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

FILE PHOTO: Congolese health workers collect data before administering ebola vaccines to civilians at the Himbi Health Centre in Goma, Democratic Republic of Congo, July 17, 2019. REUTERS/Olivia Acland/File Photo

By Fiston Mahamba, Kate Kelland and Aaron Ross

GOMA, Democratic Republic of Congo (Reuters) – The resignation of Congo’s health minister in the midst of the country’s worst Ebola outbreak could clear the way for a second experimental vaccine to be deployed. But the new shot would likely take months to win the trust of frightened locals and show results, health officials say.

Oly Ilunga, who opposed using the vaccine developed by U.S. pharmaceutical giant Johnson & Johnson, resigned as minister on Monday after being bumped off the Ebola response team.

The World Health Organization recommended the two-dose shot to complement a vaccine by U.S. drugmaker Merck, which has proved highly protective but is in relatively short supply.

Proponents, including medical charity Medecins Sans Frontieres (Doctors Without Borders) and the Wellcome Trust, said the new vaccine could be deployed to areas not yet affected by Ebola to create a firewall against the virus, which the WHO declared an international health emergency last week.

But Ilunga said the J&J vaccine had not been proven effective and could confuse people in eastern Democratic Republic of Congo, where wild rumors are hampering the response.

“Congolese have the right to have the gold standard, the best vaccine,” he told Reuters on Thursday, in his first public comments since resigning. “They don’t need to be the subject of experimentation.”

“You can’t have a group of promoters, producers of the vaccine (and) university researchers wanting to introduce the vaccine without contacting the health authorities,” he said, without elaborating further.

Paul Stoffels, J&J’s chief scientific officer, denied there were any efforts to secretly introduce the vaccine and said the company had been in full communication with Congolese authorities.

But skepticism about new medicines can resonate strongly on a continent where some pharmaceutical trials have faced accusations in the past of failing to obtain informed consent and providing sub-par care to participants.

For example, some U.S. government-funded trials of HIV drugs in the 1990s were accused of double standards for giving placebos to women in Africa when effective therapies existed, a practice that is not generally allowed in the United States and other Western nations on ethical grounds. Researchers defended the use of placebos as scientifically necessary.

Jean-Jacques Muyembe, an epidemiologist and Ebola expert named to lead Congo’s response team, dismissed Ilunga’s concerns and said authorities would revisit whether to deploy a second vaccine. However, he downplayed the importance of the decision.

“I don’t think that a vaccine is what’s holding back the response,” he told Reuters, noting that previous Ebola outbreaks had been contained quickly without a vaccine.

“We could use or not use. It won’t change the evolution of the epidemic,” he said.

“NOT ETHICAL”

The nearly year-long outbreak has infected more than 2,500 people and killed more than 1,700, numbers topped only by a 2014-16 outbreak in West Africa that killed more than 11,300. This month, a case was detected in Goma, a city of 2 million on the border with Rwanda, heightening fears about the spread of the hemorrhagic fever.

Efforts to contain it have been undermined by mistrust of health workers and violence by armed militias. Treatment centers have been attacked. Local campaigners say people are scared and confused about the various medicines being used. In addition to the vaccine, four experimental treatments are being given to Ebola patients.

All are still unlicensed, which means they can only be used in clinical trials overseen by Congo’s health ministry. “It is not ethical to test vaccines on people,” said Matina Mwanack, the administrator of an advocacy group in the eastern Congo city of Butembo called Families United Against Ebola.

“(We) have suffered a lot from the lack of needed information about the vaccines and treatments being tested.”

Omar Kavota, who heads a group of religious and political leaders in eastern Congo, said “introducing a second vaccine would amplify rumors”, including over why some patients got one while others received the second.

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

STOCKPILES

Proponents of a second vaccine argue it can only be tested in a live outbreak since it would be unethical to deliberately infect trial volunteers. They propose deploying it where the disease has not yet spread, while the Merck vaccine continues to be used to protect contacts of suspected cases.

