The Challenges and Dilemmas of Ebola Vaccines

(Posted by Rishab Nandan – 7.23.19)

The topic of benefits of vaccinating may be somewhat polarizing leading to much debate, but in cases of deadly outbreaks like Ebola, leaving room for a debate may seem like a luxury that is too costly.  Consequences of inaction can be so dire that the mounting death toll in places like Democratic Republic of Congo (DRC) due to Ebola is forcing the World Health Organization (WHO) and Medicines Sans Frontiers (Doctors without Borders) to press for vaccines that have not even been approved.

The recent political tensions between leadership in DRC between the President and health minister, over allowing yet another unapproved vaccine from Johnson and Johnson (J&J) in addition to the vaccines from Merck & Co be used, speaks to the gravity of the situation. The President stepped in to take control over the fight against Ebola, allowing J&J vaccines in addition to Merck and Co’s, to deal with this “exceptionally complex epidemic”. Health care officials are desperate to use all the tools at their disposal to contain the spread of Ebola and the coordinated use of both the Merck and Johnson & Johnson vaccines, both not approved by the Food and Drug Administration in the United States or by any other government agency in the world, is an example just how serious the situation is.

While the efficacy of the J&J vaccine has not been tested widely in the field, the Merck vaccines have been used successfully to provide some level of relief in protecting healthcare personnel working with Ebola patients. Ebola vaccines have been hindered by the unfortunate reality that the only effective way to test if they actually work is to conduct clinical trials during an outbreak. The West African outbreak of 2014-2016 allowed for some clinical trials to take place. But only the Merck vaccine testing in Guinea was able to generate results. The outbreak ended before trials could determine if other experimental vaccines or any of the experimental Ebola drugs worked.

Based on the Guinea trial results, the WHO advised that the Merck vaccine should be used in future outbreaks. But organizations involved in funding the development of these vaccines such as the Wellcome Trust and CEPI — the Coalition for Epidemic Preparedness Innovations — have been pressing for others to be deployed as well to determine if they work. The WHO’s vaccines advisory committee, the Strategic Advisory Group of Experts on Immunization, has been strongly pushing for trials of other vaccines be conducted in DRC. This is a situation where there is no time to wait for a 100% solution – a solution that is good enough and timely and likely to help is better than debating about the pros and cons of vaccinations – Ebola does not leave room or time for the luxury of vaccine debates – it is time for action and for creative solutions to develop effective immediate solutions

https://www.fiercepharma.com/vaccines/amid-push-for-j-j-vaccine-congo-ebola-outbreak-health-minister-steps-aside
https://www.statnews.com/2019/07/17/debate-testing-second-ebola-vaccine/