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When Ebola struck the northwestern Congo city of Mbandaka in 2018, health officials had to act swiftly: the city was connected by regular boat service to the sprawling capital Kinshasa, where the deadly virus could spread. out of control.
Unlike previous outbreaks, they had a new weapon, an experimental vaccine that could revolutionize the fight against Ebola, if they could keep the vials between minus 60-80 degrees Celsius in tropical humidity and on rough terrain. As the world embarks on an unprecedented campaign to bring ultra-cold COVID-19 vaccines to billions in remote areas, the experience of the Democratic Republic of the Congo contains vital lessons for distributing the vaccine and gaining the trust of those who use it. receive.
Congo itself will try to use local technology and expertise to vaccinate its people against COVID-19. The country has recorded more than 15,000 cases and 369 deaths from the virus, and faces a second wave of infections. Between 2018-2020, health workers vaccinated more than 400,000 people in three Ebola outbreaks, carrying vials colder than an Antarctic winter through warm forests and along muddy mountain roads. When cars couldn’t pass, they drove motorcycles. If water was the only way, they used canoes.
“These roads are often flooded during the rainy season. Many times you have to cross rivers that may not have bridges,” said John Johnson, immunization and outbreak response adviser at the French medical charity Médecins Sans Frontieres (MSF). It was the largest launch of an ultra-cold chain vaccine ever, said a spokesperson for GAVI, an alliance of governments, pharmaceutical companies and charities that runs global vaccination campaigns.
In Mbandaka, a large-scale crisis was avoided. The vaccine and well-trained sanitary protocols contained the virus. GIANT THERMOS
The key to the launch was a high-tech thermos that could fit on a motorcycle or canoe and keep vials cold for a week – essential in the Congo, where fewer than one in 10 people have access to electricity. The Arktek device works like a giant coffee thermos that can be filled with hundreds of vaccines and special ice packs made from various materials.
Produced in China by Aucma and with a retail price of around $ 2,300 per unit, it was developed in 2014 to store polio vaccines at 2-8 degrees Celsius and was modified when the Ebola vaccine from Merck for use in Guinea and Sierra Leone during a 2013-16 outbreak. . “Like most thermoses designed to keep your coffee hot or a cold drink cold, they use a vacuum cleaner to protect the product from the environment,” said Daniel Lieberman of Global Health Labs (GHL), a nonprofit research organization. created by the Gates Foundation who helped design it.
In the Congo, they found that the best ice packs used salt water, which kept the vaccine frozen for up to a week without electricity. Health teams in the Congo established a network of freezers from which Arktek was deployed. That helped doctors reach remote areas and end an epidemic in the east that killed more than 2,200 people in two years, the second-worst Ebola outbreak in history.
GHL is now readjusting Arktek for use with dry ice, which could keep up to 1,500 doses of Pfizer-BioNTech’s COVID-19 vaccine frozen for several weeks. WINNING CONFIDENCE
Advances in cold chain technology mean little if healthcare workers do not earn the public’s trust and dispel misinformation about vaccines. WHO officials say that during the 2018-2020 Ebola outbreak in the Congo, they made the mistake of not employing local health workers.
Rumors spread that the vaccine would make men weak, women infertile, and children less intelligent. More than 300 attacks on health workers were recorded, leaving six dead. “They need to understand what they are getting and the risks and benefits. The mistake that is often made is diluting the message and making it too simple,” said MSF’s Johnson.
The WHO used only local health workers to distribute the vaccine in a subsequent outbreak in the west, which ended in six months with 55 deaths. Skepticism about vaccines is not limited to central Africa. A 2018 study of 140 countries by the London-based medical charity Wellcome Trust found that low-income regions tend to be more confident that vaccines are safe than high-income regions.
A third of people in the UK say they have seen messages discouraging the public from receiving a coronavirus vaccine, according to research by King’s College London and British research company Ipsos MORI. Addressing the doubts is essential now, before the massive COVID-19 vaccination campaigns begin, said Touré Alhassane, who led the WHO vaccine launch during the latest Ebola outbreak in Congo, which ended in November.
“Even if you have all the money in the world and you have everything to implement it, if the community is not with you, you are not going to be successful,” he said.