“Both vaccines should work hand in hand,” said Peter Piot, director of the London School of Hygiene and Tropical Medicine and one of the scientists who first discovered the Ebola virus.

Since the West African outbreak, J&J has tested its vaccine on more than 6,000 volunteers in a dozen trials, confirming its safety and ability to generate an immune response.

It requires two injections 56 days apart – another obstacle cited by Ilunga – in an area where fighting causes frequent displacement but should last longer.

“The goal is to give a long-term safe profile for people who may never be exposed to Ebola,” said J&J’s Stoffels, adding that 1.5 million doses were available.

Josie Golding, head of epidemics at the Wellcome Trust, said “we could run out of Merck vaccines” if the outbreak extends into a second year. Health authorities have already begun using smaller doses to ration supplies.

Congo’s health ministry disputes there is a shortage of the Merck vaccine. The company said it expects to produce about 900,000 doses over the next six to 18 months, in addition to 440,000 doses that have already been donated or are available.

The ministry has also considered potential vaccines developed by China’s CanSino Biologics and the Russian research institutes Rospotrebnadzor and Gamaleya, but those discussions are less advanced.

(Mahamba reported from Goma, Kelland from London and Ross from Dakar; Additional reporting by Stanis Bujakera in Kinshasa and Manas Mishra in New York; Editing by Tim Cocks, Alexandra Zavis and Giles Elgood)

WHO sounds Ebola alarm as risks intensify

A Congolese health worker administers ebola vaccine to a child at the Himbi Health Centre in Goma, Democratic Republic of Congo, July 17, 2019. REUTERS/Olivia Acland

By Tom Miles

GENEVA (Reuters) – The World Health Organization on Wednesday declared Congo’s Ebola outbreak an international health emergency, sounding a rarely used global alarm after the virus threatened to spread to a major city and into neighboring countries.

Despite a highly effective vaccine and a swift international response after it was declared 11 months ago, the outbreak has proved tenacious in an unstable region beset by violence, becoming Congo’s worst ever, with almost 1,700 dead.

A vast campaign of vigilance and vaccination, with almost 75 million screenings, has kept the highly infectious virus almost entirely confined to two provinces in northeastern Congo. The emergency committee of international health experts that advises WHO had thrice declined to declare an emergency.

But this month a pastor died after traveling to Goma, a city of 2 million and a gateway to other countries in the region. On Wednesday, the WHO reported a fisherwoman had died in Congo after four vomiting incidents at a market in Uganda, where 590 people may be sought for vaccination.

“The committee is concerned that a year into the outbreak, there are worrying signs of possible extension of the epidemic,” the committee’s report said.

The committee had been under pressure from many experts who felt the scale of the outbreak and the risks meant it had to be given the emergency status – only the fifth such disease outbreak since the WHO introduced such designations in 2005.

“It shows no sign of coming under control,” said Peter Piot, a member of the team that discovered Ebola and is now director of the London School of Hygiene & Tropical Medicine.

“I hope that today’s decision serves as a wake-up call to drive high-level political action, improved coordination, and greater funding to support DRC in their efforts to stop this devastating epidemic,” he said.

NO BORDER CLOSURES

The previous international emergencies, under a system introduced after the 2004 Asian SARS epidemic, were the 2013-2016 West African Ebola epidemic that killed over 11,300 people, the 2009 flu pandemic, polio in 2014 and the Zika virus that caused a spate of birth defects across Latin America.

The WHO committee’s chairman, Robert Steffen, tempered the outbreak’s designation as an emergency by saying it remained a regional, rather than a global threat, and stressed that no country should react to Ebola by closing borders or restricting trade.

The WHO has warned that the nearby countries of Rwanda, South Sudan, Burundi and Uganda are the most at risk, while Central African Republic, Angola, Tanzania, Republic of Congo and Zambia are in a second tier.

Earlier this week the WHO said hundreds of millions of dollars were needed immediately to prevent the outbreak billowing out of control and costing far more lives and money.

