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APU Health & Fitness Infectious Diseases Original

Global Vaccine Stockpile Created to Battle Ebola Outbreaks

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In early January, Gavi, a public-private partnership based in Geneva that is leading a vaccine alliance in fighting Ebola and other viruses, announced the formation of a global emergency stockpile of 500,000 Ebola vaccines.

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Ebola has a mortality rate of between 25% and 90%, with an overall average of 50%. The first vaccine against Ebola was announced only about 14 months ago, in November 2019.

Initially, only Merck’s Ervebo vaccine will be stockpiled. But other Ebola vaccines, upon approval by the World Health Organization (WHO), could also be included.

Ervebo appears to be 100% effective 10 days after someone receives the vaccination, but it has yet to be determined how long Ervebo lasts or if there is a need for booster shots. Also, the vaccination is effective only against the Zaire strain of Ebola. Zaire ebolavirus is much more common than Sudan ebolavirus, Bundibugyo ebolavirus or Tai Forest ebolavirus.

Merck’s Vaccine Ervebo Has Already Proved to Be a Lifesaver

Merck’s vaccine has already proved to be a lifesaver. From its first use in 2018 and into 2021, approximately 340,000 individuals have received the vaccination. Over 300,000 people were vaccinated in the 2018-2020 outbreak in the DRC provinces of North Kivu and Ituri, and over 40,000 were vaccinated in the November 2020 outbreak in the province of Equateur.

UNICEF Executive Director Henrietta Fore said, “The stockpile of thousands of Ebola vaccines is a ground-breaking development.”

However, soon after the announcement, problems arose. While the announcement of the goal of 500,000 doses is a positive step, reality means that it will not be reached quickly.

Merck explored trying to find a faster way to produce vast quantities of the vaccine. The pharmaceutical company determined that its plant in Burgwedel, Germany, was the best option to produce Ervebo.

There does not seem to be a plan, however, to restart production of Ervebo at Merck’s West Point, Pennsylvania, plant, where Merck is known as MSD outside the United States and Canada. The U.S. plant produced the vaccine until the move to Burgwedel in early 2020. Merck has no plans to make the vaccine anywhere else.

Supply chain issues, such as the requirement for ultra-cold transport and storage at below -80 degrees Celsius, are already hampering production. At roughly the time of the announcement, there were fewer than 7,000 doses available.

David Heymann of the London School of Hygiene and Tropical Medicine said, “The challenge for the Ebola stockpile is to have enough vaccine immediately ready to roll out – hopefully there will be more vaccines to add to the stockpile in the future.”

A New Ebola Outbreak Occurred in Butembo

Earlier this month, a new Ebola outbreak began to threaten the citizens of the DRC, once again in Butembo, a city of 700,000 in North Kivu province, according to The New York Times.

The victim, the wife of a farmer who survived the disease, died on Feb. 3, just three days after showing symptoms but before the results came back showing that she had tested positive for Zaire ebolavirus. She was treated first in Beina, a small town about 55 miles from Butembo, where she and her family lived.

The DRC government, supported by UNICEF and other aid organizations, began trying to trace everyone with whom she came into contact in an attempt to eradicate any vestiges of the disease before the virus could spread. Already, there have been more than 70 identified contacts, each of whom will require being quarantined until the results come back.

WHO Director-General Tedros Adhonom Ghebreyesus remains concerned, even though no new cases have been identified as of Feb. 8. “It’s possible there will be further cases because the woman had contact with many people after she became symptomatic,” Ghebreyesus said.

It Is Not Uncommon for Sporadic Cases to Occur after a Major Ebola Outbreak

According to the WHO, it is not uncommon for there to be sporadic cases after a major outbreak. However, since the 2018-2020 outbreak in North Kivu and Ituri provinces, there has not been another suspected case. That outbreak, which roughly centered in the Beina-Butembo area, infected nearly 3,500 individuals, killing 2,299 of them.

Likewise, it is unknown how many of the 300,000 people who received the Ervebo vaccination in 2020 reside in the Beina-Butembo area. Although the number is likely to be considerable, it will still be a small percentage of all the people living in the area. While it is likely too soon after the recent vaccinations to perhaps offer significant data, it remains a concern that Merck still cannot determine how long the vaccine will be effective or if it will require subsequent booster shots.

Aid Agencies Are Concerned about an Ongoing Internal Conflict in the DRC

Of additional concern for the WHO, UNICEF and all other relief agencies is the three-year-long ongoing conflict by nearly 130 different armed groups in Ituri and Kivu provinces.

These insurgents of armed men, as well as children soldiers, number in the tens of thousands. They and the Congolese government security forces meant to protect the population continue the egregious violence, which includes killings, mass rapes and abductions. 

The day before the announcement of the woman’s death from Ebola, according to the United Nations, at least 849 civilians had been killed in attacks in Ituri and North Kivu provinces in 2020. The UN also reported at least 534 kidnappings, of which 457 were of civilians forced into slave labor.

Hundreds of thousands more were likely displaced but the exact number is unknown. In the previous two years at least 2,000 people were killed, over 3,500 were abducted and hundreds of thousands of civilians were displaced.

Ebola Outbreaks Have Generally Been Rare and Unpredictable

Ebola outbreaks have generally been rare and unpredictable. Beyond the threat of an Ebola outbreak or an existing epidemic, there is no real market for the vaccine. Therefore, the work of Gavi and Merck, while commendable, is costly. Yet it is worth it for those living in the Ebola-infested areas of Central Africa.

Merck and other pharmaceutical companies, as well as researchers, need to continue their study of deadly viruses. And it is the responsibility of the United States and other Western nations to fund this research in order to develop a better understanding of not only Ebola, but of all viruses, including the current pandemic caused by the novel coronavirus and its variants. At the same time, the United Nations needs to become more active in its attempts to bring peace to the area.

Dr. Brian Blodgett is an alumnus of American Military University, who graduated in 2000 with a master of arts in military studies and a concentration in land warfare. He retired from the U.S. Army in 2006 as a Chief Warrant Officer after serving over 20 years, first as an infantryman and then as an intelligence analyst. He is a 2003 graduate of the Joint Military Intelligence College where he earned a master of science in strategic intelligence with a concentration in South Asia. He graduated from Northcentral University in 2008, earning a doctorate in philosophy in business administration with a specialization in homeland security. Dr. Blodgett has been a part-time faculty member, a full-time faculty member and a program director. He is currently a full-time faculty member in the School of Security and Global Studies and teaches homeland security and security management courses.

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