On Congo's muddy trails, lessons for a global COVID vaccine rollout

Global Health

22/12/2020 07:00

By Hereward Holland
    KINSHASA, Dec 22 (Reuters) - When Ebola hit the city of
Mbandaka in northwest Congo in 2018, health officials had to act
fast - the city was connected via regular boat service to the
sprawling capital Kinshasa, where the deadly virus could spread
out of control. 
    Unlike in previous outbreaks, they had a new weapon - an
experimental vaccine that could revolutionise the fight against
Ebola - if they could keep the vials between minus 60-80 degrees
Celsius in tropical humidity and across rough terrain.  
    As the world embarks on an unprecedented campaign to bring
ultra-cold COVID-19 vaccines to billions in remote areas,
Democratic Republic of Congo's experience holds vital lessons in
distributing the vaccine and gaining the trust of those
receiving it.
    Congo itself will aim to use the technology and local
expertise to get its people vaccinated against COVID-19. The
country has recorded over 15,000 cases and 369 deaths from the
virus, and faces a second wave of infections.  urn:newsml:reuters.com:*:nL4N2IW2CJ
 urn:newsml:reuters.com:*:nL1N2IV1KW    
    Between 2018-20, health workers inoculated more than 400,000
people in three Ebola outbreaks, lugging vials colder than an
Antarctic winter across warm forests and along mud-clogged
mountain roads. When cars could not pass, they drove motorbikes.
If water was the only way, they used canoes.  
    "These roads are often flooded during the rainy season. A
lot of times you have to cross rivers that may not have
bridges," said John Johnson, an immunisation and outbreak
response advisor for French medical charity Medecins Sans
Frontieres (MSF).
    It was the largest ever roll-out of an ultra-cold chain
vaccine, said a spokesperson for GAVI, an alliance of
governments, drug companies and charities that arranges global
vaccination campaigns. 
    In Mbandaka, full-scale crisis was averted. The vaccine, and
well drilled health protocols, contained the virus.
    
    GIANT THERMOS
    Key to the roll-out was a high-tech thermos that could fit
on a motorbike or in a canoe and keep vials cold for a week -
essential in 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
of various materials.
    Produced in China by Aucma and retailing for around $2,300
per unit, it was developed in 2014 to store polio vaccines at
2-8 degrees Celsius, and tweaked when Merck's Ebola vaccine was
approved 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 to shield the product from
the environment," said Daniel Lieberman from the Global Health
Labs (GHL), a non-profit research organisation created by the
Gates Foundation which helped design it.
    In Congo, they found the best ice packs used salt water,
which kept the vaccine frozen for up to a week without power. 
    Health teams in Congo set up a network of deep freezers from
which the Arktek was deployed. That helped medics reach remote
areas and end an epidemic in the east that killed over 2,200
people in two years, the second-worst Ebola outbreak in history.
    GHL is now retuning the 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 TRUST
    Advances in cold chain technology mean little if health
workers do not earn public trust and dispel misinformation about
vaccines. 
    WHO officials say that during Congo's 2018-20 Ebola
outbreak, they made the mistake of not employing local health
workers.
    Rumours spread that the vaccine would make men weak, woman
infertile and children less intelligent. More than 300 attacks
on health workers were recorded, leaving six dead.
    "They need to understand what they're getting and the risks
and the benefits. The mistake that's often made is in watering
down the message and making it too simple," MSF's Johnson said.
    The WHO used only local healthcare workers to distribute the
vaccine in a subsequent outbreak in the west, which ended in six
months with 55 deaths.
    Vaccine scepticism is not confined to central Africa. A 2018
study of 140 countries by the London-based Wellcome Trust
medical charity found that low-income regions tend to have
higher confidence that vaccines are safe than high-income ones.
    A third of people in the United Kingdom say they have seen
messages discouraging the public from getting a coronavirus
vaccine, according to research by King’s College London and
British research company Ipsos MORI.
    It is essential to address doubts now, before mass COVID-19
vaccination campaigns begin, said Touré Alhassane, who led the
WHO's vaccine rollout during Congo's latest Ebola outbreak,
which ended in November.
    "Even if you have all the money in the world, and you have
everything to implement it, if the community are not with you,
you are not going to succeed," he said. 

 (Reporting and writing by Hereward Holland;
Editing by Edward McAllister and Ed Osmond)
 ((hereward.holland@thomsonreuters.com; +254 20 499 1232;
Reuters Messaging:
hereward.holland.thomsonreuters.com@reuters.net))