But WHO chief Tedros Adhanom Ghebreyesus, who convened the emergency committee after viewing the Goma case as a “potential gamechanger”, said the designation as an international emergency was not meant to suggest that some countries had been withholding funds and would now unlock them.

One priority was to accelerate the production of the vaccine, which is in short supply. It is produced by Merck and still unlicensed, which means it can only be used in a clinical trial overseen by Congo’s health ministry.

WHO has already begun using smaller doses to ration supplies and the committee recommended taking “all measures to increase supplies”, including contracting supply to other manufacturers and transferring Merck’s technology.

(Reporting by Tom Miles, Kate Kelland and Nairobi newsroom; Editing by Gareth Jones, John Stonestreet and Dan Grebler)

Congolese cross-border trader’s Ebola death fuels Uganda outbreak fears

FILE PHOTO: A Congolese health worker prepares to administer Ebola vaccine, outside the house of a victim who died from Ebola in the village of Mangina in North Kivu province of the Democratic Republic of Congo, August 18, 2018. REUTERS/Olivia Acland/File Photo

By Tom Miles

GENEVA (Reuters) – A Congolese woman who died of Ebola this month vomited four times in a Ugandan market after crossing the border days earlier to sell fish, the WHO said, fuelling fears that the virus may be spreading beyond the Democratic Republic of Congo.

The current outbreak of the highly infectious disease has been all but confined to Congo, killing 1,673 people there – more than two-thirds of those who contracted it – over the past year, and three in Uganda last month.

A World Health Organization panel is debating whether to declare the outbreak “of international concern”, a designation that the agency’s head suggested a case this month in the large Congolese city of Goma had made more likely.

The fisherwoman traveled across the border to Mpondwe market on July 11, according to a Ugandan Health Ministry report published on Wednesday by the WHO.

It said 19 fishmongers were listed as having had possible contact with her while another 590 could be targeted for vaccination.

The health response to the virus relies on tracking down and testing people who may have been exposed to it and vaccinating them and anybody they have had contact with.

Ugandan and Congolese officials were working to find people who might have been put at risk by the dead woman, who appeared to have used an illegal border crossing, health ministry spokesman Emmanuel Ainebyona said.

So far “no one has been found to be positive of the Ebola virus. The team is still monitoring the tested traders,” he said.

The report said health workers had not established where the fishmonger spent nights, who transported her merchandise and who cleaned up her vomit.

The Ministry and the WHO said there were currently no confirmed Ebola cases in Uganda.

The WHO’s emergency committee of international experts were meeting on Wednesday for a fourth time to consider if the 11-month outbreak constituted a “public health emergency of international concern” (PHEIC), and will announce their decision at 1700 GMT.

A PHEIC declaration would be just the fifth in WHO history and include recommendations for international action. It could also help unlock sorely needed funds.

Last month the committee decided the potential disruption of declaring one risked causing economic harm while achieving nothing.

But WHO chief Tedros Adhanom Ghebreyesus said this week that the case in Goma was a potential game-changer since it meant Ebola might now spread among the urban population and into neighboring Rwanda.

A separate WHO report cited a very high risk for Uganda’s Arua district, which borders a Congolese area where an Ebola patient died after having had contact with over 200 people. Two deaths in Arua were under investigation.

(Reporting by Tom Miles and Nairobi newsroom; Editing by Gareth Jones and John Stonestreet)

Ebola is real, Congo president tells skeptical population

FILE PHOTO: A health worker wearing Ebola protection gear, walks before entering the Biosecure Emergency Care Unit (CUBE) at the ALIMA (The Alliance for International Medical Action) Ebola treatment centre in Beni, in the Democratic Republic of Congo, March 30, 2019. Picture taken March 30, 2019.REUTERS/Baz Ratner/File Photo

GOMA, Democratic Republic of Congo (Reuters) – Congolese President Felix Tshisekedi on Tuesday implored people in areas hit by the nation’s worst-ever Ebola outbreak to accept the disease is real and trust health workers.

