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The WHO has announced the rapid deployment of staff, medical
equipment and vaccines following the emergence of new Ebola cases
in Guinea and the Democratic Republic of Congo (DRC).
The outbreak in Guinea marks the first time the disease has been
reported there since the last major West Africa outbreak, which had
started in that country and ended in 2016.
The re-emergence of Ebola comes just as countries in Africa
prepare to receive first major consignments of COVID-19 vaccines
through the Gavi and WHO-led COVAX Facility. The swift response
highlights concerns that transmission of Ebola across borders could
unleash a dangerous clash of infectious disease outbreaks and
overwhelm weak and under-staffed healthcare systems across the
region.
Yet despite the alarm, rapid actions to reinforce surveillance,
contact tracing, testing, and treatment, which were already well
underway last week, show that national authorities and WHO teams
now have considerable expertise and experience to draw on. This is
due to the significant capacity building and preparedness planning
that took place during the previous major outbreak in
2014-2016.
The consignment of 11,000 doses of Ebola vaccine from the WHO
arrived in Guinea on 23 February, and immunisations are expected to
begin imminently. The WHO separately announced that a further 8,500
doses would soon be shipped from the US and 8,000 vaccine doses
already stocked in DRC were being used to immunise people at high
risk in that country. The prompt response is indicative of a
beefed-up arsenal of new healthcare products now available to fight
the disease.
The WHO has released USD1.25 million to support the response in
Guinea and to strengthen surveillance and preparedness in
neighbouring Cote d'Ivoire, Guinea-Bissau, Liberia, Mali, Senegal
and Sierra Leone. The United Nations Central Emergency Response
Fund has also disbursed USD15 million to support the response.
The epicentre of this latest outbreak in Guinea is in a border
area of the country, as was the situation at the start of the last
major outbreak in 2014, when infections moved across land borders
to Sierra Leone and Liberia. Consequently, authorities in those
neighbouring countries were quick to announce increased vigilance
and the WHO is also co-ordinating with officials in Cote d'Ivoire,
Mali, Senegal and other countries at risk in the sub-region.
Although the WHO has not confirmed the name of the Ebola vaccine
deployed, IHS Markit believes that Ervebo (rVSV-ZEBOV-GP), an
injectable single-dose vaccine manufactured by Merck Sharp &
Dohme (MSD, US), will play the lead role, since the WHO has
recently announced the establishment of a global Ebola vaccine
stockpile to ensure swift outbreak responses, starting with
supplies of the MSD vaccine. Ervebo was initially approved by the
European Medicines Agency (EMA) in November 2019. Since then, the
product has also been approved by the US Food and Drug
Administration (FDA), as well as in eight African countries. It has
also secured pre-qualification by the WHO, allowing it to be
fast-tracked by national regulatory agencies for urgent
deployment.
Other new products could also potentially be at the disposal of
national and international teams tasked with preventing a repeat of
the 2014-2016 outbreak. In July 2020, Janssen Pharmaceuticals
(subsidiary of Johnson & Johnson [J&J], US) became the
second pharmaceutical company to be granted marketing authorisation
by the EMA for an Ebola vaccine - its regimen of Zabdeno (Ad26.
ZEBOV) and Mvabea (MVA-BN-Filo) administered eight weeks apart.
Prior to its European authorisation, the two-dose vaccine was used
in DRC to complement the use of Ervebo as part of a major clinical
trial to generate data in a real-world setting.
On the therapies front, Regeneron Pharmaceuticals (US) received
US FDA approval in October 2020 for Inmazeb (atoltivimab,
maftivimab, and odesivimab-ebgn), comprising a cocktail of three
monoclonal neutralising antibodies, for the treatment of infections
caused by Zaire ebolavirus after clinical trials demonstrated its
superiority compared with other investigational agents - ZMapp
(Mapp Biopharmaceutical, US) and remdesivir (Gilead Sciences, US) -
in terms of mortality. Inmazeb was provided under a compassionate
use protocol during a 2018 Ebola outbreak in DRC. Regeneron stated
at the time of final approval by the FDA that it would continue to
provide Inmazeb on a not-for-profit basis for outbreaks in the DRC
and that it was working with non-governmental organizations and
public health agencies to ensure continued access in low- and
middle-income countries.
Although reported numbers of confirmed novel coronavirus
infections in the Africa region are proportionately low, accounting
for only 3% of the cumulative number of confirmed cases globally,
the pandemic has already placed significant pressure on
under-staffed and ill-equipped health facilities in many locations.
Failure to interrupt transmission of Ebola could unleash a
dangerous clash of infectious disease outbreaks and overwhelm weak
healthcare systems in West Africa. However, the swift response is
testament to how much better prepared authorities are to deal with
Ebola this time round. The capacity for surveillance, testing, and
contact tracing is far more robust, and newly available vaccines,
along with an approved new cocktail of monoclonal neutralising
antibodies from Regeneron, have dramatically enhanced the tools at
hand to fight the virus.
Posted 23 February 2021 by Sacha Baggili, Research Analyst, Life Sciences