After multiple Ebola deaths in Congo, experimental vaccine offers hope

As the Democratic Republic of Congo faces its ninth outbreak of the Ebola virus, the World Health Organization adopts a vaccine strategy similar to the one that eradicated small pox in the '70s.

But doctor calls the affected region 'one of the most remote and difficult terrains on Earth'

A health worker is sprayed with chlorine after visiting the isolation ward at Bikoro hospital, Democratic Republic of Congo, on Saturday. (Jean Robert N'Kengo/Reuters)
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On Wednesday morning, 4,000 Ebola vaccines arrived in Kinshasa, the capital of the Democratic Republic of Congo. 

They're being shipped to Bikoro, where an Ebola outbreak was declared last week. It's the first time a vaccine is being deployed this early into an Ebola outbreak.

So far, there have been two confirmed cases of Ebola, and 22 people have died. The World Health Organization (WHO) suspects many more have come into contact with the disease.

Dr. Peter Salama recently returned from Bikoro, northeast of Kinshasa. He's the deputy director-general for Emergency Preparedness and Response of the World Health Organization.

He spoke with As It Happens host Carol Off from Geneva, Switzerland. Here is a part of their conversation.

Dr. Salama, what are you hoping this Ebola vaccine is able to accomplish in the D.R.C.?

Since Ebola was discovered in 1976, whenever we've had an outbreak, the main objective has been just to contain the outbreak from spreading.

Now we have a real opportunity with this new vaccine to really change the paradigm. We're able to prevent it potentially from spreading further within given populations. And we're also potentially able to treat with much higher levels of success and survival, with therapeutics as well.

Peter Salama is the Deputy Director-General for Emergency Preparedness and Response of the World Health Organization, WHO. (Salvatore Di Nolfi/Associated Press)

But you're just sending 4,000 vaccines. What is that going to do in a population of tens of thousands?

This is not your average, run-of-the-mill immunization program, where you just vaccinate everyone in a certain geographical area.

This is a very specific strategy called ring vaccination, where you identify cases, then you identify everyone who has been in contact with those cases, and then the contacts of those contacts. And you stop the spread of the virus that way.

It [was] a very similar strategy that eradicated small pox. And it was used in a trial a couple of years ago in Guinea to demonstrate that this vaccine, used with that strategy, can be 100 per cent effective.

The vaccine itself has to be kept between -60 and -80 degrees Celsius — in one of the most difficult, hot, poorly-serviced areas of the world, over the geographical spread of 100 kilometres.- Dr. Peter Salama

You just returned from Bikoro, ground zero of this recent Ebola outbreak. Can you describe what you saw?

This is one of the most remote and difficult terrains on Earth.

Bikoro's a small town, surrounded by thousands of kilometres of densely-forested land. There are very few paved roads. It's a couple of hundred kilometres from the nearest major urban centre, Mbandaka — the capital of Équateur province in northwest D.R.C.

And there's very little infrastructure. Bikoro has virtually no power on the grid, no electricity. If there's any power at all, it's run by generators.

So this is really the challenge that we're facing. We're implementing on one hand a very sophisticated vaccination program, where the vaccine itself has to be kept between -60 and -80 degrees Celsius until the days of the trial — and on the other hand, in one of the most difficult, hot, poorly-serviced areas of the world, over the geographical spread of 100 kilometres.

So it's going to be extremely challenging logistically and from a manpower perspective.

And how many cases of Ebola are you dealing with at this point?

We have 42 suspected cases — around 22 deaths at this point.

But our biggest fear is that the town of Mbandaka — which has a population between one and two million people — is now at risk. There are three suspected cases in Mbandaka. If they [are] confirmed, that's going to be a game-changer in terms of the potential for this outbreak to spread, because Mbandaka is on the Congo River. It's like a highway for that part of northwest Congo.

(UPDATE: After our interview, the D.R.C.'s Minister of Health Oly Ilunga confirmed one new positive Ebola case in Mbandaka.)

The first signs of symptoms emerged in early April. Some are asking why it took weeks to confirm.

We don't know when the index case —  the first case — really occurred. You're right, it was likely to have been sometime in April. But it wasn't confirmed by a laboratory until May 8. And we started the response on the same day.

If you're asking why it took a couple of weeks to confirm, remember we're talking about one of the most remote places on Earth. And D.R.C. is a country we could call the prototype of a fragile state: in conflict, millions of people displaced, food insecurity, and has hundreds of outbreaks every year, many of them with overlapping symptoms to Ebola.

Undated colourized transmission electron micrograph file image showing an Ebola virus virion. Made available by the Center for Disease Control (CDC). (Frederick Murphy/Associated Press)

This is the ninth known Ebola outbreak to strike the D.R.C. What effect is it having on people's psyche? How distressed are they to see this virus back?

The Congolese know Ebola. They've seen it before. There are negatives and positives to that. Of course they know it has an extremely-high death rate — up to 90 per cent for this strain of the virus.

But they also know that it can be controlled — that certain exposures to wild animals can [put] them at risk.

And they also know some behaviours that can propagate the disease, such as contact with dead bodies, going to traditional healers and contact with the sick.

So people have some baseline knowledge of how to protect themselves. And it's up to us as the international community to build on that baseline knowledge and engage the communities, so they don't feel powerless against the threat. Some of this at least is in their own hands to protect themselves and their families.

Written by Jeanne Armstrong and Kevin Ball. Interview produced by Jeanne Armstrong. Q&A edited for length and clarity.