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Congo Gets First Desperately Needed Mpox Vaccines, But Vaccination Campaign Faces Huge Challenges
Johannesburg — The Democratic Republic of Congo, at the epicenter of a global health emergency declared over a still-growing mpox outbreak, received a first delivery of 99,000 vaccines for the virus Thursday, with a second delivery of 101,000 expected Saturday, the head of the World Health Organization said.
Congolese health officials tell CBS News they hope to start getting the vaccines into the arms of frontline health workers and close contacts of confirmed cases by the beginning of October, with a quicker rollout likely impossible due to logistical challenges.
Officials in Congo say they've struggled to diagnose patients and provide basic care in the vast country of 100 million people, where a fragile, under-resourced health care system is also burdened by stigma associated with the virus previously known as monkeypox.
A lack of diagnostic materials and basic medicines to treat the virus, which can improve survival rates, have also hampered efforts to contain the outbreak.
A patient with mpox waits for treatment at the Kavumu hospital in Kabare territory, South Kivu region, Democratic Republic of Congo, Sept. 3, 2024. Arlette Bashizi/Bloomberg/Getty Greg Ramm, Congo country director for the Save the Children charity, told CBS News that mpox cases were still skyrocketing. He lamented what he said was scant attention being paid globally to the crisis, suggesting the world only starts to really take heed when diseases, such as past outbreaks of Ebola, spread beyond Congo's borders.
A litany of challenges for the mpox vaccination campaignThe first shipment of about 200,000 vaccines, donated by the European Union, will be sent to six targeted provinces. They must be kept continuously at minus-130 degrees Fahrenheit until they are administered, in what's referred to as cold chain storage — an added challenge for the developing nation.
Dr. Tedros Adhanom Ghebreyesus, director-general of the United Nations' World Health Organization, said the WHO had "supported the government to get the necessary cold chain in place for the vaccine delivery."
Congo is a country the size of Western Europe. It is rich with natural resources, including highly sought-after cobalt and copper, and is home to the world's second largest rainforest. But those resources have been fought over by militant groups for decades and, despite its bounty of natural wealth, the World Bank ranks Congo among the five poorest nations in the world.
The overwhelming majority of the Congolese people have never benefitted from the country's resources, with roughly 75% of the population living on only about $2 per day or less.
Congo President Felix Tshisekedi has set up a $10 million fund to support the response to the outbreak. Hospitals in the hardest hit areas have reported running out of medicine every day, with officials saying they face challenges even providing sufficient food to patients.
Doctors with several charities working in the country have told CBS News they're overstretched and short on supplies, even having to use tents and mattresses on the floor of makeshift isolation wards to treat a constant influx of patients.
The desperately needed vaccines are expensive. Health officials tell CBS News that during the 2022 mpox outbreak, manufacturer Bavarian Nordic was selling a single dose of its vaccine for $110.
Jean Kaseya, Director-General of the Africa Centers for Disease Control, has said the continent now needs some 10 million doses to stop the spread of the virus.
"We need to talk about 2 million vaccines to Congo, which is hundreds of thousands of dollars," said Ramm.
The first few thousand vaccines will be prioritized for health care workers and contacts of known cases, so the initial administration may do little to halt the spread of the virus in Congolese communities.
WHO declares mpox outbreak in Africa a global health emergency 02:47Mpox can look at first like measles or chickenpox on the skin, with pus-filled lesions and flu-like symptoms. It is a more pressing health concern for those with weaker immune systems, including young children and pregnant women. There are no rapid tests to diagnose mpox, and Congo has only six labs to process the PCR tests, thanks largely to capacity built up during the coronavirus pandemic.
The cost of PCR tests is also largely prohibitive in much of Africa.
Treating the virus requires antibiotics for bacterial infections caused by the lesions, painkillers for fevers and proper nutrition and clean water. These basic needs are a daily challenge at health care sites in Congo.
A deadly outbreak for Congo's childrenMost of the schools in the country, which reopened this week, lack running water, disinfectants and soap – basic items that can help prevent the spread of the virus. More than 600 children have died of mpox this year alone in Congo. Young people are more vulnerable due to other prevalent health issues in the country, including malaria, measles and other childhood diseases.
A laboratory specialist takes a sample from a patient suspected of being infected with mpox at the Kavumu hospital in Kabare territory, South Kivu region, Democratic Republic of Congo, Sept. 3, 2024. Arlette Bashizi/Bloomberg/Getty Mpox was discovered in Denmark in 1958 in research monkeys and named monkeypox. It was first found in humans in 1970 in what was then known as Zaire, now Congo.