Mistrust of first responders and widespread misinformation propagated by some community leaders has led many in affected areas of eastern Democratic Republic of Congo to refuse vaccinations. Instead, they turn to traditional healers, whose clinics have contributed to the hemorrhagic fever’s spread.

“It is not an imaginary disease,” Tshisekedi said after arriving in the city of Beni on his first tour of eastern Congo since being inaugurated in January.

“If we follow the instructions, in two or three months Ebola will be finished,” he optimistically told a crowd after having his temperature taken and washing his hands, as required of all incoming passengers to Beni airport.

Congo has suffered 10 outbreaks of Ebola, which causes severe vomiting, diarrhea and bleeding, since the virus was discovered there in 1976. The current one has seen 1,264 confirmed and probable cases and 814 deaths since it was declared last August.

It is surpassed only by the 2013-2016 outbreak in West Africa, in which more than 28,000 cases were reported and more than 11,000 people died.

Following a series of attacks on treatment centers by unidentified assailants in February and March, the current outbreak is now spreading at its fastest rate yet.

More than 100 cases were confirmed last week.

Tshisekedi, who won a disputed election last December to succeed Joseph Kabila, also called on Tuesday for the disarmament of dozens of militia that operate in the east and whose presence has complicated the Ebola response.

“The time of armed groups is over,” he said. “The new government is reaching out to these children of the country to surrender arms through disarmament programmes.”

(Reporting by Fiston Mahamba and Stanis Bujakera; Writing by Giulia Paravicini; Editing by Aaron Ross and Andrew Cawthorne)

Congo Ebola center set on fire after armed attack

Burned structures are seen after attackers set fire to an Ebola treatment center run by Medecins Sans Frontieres (MSF) in the east Congolese town of Katwa, Democratic Republic of Congo February 25, 2019. Picture taken February 25, 2019. Laurie Bonnaud/MSF/Handout via REUTERS

GOMA, Democratic Republic of Congo (Reuters) – Armed assailants attacked an Ebola treatment center in eastern Democratic Republic of Congo on Wednesday, setting off a fire and becoming embroiled in an extended gun battle with security forces, health officials said.

The identity and motive of the assailants were unclear. Aid workers have faced mistrust in some areas as they work to contain an Ebola outbreak.

Burned structures are seen after attackers set fire to an Ebola treatment center run by Medecins Sans Frontieres (MSF) in the east Congolese town of Katwa, Democratic Republic of Congo February 25, 2019. Picture taken February 25, 2019. Laurie Bonnaud/MSF/Handout via REUTERS

Burned structures are seen after attackers set fire to an Ebola treatment center run by Medecins Sans Frontieres (MSF) in the east Congolese town of Katwa, Democratic Republic of Congo February 25, 2019. Picture taken February 25, 2019. Laurie Bonnaud/MSF/Handout via REUTERS

Dozens of armed militia also regularly attack civilians and security forces in eastern Congo’s borderlands with Uganda and Rwanda, which has significantly hampered the response to the disease.

The health ministry said in a statement that 38 suspected Ebola patients and 12 confirmed cases were in the center at the time of the attack. Four of the patients with confirmed cases fled and are being looked for, it said.

None of the patients who have been accounted for were injured, nor were any staff members, the ministry added.

French medical charity Medecins Sans Frontieres (MSF), which runs the center together with the ministry, condemned the “deplorable attack” and said its efforts were focused on the immediate safety of patients and staff.

The attack in the city of Butembo was the second in Congo’s Ebola-hit east this week. On Sunday unidentified assailants set fire to a treatment center in the nearby town of Katwa, killing a nurse.

The current Ebola outbreak, first declared last August, is the second deadliest of the hemorrhagic fever since it was discovered in Congo in 1976. It is believed to have killed at least 553 people so far and infected over 300 more.

