to give his phone number to the health teams in the community and when they found him, he hung up on them.
Health workers desperately needed to persuade him to be vaccinated against Ebola after a friend became ill from the deadly and highly contagious disease.
But after a few days, Nduhi was dead. His widow and their four young children got a positive Ebola test result and a chilling warning from a team of health workers: "If you do not accept the vaccination, you can prepare for die."
Deep distrust – combined with political instability and deadly violence – has seriously undermined efforts by Congolese public health authorities to halt the epidemic by searching for and vaccinating people who may be at risk. have been in contact with infected persons.
Health experts agree that the experimental Ebola vaccine has saved a multitude of people in Congo. But after almost a year and about 171,000 doses, the epidemic shows little sign of decay. The virus has killed more than 1,700 people and has now arrived in the largest city in the region, Goma. Last week, the World Health Organization declared the epidemic a global health emergency.
During the 2014-2016 Ebola outbreak in West Africa, which claimed the lives of more than 11,300 people, health workers could only dream of d & # 39; a vaccine with an effectiveness rate of 97.5% that could improve the chances of survival even in people already infected.
"We have it now and it is not the miracle we wanted," said Dr. Joanne Liu, president of Doctors Without Borders. "The fact that we have used so many vaccines and the epidemic has not stopped shows us that the search for contacts is not excellent."
According to the WHO, not less than 90% of people eligible for vaccination have accepted it, but this figure only includes people who provided the tracers with sufficient contact information for appear on a list. The success rate excludes those who were suspicious of health workers and who had fled, or those who could not be found.
Health workers use a so-called ring vaccination strategy: the vaccine is first administered to those who were in close contact with a sick person. Then a second ring is created giving the vaccine to those who have been in contact with these people.
Because of the difficulties in making this strategy work, some people were not vaccinated until they became infected with the virus, and they still developed the Ebola virus. This has increased doubts about the vaccine in communities where public health campaigns led by foreigners were already perceived with suspicion and hostility.
"Rumors ran that if you were to be vaccinated, you would die," said Liboke Kakule Muhingi, a 43-year-old farmer from Mangina, where the outbreak began last August.
His mother was among the first to die. Then, one by one, six of her sisters who had taken care of their sick mother were killed by Ebola. Kakule accepted the vaccine and ensured that his wife and eight children also received it.
"If it was not the case, we would all be dead," he said.
In some cases, health teams have been unable to reach certain areas because of violence or rebel activity. Earlier this month, the head of the Congolese Ministry of Health's response efforts in Beni was unable to return after a field visit while the army was fighting rebels of the ADF, linked to the country's military. Islamic State.
In most cases, however, contact lists have collapsed simply because people deliberately evaded health workers or did not understand that they should not travel after being exposed. A pastor who became the first confirmed case in Goma had apparently entered false names at health checkpoints to avoid detection. He had been sick in the town of Butembo and then took a bus while being sick.
The WHO and the Congolese Ministry of Health have now changed tactics and are offering the vaccine to anyone who wants it.
With the arrival of Ebola in Goma, a city of more than 2 million residents, some are wondering if there will be enough vaccine if the epidemic continues.
The vaccine maker, Merck, has announced that it has 245,000 doses of 1 milliliter and that it could reach 900,000 doses over the next 18 months. In Congo, the dose was also reduced to 0.5 ml, doubling the supply.
"Whether available doses are sufficient or not to meet the demands depends on the evolution of the epidemic, access to communities and the successful development of additional dose production by Merck at the beginning of 2020, "said WHO.
There is a second experimental vaccine, produced by Johnson & Johnson, but health officials in the Congo said it would not be used because it would require additional testing and cause too much confusion. It requires two doses administered one month apart.
It is not clear how long the Merck vaccine will protect people. Scientists know, thanks to the first studies, that it lasts at least a year, but the epidemic is approaching this threshold. The only study to report a longer life span of the vaccine followed only a small number of healthy volunteers in Geneva for two years.
The new strategy of giving shots to all those who want it implies the setting up of "ephemeral" sites in the most affected neighborhoods. Last week, a vaccination team went to the Beni neighborhood where Nduhi's wife had remained after his death.
Outside the mud brick house where her children were still living, a van full of plastic tables and chairs stopped. Soon, a tent was set up and the vaccination teams put on eye protection and a yellow surgeon's gown. The neighborhood kids climbed the trees to watch.
Baraka Kathembo Makasi, a 22-year-old motorcycle taxi driver, took away his wife and two children.
"At first I refused," he said, "but I started to see people dying and I decided to go."
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