Ninety percent of the total mpox cases in the world are in Congo, where people are testing positive for both the newer Clade 1b and the Clade 1a strains. The Clade 1b strain was first detected in the country in September 2023 and has recently been detected in 13 African nations.
More than 655 deaths have been blamed on the virus in Congo, and there are about 20,000 suspected cases.
Health care workers who spoke with CBS News said they fear the real caseload is much larger, as they can only readily access some parts of the country.
Stigma remains a major problem, with communities often looking to traditional healers before turning to Western medicine. Throughout the Ebola outbreaks, it was common for local communities to hide cases of the virus from health care workers, with some claiming the virus only arrived with Western health care workers in their familiar white suits.
Fear of mpox hitting Congo's cities and IDP campsThe outbreaks have remained fairly isolated to several areas in Congo, but the fear is the virus will hit major cities, such as the densely packed capital Kinshasa, which is home to some 15 million people. The city has seen only a few confirmed cases so far.
A view of the town of Kavumu, where there has been an outbreak of mpox in Kabare territory, South Kivu region, Democratic Republic of Congo, Sept. 3, 2024. Arlette Bashizi/Bloomberg/Getty There are also camps for internally displaced people in the Eastern Goma region where as many as 1 million people have sought shelter — most of whom have fled fighting among the various militia groups that plague Congo. Efforts to educate the displaced people about mpox are underway, but health care workers tell CBS News it can be difficult to distinguish, at least at first, from other skin diseases that are prevalent in the tent camps due to the lack of hygiene and clean water, such as scabies.
As the rainy season approaches, health care workers worry the IDP camps could be facing a perfect storm, with possible increased mortality from the ever-mutating mpox virus, endemic cholera and possible measles outbreaks coupled with shortages of food, water and medicine and poor basic hygiene.
"This is a forgotten community to the world," Lindis Hurum, a project coordinator for the Doctors Without Borders charity in Congo told CBS News, adding that most people in the camps were more worried about surviving until the next week than they were about mpox.
Hurum spoke with CBS News after visiting one of the IDP camps, where she had just met a woman who told her she was facing an impossible choice: Stay at the camp with her family in the horrible conditions and face the health risks, or return to their village in the midst of heavy fighting among the militias.
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MoreSarah CarterEbola: How A Killer Disease Was Stopped In Its Tracks
A health worker monitors the temperature of a traveller from the DR Congo
One of the world's deadliest viruses, Ebola kills up to half of those it infects. But despite appearing to have all the hallmarks of a potential epidemic, the latest outbreak developed in a very different way.
It was the ninth Ebola outbreak to hit the Democratic Republic of Congo in a decade, killing 29 people and leaving at least 60 children orphaned.
While one death is too many, the West Africa epidemic of 2014-16 claimed more than 11,000 lives and it is hoped that later this week the most recent outbreak will be declared officially over by the World Health Organization.
The relatively small number of deaths follows the use of an experimental vaccine, which may have saved hundreds, or even thousands of lives.
Fragile health system
Although the outbreak began in a remote area, there was a real danger that large numbers could be infected.
It appeared close to neighbouring Central African Republic and the Republic of Congo - a vast area with a great ebb and flow of people and a fragile health system. It is also an area linked by river and road to the capital Kinshasa - home to 10 million people.
When the virus returned in 2018, it could be quickly deployed, once the DRC government had approved its experimental use. This vaccine is designed for use against the Zaire strain of Ebola, which caused both this outbreak and the previous one.
Scientists and health workers set to work tracking all potential transmissions since the first case had been reported.
Front-line health workers, people in contact with confirmed Ebola cases, and their contacts all needed to be given the vaccine.
However, keeping the vaccine safe and making sure it reached the right people was not a straightforward task.
The vaccine must be kept extremely cold, at minus 70C.
This is difficult and expensive to do in a remote environment with unreliable electricity. Alongside the vaccine, fridges and generators had to be flown into the region by helicopter.
Isolation and treatment facilities had to be built, mobile laboratories set up and local laboratory technicians trained to test samples and confirm cases of Ebola.
Gaining consent
For the vaccine to be effective, it had to be given to the right people.
Health workers spoke to patients, their families and the wider community to dispel rumours, build trust and avoid panic.
