It’s been ten days since Jean René* lost his brother to Ebola virus disease (EVD).

"My brother’s wife has come to live with my family," said Jean René, who lives in a community about 20 kilometers north of Mbandaka, the first urban centre in the Democratic Republic of Congo to have confirmed cases of EVD during the current outbreak.

Though mourning the loss of his brother, Jean René is comforted because his sister-in-law and the rest of his extended family have received the vaccine against Ebola.

Since the family came in contact with a person with Ebola, they are considered at high risk of the disease and have participated in the ring vaccination, which has been taking place in Mbandaka since 21 May 2018. 

"Ring vaccination is a new and vital tool in the control of Ebola," said Dr Michael Ryan, WHO Assistant Director-General, Emergency Preparedness and Response. "I just spent the day out with the vaccination teams in the community, and for the first time in my experience, I saw hope in the face of Ebola and not terror. This is a major milestone for global public health."

The ring vaccination is led by the National Institute of Biomedical Research and the Ministry of Health of the Democratic Republic of the Congo, which is working with a wide range of partners, including WHO, Médecins sans Frontières and UNICEF. Gavi, the Vaccine Alliance, contributed funds towards the operational costs, and through an agreement with Merck, the vaccine developer, helped ensure that 300 000 investigational doses of the vaccine are available in case of an outbreak. The vaccination is being provided to the contacts of confirmed cases, and the contacts of contacts, as well as healthcare workers, front line responders and other people with potential exposure to Ebola.

Transfer of Ebola response experience between Guinea and the Democratic Republic of the Congo comes full circle

This vaccination effort is also the result of a major collaboration between the Democratic Republic of the Congo and the Republic of Guinea. In 2015, a ring vaccination trial took place in Guinea and found the vaccine to be highly effective against Ebola. Due to the results of the trial, the yet to be licensed rVSV-ZEBOV Ebola vaccine has been approved for ‘compassionate use’ in outbreaks. This means that although the vaccine has not yet been formally approved by a full regulatory process, there is no viable alternative and it has proven sufficiently safe and effective to be recommended for use.

Dr Alhassane Toure coordinated the field operations of the Guinea trial, and now he is leading the efforts in the Democratic Republic of the Congo. Guinean authorities gave their approval to loan more than 30 of the country’s health experts to the Democratic Republic of the Congo for the ring vaccination. 

"I am here to help my brothers and friends in the Democratic Republic of Congo to fight against Ebola," said Dr Alhassane. "Ring vaccination can help stop the spread of the Ebola virus."

Dr Alhassane and his team are working with 50 health workers from the Democratic Republic of the Congo to share the expertise they have in ring vaccination. In addition, Dr Ismaila Ibrahima Sani from Niger is coordinating the actions in the field.

This transfer of knowledge and cooperation between Guinea and the Democratic Republic of the Congo has now come full circle.

"I’m very proud because the Democratic Republic of the Congo sent a team to Guinea the year before last to support Guinea’s fight against Ebola, and now Guinea has sent vaccination experts to help them," said Professor Jean-Jacques Muyembe-Tamfum, Director-General of the National Institute for Biomedical Research. "This is a great example of south-to-south cooperation."

Campaign expanding to remote affected areas

In the past week, the teams have vaccinated more than 420 eligible people in rings around the four cases of Ebola which have been confirmed in Mbandaka. In addition, the vaccine has been offered to health care workers in the area.

"It is possible that there will be new cases confirmed of Ebola in the city," said Ana Maria Henao-Restrepo from the Initiative for Vaccine Research at WHO. "However, it is reassuring to witness that the affected families and communities are accepting our teams and that they have been able to implement ring vaccination."

Vaccination has begun in other areas of Equateur Province with confirmed cases of Ebola. On 28 May, ring vaccination began in Bikoro, which is 150 kilometres from the provincial capital. Later this week, vaccinators from Guinea and the Democratic Republic of the Congo are expected to start ring vaccination in Iboko health zone, which is the most remote of the three areas reporting confirmed cases.

* name changed to protect privacy