Vaccination Imperatives, DRC

"Ebola is not the only epidemic the country [Democratic Republic of Congo] is experiencing, nor is it the most deadly."
"If the question is how come, with this effective vaccine [Ebola vaccine], we haven't been able to stop it, I think the answer is that it's not getting to the right people at the right time."
Dr.Seth Berkely, head, global vaccine alliance GAVI

"Due to the lack of sufficient scientific evidence on the efficacy and safety of other vaccines as well as the risk of confusion among the population, it was decided that no clinical vaccine trials will be allowed throughout the country."
DRC Ministry of Health

"There are areas where surveillance is weak, mainly because of insecurity. So sometimes the virus gets into a locality relatively undetected. Right now we are chasing the virus as it moves from place to place. What's important is to take a more structured approach that looks at the things that are stopping the public health response from happening."
"As we step up our engagement with communities, including by listening to their needs beyond Ebola and finding ways to meet them, we are seeing some of the reticence to the response ease."
"This will take time in some areas that have historically been distrustful of outsiders. We are making progress, but need to do more. The virus will find a way to continue to replicate if we don't have all the holes plugged."
United Nations (UN) Ebola response coordinator, David Gressly

A Ugandan health worker administers an Ebola vaccine to a child in Kirembo village, near the border with the Congo in Kasese district, Uganda in June 2019. (James Akena/Reuters)

Recently returned from the Democratic Republic of Congo, Dr. Berkeley muses over the fragile state of circumstances in the country, wracked with the results of never-ending conflict and Islamist terrorist attacks by Boko Haram -- which have placed ongoing stress on the ability of a government newly-awakened to the imperative of vaccinating the nation's children to prevent not only Ebola but but other vaccine-preventable diseases that have taken their deadly toll on vulnerable children.

This year in the DRC there has been a 700 percent increase in measles cases, the cause of 2,000 deaths, a public health crisis that has been overlooked, while the fear of Ebola takes centre-stage. The government of the DRC declared the absence of routine immunization in the country represents a health emergency as it initiated an aggressive program to launch a new program aiming to inoculate a greater number of children against a hitherto-overlooked health threat.

The Ebola epidemic overwhelming the country at the present time was declared recently by the World Health Organization to represent an internationally concerning health emergency. The current DRC Ebola epidemic is considered a case study in vaccine limitations where even the most reliable tools cannot function in the absence of public trust -- notoriously weak in the Democratic Republic of Congo.

Vaccine-preventable diseases rising world-wide, might see health authorities looking to the DRC as a learning opportunity in how such emergencies are to be handled for greatest effectiveness in other countries, with particular emphasis on the vital necessity of high vaccination rates alongside allied fundamentals of public health. Putting the DRC in the spotlight as a literal living laboratory in handling this kind of health emergency.

The vaccine most successfully utilized to date, developed in Winnipeg, Manitoba, which was tested during the last major such epidemic has been the most reliable, yet even so the vaccine alone cannot solve the growing problem of infection. Officials harbour fears that Ebola will spread more rapidly if it becomes established in the east, close to the border with Rwanda; up to 40 percent of new cases are turning up in the community of Goma, indicating further spread remains a real risk.

Ebola has killed 1,700 people thus far, and adding that to the rise of diseases like measles and an impending crisis in the public health system of the DRC looms, resulting from the population's endemic mistrust of health and other officials operating the country's public health system. Heroic efforts have now been recognized in the DRC where 180,000 people have been vaccinated in relatively short order, with another 460,000 doses of vaccine available.

This, in a nation afflicted with ongoing violence, conflict and mistrust. Islamist terrorist groups have inflicted countless attacks on health workers, making their work more dangerous and difficult. Still, according to Dr Berkley, the Ebola vaccine has ensured the outbreak has been prevented from reaching the point of "spinning out of control". Without the vaccine the current outbreak would in all probability become even more serious than the West African Ebola epidemic that killed over 11,000 people in 2014-16.

A second crisis has emerged, however, even as the Ebola epidemic continues to fester, with measles and cholera outbreaks.

