DR Congo: 'If Ebola is properly monitored, you can put out the flames very quickly'
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The French NGO Médecins sans Frontières (MSF) has been delivering vaccines to some of the remotest villages in DR Congo ever since a new Ebola outbreak was declared there last month. FRANCE 24 spoke to MSF emergency programme manager Hugues Robert.
FRANCE 24: The new vaccine rVSV-ZEBOV was used successfully on a few thousands people in Guinea during the last Ebola outbreak in West Africa, but it is still in its experimental stage. Are there any ethical problems linked to the use of this vaccine this time?
Hugues Robert: The vaccine is only offered to people who are very likely to catch the disease. Patients can choose whether or not to accept it, and this is done through a written agreement. Typically, a family that has had a case of Ebola and who has cared for that person, who has fed and cleaned him or her and washed his sheets and clothes, has a higher risk of getting sick.
People who are given the vaccine are very well informed beforehand on the possible side effects. We are aware of some of them, especially arthritis and skin lesions (papules), which aren’t difficult to treat but are uncomfortable for the patient. However, the fact that we are still at the experimental stage means that there is a whole procedure in place for patients and for monitoring them afterwards. This procedure forces us, when we are working in very remote places, to return to see our patients every 28 days and, if a woman is pregnant, until the end of her pregnancy.
All of that takes much more time than it does when a vaccine has been approved, and it limits the number of people we can innoculate. It’s much more complicated to vaccinate more than 40 to 50 people a day if we want to make sure that all the right procedures are followed. We’re not far off from rVSV-ZEBOV being approved, but we can’t yet carry out a mass vaccination as it has been done for measles when several hundred people can be reached daily.
Why did you choose the ring vaccination method rather than a mass vaccination campaign?
A global mass campaign isn’t possible, firstly because of the number of vaccines available but also because of the way we can administer it. Because rVSV-ZEBOV hasn’t yet been approved, we can’t go as fast as we would do with a mass vaccination. This ‘ring’ method means we can target the areas and people who are most at risk. Eventually, if the situation is properly monitored, you can put out the flames very quickly. From that point of view, there is no point in flooding the population with vaccines.
How do people react when the medical teams arrive, especially in the remote areas of Iboko and Bikoro?
This vaccination campaign has been surprisingly well received and more people have shown interest than we can cater for. We can only vaccinate people who have been exposed to the disease, the people who are close to them and those who are involved in the campaign. We’ve broadened the vaccination to include traditional doctors and people from religious communities, who take care of patients and other professions at risk, like taxi motorbikes, which transport these patients. We work in a practical way by understanding how the community works and who is most at risk.
However, there is a difference between vaccination and managing contaminated patients. We are operating in the countryside, where, as in any epidemic, people are fearful and reticent to bring in close family members or friends. This attitude is obvious in Mbandaka (the capital of Équateur Province) and in remoter areas, and it’s all part of the fear this disease inspires. That’s why we are working closely with the community to explain what we are doing and why. It is a pity that the awareness campaign hasn’t yet reached some of the remotest areas where the disease’s epicentre is, although the first MSF teams reached the Iboki region as early as May 9to treat infections. There is still some resistance, but we’re in this for the long haul and this work will take some time.
I’ve met some community chiefs – people who represent this very traditional society – and they are very open to discussions, which you need to allow things to evolve. I was much more concerned two weeks ago, but the more involved we get, the more progress there is.
The World Health Organiwation would like to try using five healing drugs on patients who have been infected with the Ebola virus, three of which have not been tested on humans. The DR Congo health ministry should soon give it the go-ahead. Do you approve ?
MSF is associated with one of those experimental molecules. In a case like Ebola, these drugs can, as an exception, be given the green light. In such cases, the patient (or the family if the patient is a child) is given the choice of using or not the medicine. We know that patient only has a very small chance of survival, so we offer a him or her a choice of trying out the molecule knowing that it’s more of an opportunity than anything else given the poor prospects that patient has. Often, the doctor decides everything, but in this case, the patient is given a choice.