Thank you for this interesting article. However, there are some important considerations that policymakers will need to consider when adopting this plan. Reduced vaccine dosing has been used in other disease contexts during episodes of vaccine shortage with good effects. However, in the context of Ebola, do we know: How long will partial immunity resulting from reduced vaccine dosing persist? How is post-exposure carriage affected by reduced vaccine regimens? Will having a partially immunized population complicate future vaccine efforts? And: do we have experience in humans of serially administering the acute phase vaccine and then the second - longer-term one? We cannot assume that this is necessarily safe. If we our answers to these questions are guesses, and we are wrong, the response in the Eastern DRC communities will be swift and harsh.
In spite of these considerations, the idea to begin general vaccination of the general population is a good one to consider given the overall socio-political situation in eastern DRC.
We need to remember that this section of the country did not participate in elections although promised their own vote in March 2019. Their exclusion was not accidental. The opposition candidate was the favorite in the region. Thus, the anger and suspicion attached to local reaction to government-sponsored vaccination activities has some basis - even if mis-directed against the health care community.
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When are we going to take community engagement seriously? The ‘hard science’ of it is absolutely critical, but even this article gives no attention to ‘why’ so many health workers have been killed!!! I was in Sierra Leone during 2014-15 outbreak and the lessons were painful and expensive! As traditional wisdom says ...’the pill (or vaccination) only works if the people take it’ ...the ‘softer sciences’ is where the rest of the answer lies...
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There is another element of this that has yet to be tackled, as far as I can see: Pre-existing low confidence in the health systems and services among the local population of this region in DRC.
I supported implementation of a Mine Risks Education project in Beni until last year and from what I observed, there was little reason then to be confident that the Public Health authorities had a handle on the most basic of essential services as the system was entirely neglected. It could hardly have been called a 'system' at all with its inadequate infrastructure, low quality or absent supplies, poorly prepared staff, and non-existent attention to services coordination.
It is no surprise that the population in Beni have rejected or resisted anything coming their own Public Health authorities or any of the efforts being badged as jointly implemented with international partner agencies.
Widespread insecurity and the inability of the local Governments to get a grip on it have not helped to build trust either.
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While the inoculation campaign is commendable, the spread of ebola will not stop until the DRC government and its agents become serious about enforcing the measures that are in place to halt its spread. During my recent visit to North Kivu province, there were Unicef check points along rural roads but the majority of local residents failed to stop and wash their hands in chlorine water and have their temperatures taken as they were supposed to. Government troops watched passively as dozens of minibus taxis and swarms of motorcycles buzzed past the check points without stopping. The Unicef officials told me that they were powerless to force residents stop at the check points.
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