Aid workers in the Democratic Republic of the Congo began giving an experimental Ebola vaccine to health workers on 8 August—one week after the World Health Organization declared an outbreak of the virus. First responders and public-health staff are scrambling to contain the outbreak while planning how to roll out the vaccine to communities in the middle of a conflict zone.

The virus is spreading in northern Kivu and Ituri, in the eastern part of the Democratic Republic of the Congo (DRC). As of 6 August, 43 people have shown symptoms of Ebola—including 36 who have died. But violence perpetuated by more than 100 armed groups fighting over resources and power in those lush, green provinces has escalated this year in advance of the country’s December presidential election. This is the nation’s tenth Ebola outbreak since 1976, but it is the first in this tumultuous eastern region.

“The situation is volatile,” says Ibrahima Soce-Fall, the director of the World Health Organization’s (WHO) emergency operations in Africa, based in Brazzaville in the Republic of the Congo.

Even so, researchers are also gearing up to give people with Ebola experimental antibody and antiviral drugs in addition to the vaccine.

Making contacts

Soce-Fall says that at least 2,000 doses of the experimental vaccine, called rVSV-ZEBOV, remain in the country from the last Ebola outbreak which ended in July, and more are on the way. The DRC will need a larger vaccine supply now because the strategy deployed during the last outbreak will not work for the current one. That last outbreak, which hit western DRC, lasted three months.

During the previous outbreak, officials vaccinated health workers, people who had direct contact with someone with Ebola and the contacts of those contacts. But the instability in Kivu and Ituri has made tracking such connections difficult. In towns where people have been infected but officials can't track down their contacts, workers may vaccinate the entire community instead, says Soce-Fall.

An inability to track these connections worries epidemiologists because the virus spreads through people on the move. Humanitarian groups estimate that this year, nearly 750,000 people in northern Kivu have fled from militia fighters who maim and rape people and burn villages to the ground. And about a million refugees who have been displaced from their homes by fighting over the past decade often continue to travel between cities in the region. Some refugees migrate through the porous borders of neighbouring countries such as Uganda, Rwanda and Burundi.

Armed escorts

Aid agencies must now figure out how to get into these conflict zones to fight Ebola without endangering their staff. They may travel with armed security escorts provided by the DRC government for their protection, said Peter Salama, the WHO’s director of emergency preparedness and response, at a press briefing on 3 August.

But a key organization fighting Ebola in the area, Médecins Sans Frontières (MSF), hesitates to use that approach. The group feels that traveling with armed escorts risks their ability to help people of various political affiliations, says Salha Issoufou, the head of MSF’s operation in DRC. So MSF will forgo the escorts.

The next phase of the response by the WHO, the Congolese government and aid groups will be to treat people with Ebola using experimental drugs. That could begin later this week, says Steve Ahuka, a virologist at the National Institute for Biomedical Research based in Kinshasa. A national review board that evaluates research ethics has approved the use of these treatments, and Ahuka says that a few therapeutics have just arrived in the region.

One treatment is an antibody called mAb114, manufactured by Mapp Biopharmaceutical in San Diego, California. Two other treatments include the antiviral drugs Favipiravir (T-705), made by Japanese company Toyama Chemical, and Remdesivir (GS-5734), produced by Gilead, based in Foster City, California.

“Thanks to our experience from the previous outbreak, we are prepared,” says Ahuka.

This article is reproduced with permission and was first published on August 8, 2018.