Deployment of second Ebola vaccine would not be a quick fix, warn experts

GOMA, Democratic Republic of Congo (Reuters) – The resignation of the Congolese Minister of Health in the midst of the worst Ebola outbreak could pave the way for a second experimental vaccine. But the new shot would likely take months to gain the confidence of the scared locals and show results, say the health authorities.

Oly Ilunga, who opposed the use of the vaccine developed by the US pharmaceutical giant Johnson & Johnson, resigned as minister on Monday after being ejected from the Ebola response team.

The World Health Organization has recommended the injection of the two-dose vaccine in addition to a vaccine from the US manufacturer Merck, which has been very protective, but the supply is relatively limited.

Promoters, including Medecins Sans Frontieres (Médecins Sans Frontières) and the Wellcome Trust, said the new vaccine could be deployed in areas not yet affected by the Ebola virus to create a firewall against the virus. WHO declared last week as an international health emergency. .

Ilunga added that the J & J vaccine had not yet proven its effectiveness and that it could cause confusion in the east of the Democratic Republic of Congo, where illicit rumors hinder the response. In his letter of resignation, he stated that the lawyers had demonstrated a "lack of ethics by hiding important information from the medical authorities," without giving details.

Such skepticism may resonate strongly on a continent where some pharmaceutical trials have already been accused of failing to obtain informed consent and providing poor quality care to participants.

For example, trials funded by the US government on anti-HIV drugs in the 1990s were double standards for giving placebos to African women when effective treatments existed, a practice generally prohibited in the United States. in other western countries for ethical reasons. . Researchers have defended the use of placebos as scientifically necessary.

Jean-Jacques Muyembe, an epidemiologist and Ebola expert appointed to head the Congolese intervention team, dismissed Ilunga's concerns and said the authorities would review the possibility of deploying a second vaccine. However, he downplayed the importance of the decision.

"I do not think the vaccine is slowing the answer," he told Reuters, noting that previous Ebola outbreaks were quickly controlled without a vaccine.

"We could use or not use. This will not change the evolution of the epidemic, "he said.

"NOT ETHICAL"

The epidemic that lasted nearly a year infected more than 2,500 people and killed more than 1,700. This figure was only surpbaded by the 2014- epidemic. 2016 in West Africa that killed more than 11,300 people. This month, a case was detected in Goma, a town of 2 million residents on the Rwandan border, raising fears of a spread of haemorrhagic fever.

Mistrust of health personnel and violence by armed militias undermined efforts to contain it. The treatment centers were attacked. Local activists say people are scared and confused about the various drugs used. In addition to the vaccine, four experimental treatments are given to patients with Ebola.

All of them still do not have a license, which means that they can only be used in clinical trials supervised by the Congolese Ministry of Health. "It is not ethical to test vaccines against people," said Matina Mwanack, a human rights group administrator in Butembo, eastern Congo, called Families United. Against Ebola.

"(We) have suffered greatly from the lack of necessary information about vaccines and treatments tested."

Omar Kavota, who heads a group of religious and political leaders in eastern Congo, said that "the introduction of a second vaccine would boost rumors", including on why some patients received one while others received the second.

Muyembe said communicators have been appointed to make the process more transparent.

STOCKPILES Proponents of a second vaccine claim that it can only be tested in a live epidemic because it would be unethical to deliberately infect test volunteers. They propose to deploy it where the disease has not yet spread, while the Merck vaccine continues to be used to protect contacts from suspected cases. "The two vaccines must work together," said Peter Piot, director of the London School of Hygiene and Tropical Medicine and one of the scientists who discovered the Ebola virus. Since the outbreak in West Africa, J & J has tested its vaccine on more than 6,000 volunteers over a dozen trials, confirming its safety and ability to generate an immune response.

It requires two injections several months apart – a potential obstacle in an area where fights involve frequent movement – but should last longer. "The goal is to provide a safe long-term profile for people who may never be exposed to Ebola," said Paul Stoffels, J & J's chief scientist, adding that 1.5 million doses were available. Josie Golding, outbreak manager at the Wellcome Trust, said "we could miss Merck vaccines" if the outbreak continues into a second year. WHO has already started using lower doses to ration supplies.

The Congolese Ministry of Health contests a shortage of Merck vaccine. The company said it plans to produce about 900,000 doses over the next six to 18 months, in addition to the 440,000 doses that have already been given or are available.

The ministry also looked at potential vaccines developed by Chinese companies CanSino Biologics, Russian company Rospotrebnadzor and Russian research institute Gamaleya, but these discussions are less advanced.