(Reporting by Fiston Mahamba; Additional reporting by Giulia Paravicini; Writing by Aaron Ross; Editing by Gareth Jones and Rosalba O’Brien)

Ebola outbreak in east Congo now world’s second biggest

FILE PHOTO: A medical worker wears a protective suit as he prepares to administer Ebola patient care at The Alliance for International Medical Action (ALIMA) treatment center in Beni, North Kivu province of the Democratic Republic of Congo September 6, 2018. REUTERS/Fiston Mahamba/File Photo

KINSHASA (Reuters) – The Ebola outbreak in eastern Congo is now the second biggest in history, with 426 confirmed and probable cases, the health ministry said late on Thursday.

The epidemic in a volatile part of Democratic Republic of Congo is now only surpassed by the 2013-2016 outbreak in West Africa, where more than 28,000 cases where confirmed, and is bigger than an outbreak in 2000 in Uganda involving 425 cases.

Ebola is believed to have killed 245 people in North Kivu and Ituri provinces where attacks by armed groups and community resistance to health officials have hampered the response.

Congo has suffered 10 Ebola outbreaks since the virus was discovered there in 1976. It spreads through contact with bodily fluids and causes hemorrhagic fever with severe vomiting, diarrhea and bleeding, and in many flare-ups, more than half of cases are fatal.

“This tragic milestone clearly demonstrates the complexity and severity of the outbreak,” Michelle Gayer, Senior Director of Emergency Health at the International Rescue Committee said in a statement. “The dynamics of conflict (mean) … a protracted outbreak is … likely, and the end is not in sight.”

(Reporting by Giulia Paravicini; Editing by Tim Cocks and Andrew Heavens)

Current Ebola outbreak is worst in Congo’s history: ministry

FILE PHOTO - Workers fix an Ebola awareness poster in Tchomia, Democratic Republic of Congo, to raise awareness about Ebola in the local community, on October 9, 2018. Picture taken October 9, 2018. WHO/Aboulaye Cisse/Handout via REUTERS

KINSHASA (Reuters) – The current Ebola outbreak in the Democratic Republic of Congo is the most severe in the country’s history with 319 confirmed and probable cases, the health ministry said late on Friday.

The hemorrhagic fever is believed to have killed 198 people in North Kivu and Ituri provinces, where attacks by armed groups and community resistance to health officials have complicated the response.

FILE PHOTO: A Congolese health worker prepares to administer Ebola vaccine, outside the house of a victim who died from Ebola in the village of Mangina in North Kivu province of the Democratic Republic of Congo, August 18, 2018. REUTERS/Olivia Acland/File Photo

FILE PHOTO: A Congolese health worker prepares to administer Ebola vaccine, outside the house of a victim who died from Ebola in the village of Mangina in North Kivu province of the Democratic Republic of Congo, August 18, 2018. REUTERS/Olivia Acland/File Photo

Congo has suffered 10 Ebola outbreaks since the virus was discovered near the eponymous Ebola River in 1976.

“The current epidemic is the worst in the history of DRC,” Jessica Ilunga, a spokeswoman for the ministry told Reuters.

With over 300 cases the epidemic also ranks as third worst in the history of the continent, following the 2013-2016 outbreak in West Africa where over 28,000 cases were confirmed and an outbreak in Uganda in 2000 involving 425 cases.

World Health Organization Director-General Tedros Adhanom Ghebreyesus said on Thursday that security represented the primary challenge in the current epidemic, followed by community mistrust.

“When there is an attack, the operation actually freezes. So we hold the operation. And when the operation stops, the virus gets advantage and it affects us in two ways,” he told reporters in Kinshasa.

“And one is catching up on the backload. Because when operations are stopped, there is always a backload of vaccinations or contact tracing. And the other, the second problem, is that more cases are generated because we can’t vaccinate them,” he said.

The confirmation of new cases has accelerated in the last month and an emergency committee of World Health Organization experts said in October that the outbreak was likely to worsen significantly unless the response was stepped up.

(Reporting by Giulia Paravicini; Additional reporting by Fiston Mahamba; Editing by Alessandra Prentice and Hugh Lawson)