More than 110,000 people in the Democratic Republic of the Congo have received an experimental Ebola vaccine, which appears to have helped slow spread of the deadly virus.

World Bank/Vincent Tremeau (CC BY-NC-ND)

Prevention Is Better Than Cure

"I honestly never thought I would see this disease in the United States."
"It was difficult -- for many of us -- to see him [unvaccinated six-year-old boy who contracted tetanus] suffer."
Dr. Judith A. Guzman-Cottrill, pediatric infectious disease specialist, Oregon Health & Science University

A new report by the Centers for Disease Control and Prevention (CDC) outlined a case of the state of Oregon's first documented pediatric case of tetanus in over thirty years. The CDC's Morbidity and Mortality Weekly Report chronicled the instance of a child living on a farm playing as children do, and an accident occurred with the six-year-old coming away with a cut to his forehead. Slight enough not to raise any alarms in the child's parents' minds who simply cleaned it up and set the incident aside as a normal enough occurrence in a child's active lifestyle.

The story, however, does not end there. This was a child who had never been inoculated against anything; no vaccination ever, for any reason. The days passed and by the sixth day following the laceration the child's parents understood from symptoms their child was experiencing -- clenching his jaw, breathing problems, and involuntary muscle spasms -- that something was seriously, fearfully awry. They took him to Oregon Health Science University hospital where he was speedily diagnosed with tetanus.

The article in the Morbidity and Mortality Weekly Report described a prolonged period of hospitalization and treatment fraught with concern over the child's recovery. And it served as a warning of the potential dangers that could accrue in encountering a disease with a formidable affect on human health and mortality; a bout with tetanus readily preventable with the proper vaccination. It took 57 days being intensively hospital-treated at a cost of over $800,000 in medical bills, for the child to finally emerge from his ordeal.

The United States, like many other national jurisdictions across the world, is currently experiencing an outbreak of measles. Once considered a 'normal' childhood infection that children conventionally came down with and speedily recovered from, it does, nonetheless pose an extremely serious risk to health and even mortality in rare cases, for some unfortunates in any population. It is entirely preventable. Its roaring return is linked with a growing contingent of people refusing vaccinations.

One of the highest rates of unvaccinated residents in the country live in Oregon, with7.5 percent of kindergarten-age children unvaccinated for non-medical reasons, according to the CDC; exemptions are given when there are verifiable medical reasons to bypass certain impacted children whom the 'herd effect' of having a sufficient number of children vaccinated must reach critical numbers for protection of children who are medically vulnerable.

The problem has become so acute in parts of the world that Italy has seen fit to make it legally mandatory for children to be vaccinated before they may enter the public school system. Generally, parents who fail to have their children vaccinated express concerns relating to side effects, or over cost, over moral or religious objections, along with scientifically-discounted fears that vaccines result in autism. Health experts remind the public that such resistance or refusal to inoculate their children raises the chances of an outbreak.

As for the parents of that six-year-old child whose brush with an early mortality was described in the CDC report by Dr. Judith Guzman-Cottrill who assisted in the medical care of the boy and was lead author of the article, despite exposure to an "extensive review" of the risks and benefits of vaccination, they have decided to turn down the second tetanus vaccination, along with any other immunization for their child recommended by the medical community.

According to the Centers for Disease Control (CDC), the boy’s parents chose not to continue with his vaccination schedule after he received the first dose and did not give any other recommended immunizations. (Getty images)

Tetanus Can Cause Difficulty Swallowing and Breathing

Tetanus is an infection caused by bacteria. Inside the body, the bacteria produce a toxin, or poison. The toxin causes your muscles to tighten and cramp painfully and causes seizures. Tetanus is also called “lockjaw” because it often causes a person’s neck and jaw muscles to tighten. This can make it hard to open the mouth or swallow. The muscle spasms and seizures can be strong enough to break bones. Muscle spasms can also cause breathing problems. People with tetanus often have to spend several weeks in the hospital under intensive care. Complete recovery can take months. If left untreated, tetanus can be deadly.  Centers for Disease Control & Prevention