An effective and safe vaccine will not be enough to prepare us for the next Ebola outbreak

Lancet Infectious Diseases
Dec 2017 Volume 17 Number 12 p1219-1318  e383-e433
http://www.thelancet.com/journals/laninf/issue/current

Comment
An effective and safe vaccine will not be enough to prepare us for the next Ebola outbreak
John S Schieffelin
Open Access – Excerpt
…Although this study [Gsell et al] is noteworthy because it provides substantially more safety and efficacy data for the rVSV-EBOV vaccine, it also points out two major hurdles remaining that every Ebola vaccine must overcome in the future, and for the cautionary tale that it provides, one that the international community will hopefully heed. First, the reported adverse event rate in Ebola ça Suffit! was 53·9%, with 98·5% classified as mild to moderate.5 In the present study, the vaccine was better tolerated with only 16% of children and 34% of adults reporting adverse events. With an adverse event rate of up to 50%, social mobilisation efforts to encourage vaccination participation will be challenging in future Ebola outbreaks. How many people refuse the seasonal influenza vaccine each year because they think it gives them the flu? Now imagine a scenario in which people think the vaccine could give them Ebola. This issue leads directly to the vaccine’s second hurdle: misconceptions, rumours, and community resistance. 34% of eligible contacts in Ebola Ça Suffit! refused or withdrew consent.5 In the current study, one affected community refused participation due to mistrust of the Ebola surveillance teams. Community resistance played a prominent part in the spread of Ebola virus during the 2013–15 outbreak.6 A weak public health infrastructure and widespread shortages of health-care workers contributed to fears and misconceptions about an unfamiliar disease with a high mortality. One that is treated in walled-off Ebola treatment units and requires medical burials, denying family members the solace provided by traditional funeral rites. These conditions fuelled rumours, mistrust, and, in some cases, violence. Surveillance, social mobilisation, and vaccination teams trained in distant capitals must seek input and support from local leaders or they risk developing a sense of coercion and distrust…7, 8