Vaccinations set to begin in Ebola outbreak epicenter

Ebola vaccination efforts will begin Monday in Bikoro, the epicenter of the current outbreak in the Democratic Republic of the Congo, the country’s health minister, Dr. Oly Ilunga, said Saturday.

The equipment required to keep the vaccine at the appropriate temperature — the so-called cold chain — has been set up at Bikoro, said Ilunga, who was vaccinated himself on Friday.

The World Health Organization said that as of Thursday, 154 people had received the vaccine, made by Merck. Ilunga told STAT that people are eager to be vaccinated.

“Now that people realize that this is really a threat and people are dying, I think that everybody wants to be protected,” he said. “So wherever we have been, people are asking to be vaccinated. The health care workers, even some community leaders, they all want to be vaccinated.”

Vaccination started earlier this week in Mbandaka, the regional capital, where four confirmed cases and one suspect case have been identified.

Cases in Mbandaka are especially concerning because it is a city of about 1.2 million people. It is also a port on the Congo River, a major transportation thoroughfare in that part of the world. The river links Mbandaka to the capitals of the DRC and two neighbors, the Republic of the Congo and the Central African Republic; the capitals of those three countries have a combined population of more than 14 million people.

Ilunga traveled to Bikoro on Saturday with a team that will prepare for the start of the vaccination effort. He also traveled to Iboko, a third location with cases. A vaccination campaign will have to happen there as well, but the location is challenging. To reach the village, Ilunga and his party flew from Bikoro by helicopter, but then had a 3-mile trek through the forest to the village.

“It is a very remote area. So before bringing vaccine there you must be sure that the cold chain is ready,” he said.

Earlier reports said that people in Iboko were not cooperating with Ebola response teams, refusing to allow samples to be taken for testing from a person who had died of what was suspected to be Ebola. But Ilunga said the villagers are no longer resisting and are even agreeing to safe burial practices for the dead. Traditional funeral customs that involve washing and touching a corpse are dangerous practices during an Ebola outbreak.

To date there have been 54 cases reported in Mbandaka, Bikoro, Iboko, and Ntondo, and 25 have died.

Ilunga said newly identified suspect cases are coming from lists of people who have been in contact with existing cases, a sign that contact tracing efforts are working. “So that means that somehow we are at the point where we are surrounding the transmission chain,” he said.

When cases are discovered who have no known links to previously identified patients, it suggests that all chains of transmission haven’t been found.

Containing this outbreak is proving to be an expensive matter. The latest estimate from the WHO suggests it may cost $57 million, more than double the earlier estimate of $26 million.

This story has been updated to reflect an increase in the Ebola fatalities.