Ebola Vaccine Could Ease Outbreak, But Risk to Cities is High

Ebola is back. On May 18, the World Health Organization (WHO) declared a “high” public health risk in the Democratic Republic of Congo, where the latest outbreak—which has its origins in a rural region called Bikoro—is rampant. So far, it’s killed at least 27 people.

In some ways, the situation isn’t all that different from what West Africans faced in 2014. The people of Congo are dealing with same strain of virus (Zaire ebolavirus), and it’s spreading in a similar way. But a lot has changed over past four years—we now have an Ebola vaccine, called rVSV-ZEBOV, for one. Also, the WHO has improved its disaster response after the organization was publicly criticized for its not-so-swift handling of the 2014 crisis in Sierra Leone.

The Ebola virus

But experts are especially concerned about one factor that distinguishes this outbreak from past outbreaks. This time, we’re seeing confirmed cases in Mbandaka, a riverside city with a population of at least 1.2 million people. As Ashish Jha, physician and director of the Harvard Global Health Institute, put it, “rural areas are not so rural anymore.” People travel outside of rural areas and into more populous ones with a higher frequency than they used to.

“I believe this is the new normal,” Jha said. “We should expect that very few outbreaks that start in rural areas will remain there.”

Mbandaka is upstream from the DRC’s capital, Kinshasa, which is home to 10 million. That ups the ante even more. “[The virus] has entered an ‘expressway’ called the Congo River, and the disease and its transmission are just a boat trip away from thousands of people,” said Patricia Abbott, an associate professor at the University of Michigan School of Nursing.

But the availability of an Ebola vaccine is an exciting and important development. While the vaccine isn’t guaranteed to quash the epidemic completely, it did perform very well in a 2016 field trial involving more than 5,000 people in Guinea.

“We now have a vaccine that appears to work,” Jha said. “That has the potential of stopping it from getting truly catastrophic.” He also noted that the WHO response has been much more robust this time around, and the DRC leadership is “doing amazing work with what they have.”

Evidence from past outbreaks suggests that this kind of leadership from the inside—as well as efforts that engage community members in prevention practices—can help contain the disease. The nature of a particular community could make a difference, too.

“There’s been a fair bit of research that shows that the social ties and bonds that form in a community are often more predictive of resilience than the resources that are there,” said Sue Anne Bell, a clinical associate professor at the University of Michigan School of Nursing. Whether or not the DRC, specifically, qualifies as socially resilient in this way is a difficult question to answer.

All of these factors will determine what plays out over the next few weeks. It’s clear, at least, that emergency teams are scaling up their response and that the vaccine should be able to help ease the outbreak’s severity.

“Where I think the jury is still out is that this is Ebola, and everyone pays attention to Ebola,” Jha said. “The real test for the WHO is how will they respond to other outbreaks that don’t get that much public attention.”