This, they explained to community leaders, was not a mass campaign.
Vaccinations were given to the Ebola patient, plus a "ring" of friends, family and contacts - as well as healthcare workers and people involved in burials. All had to give their consent.
Identifying and finding all the people suspected Ebola patients had been in contact with was a major challenge because of the location.
Health workers had to travel by motorbike to places where there are no paved roads.
Despite these challenges, there has been high uptake rate and an estimated 98% of those eligible were vaccinated.
What is Ebola?
Co-ordinated attempt
Health visitors travelling by motorbike through a remote area of DRC for a follow-up meeting with a contact
While the vaccination may have helped to save lives, better public health measures also played a crucial role in containing the outbreak.
Treatment centres and isolation zones were set up to reduce the spread of the virus and face-masks, gowns and gloves were used.
Safe burial practices also helped to limit transmission of the virus, as did screening of passengers at international and domestic ports and airports.
There has also been work to reintegrate survivors with their community because in former outbreaks survivors were sometimes ostracised by their families and neighbours.
Lessons for the future
In the three months since the outbreak began, more than 3,000 people in the region have been vaccinated.
As a result of its use - and the other precautionary measures - the epidemic is likely to end quicker than might have been expected.
But unfortunately this isn't the end of the road for Ebola, as we know it is a disease that will continue to appear in future.
Two years after it was first tested, the vaccine still works, but we don't yet know how long-lasting the protection will be.
More than one Ebola vaccine is needed, so we're not reliant on just one manufacturer.
It would also be helpful to have options for different situations - such as a single shot vaccine for quick protection and booster vaccines when there isn't an outbreak.
Researchers need to find out more about what works and why, so more lives can be saved.
To do that, we need to stop thinking of these outbreaks as isolated events - introducing a long-term programme of research and response into every Ebola outbreak.
And while Ebola is high profile, we also need to remember it isn't the only disease that could lead to an epidemic.
It's impossible to predict what the next epidemic will be, but we can be better prepared.
At-risk countries need tools and support to strengthen their health systems and monitor disease, so that they are ready before an outbreak and can save as many lives as possible.
Dr Josie Golding is the Epidemic Preparedness & Response Lead at the Wellcome Trust, a global charitable health foundation. Follow her at @BeakerH
Thousands Of Ebola Survivors Face Severe Pain, Possible Blindness
Thousands of West Africans who were infected with the Ebola virus but survived it are suffering chronic conditions such as serious joint pain and eye inflammation that can lead to blindness, global health experts said on Friday.
Ebola survivors who fought off the most severe bouts of infection are the most likely to suffer ongoing medical problems, World Health Organization experts said, and their health is becoming "an emergency within an emergency".
"The world has never seen such a large number of survivors from an Ebola outbreak," said Anders Nordstrom, a WHO representative in Sierra Leone who took part in a five-day conference this week about Ebola survivors.
"We have 13,000 survivors in the three countries (Guinea, Liberia and Sierra Leone). This is new - both from a medical and from a societal point of view," he told reporters on a telebriefing.
Daniel Bausch of the WHO's clinical care team on Ebola survivors said about half of all those who fought off the virus now report joint pain, with some suffering such severe effects that they can't work.
Eye problems including inflammation, impaired vision and - in severe but rare cases - blindness, have been reported by about 25 percent of survivors, Bausch said.
Less measurable but equally serious long-term problems, such as increasing rates of depression, post traumatic stress disorder and social exclusion, are also affecting survivors.
Since West Africa's devastating Ebola epidemic was by far the largest ever seen - infecting more than 27,000 people and killing almost 11,300 of them - scientists are not able to say whether survivors' chronic health problems are unusual.
The Ebola virus is thought to be able to survive no more than 21 days in most body fluids, such as blood and vomit, which are the primary means of transmission.
But it is also known to be able to lurk in semen and in the soft tissues of the eye for up to several months after recovery.
Scientists believe the vision impairments reported by survivors of the current outbreak are probably linked to the virus persisting in the eyes.
Bausch said sight problems, joint pain and headaches have been reported in a few survivors of previous outbreaks since the disease was first detected in 1976. But past epidemics were much smaller, meaning survivor numbers were too small to study or draw any meaningful scientific conclusions.
Specialists say, however, that it is not surprising that a virus as dangerous as Ebola could have long-term impacts, and the unprecedented outbreak in West Africa offers a unique opportunity to learn more about how to help survivors.
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