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Ebola vaccine trial in Sierra Leone battles against fear and logistics Ebola vaccine trial in Sierra Leone battles against fear and logistics
(6 months later)
Mohamed Conteh was very worried when he was offered the Ebola vaccine after a new case was confirmed in Sierra Leone’s Tonkolili district in January.Mohamed Conteh was very worried when he was offered the Ebola vaccine after a new case was confirmed in Sierra Leone’s Tonkolili district in January.
His uncle, a health worker, had come into contact with the victim, making Mohamed vulnerable. The 25-year-old student did not know what to expect from the vaccine and was scared of falling ill.His uncle, a health worker, had come into contact with the victim, making Mohamed vulnerable. The 25-year-old student did not know what to expect from the vaccine and was scared of falling ill.
“I wasn’t confident but my uncle had already taken the vaccine and this gave me courage. In the end I decided to have it because I thought it was better than falling sick with Ebola,” he says.“I wasn’t confident but my uncle had already taken the vaccine and this gave me courage. In the end I decided to have it because I thought it was better than falling sick with Ebola,” he says.
Mohamed was among 126 people in Tonkolili to be injected with the vaccine as part of a secondary ring vaccination campaign initiated after the latest death. This campaign was an extension of the first large-scale efficacy trial involving 30,000 people across affected west African nations.Mohamed was among 126 people in Tonkolili to be injected with the vaccine as part of a secondary ring vaccination campaign initiated after the latest death. This campaign was an extension of the first large-scale efficacy trial involving 30,000 people across affected west African nations.
The Tonkolili participants included 47 people aged between six and 75 who had had direct contact with the 22-year-old woman who died. The other 79 people, like Mohamed, were secondary contacts and potentially vulnerable.The Tonkolili participants included 47 people aged between six and 75 who had had direct contact with the 22-year-old woman who died. The other 79 people, like Mohamed, were secondary contacts and potentially vulnerable.
Related: Sierra Leone: we save lives of women in childbirth – while fighting Ebola | Benjamin Black
Daniel Conteh, Mohamed’s uncle, took part in a trial in October and now encourages others.Daniel Conteh, Mohamed’s uncle, took part in a trial in October and now encourages others.
“I had been directly exposed to the virus so I wasn’t scared about the vaccine because I knew that I needed it. I did worry that because it hadn’t been properly trialled something might go wrong, but I thought it was better to have it. I’m able to tell other people they will be fine if they are vaccinated too.”“I had been directly exposed to the virus so I wasn’t scared about the vaccine because I knew that I needed it. I did worry that because it hadn’t been properly trialled something might go wrong, but I thought it was better to have it. I’m able to tell other people they will be fine if they are vaccinated too.”
Dr Augustine Jimmisa, the district’s medical officer, says the biggest challenge for the trial was overcoming negative perceptions.Dr Augustine Jimmisa, the district’s medical officer, says the biggest challenge for the trial was overcoming negative perceptions.
“People are scared that a substance is being given to them to make them sick. There was a lot of suspicion and rumours that we wanted to introduce Ebola to the area. Using community mobilisers we explained the process, but it wasn’t easy for people to accept it.”“People are scared that a substance is being given to them to make them sick. There was a lot of suspicion and rumours that we wanted to introduce Ebola to the area. Using community mobilisers we explained the process, but it wasn’t easy for people to accept it.”
Other obstacles relate to underdevelopment in a country that ranks 181st out of 188 countries in the UN human development index (pdf).Other obstacles relate to underdevelopment in a country that ranks 181st out of 188 countries in the UN human development index (pdf).
Dr Tamba Manye, who works for the World Health Organisation (WHO) in Tonkolili, says logistics need to be improved before the unlicensed vaccine can be made more widely available.Dr Tamba Manye, who works for the World Health Organisation (WHO) in Tonkolili, says logistics need to be improved before the unlicensed vaccine can be made more widely available.
“There is no cold chain facility in Sierra Leone that can deal with the vaccine because it has to be stored at minus 80. The only facility is in Guinea, so we had to fly the vaccines from there. The vaccination process is still quite limited if we have another outbreak.”“There is no cold chain facility in Sierra Leone that can deal with the vaccine because it has to be stored at minus 80. The only facility is in Guinea, so we had to fly the vaccines from there. The vaccination process is still quite limited if we have another outbreak.”
Manye is monitoring participants for side effects. “We are looking for headaches, fever, rashes etc. We have had a couple of adverse events and two participants who came up with a fever but they were treated for malaria and got better.”Manye is monitoring participants for side effects. “We are looking for headaches, fever, rashes etc. We have had a couple of adverse events and two participants who came up with a fever but they were treated for malaria and got better.”
Mohamed’s experience speaks volumes about the knowledge gaps and logistical challenges involved in trials.Mohamed’s experience speaks volumes about the knowledge gaps and logistical challenges involved in trials.
“We hadn’t been told before we had the vaccine that we would suffer from anything. We were only told afterwards that this would be the case. The people who gave us the vaccines came from Guinea. They were French and couldn’t speak with us very clearly so they never told us what to expect. For the first two or three days my side, joints and head were very sore and I had a fever. But then my system started to cope and since then I’ve had no problems.”“We hadn’t been told before we had the vaccine that we would suffer from anything. We were only told afterwards that this would be the case. The people who gave us the vaccines came from Guinea. They were French and couldn’t speak with us very clearly so they never told us what to expect. For the first two or three days my side, joints and head were very sore and I had a fever. But then my system started to cope and since then I’ve had no problems.”
More than 28,600 people across west Africa have been infected during the Ebola outbreak and more than 11,300 have died. At least 17,000 survivors are still dealing with health complications and social stigma.More than 28,600 people across west Africa have been infected during the Ebola outbreak and more than 11,300 have died. At least 17,000 survivors are still dealing with health complications and social stigma.
As well as testing Ebola vaccines, Sierra Leone, Guinea and Liberia need to prevent outbreaks of other diseases, even as they struggle to rebuild decimated health systems and patch up frayed public trust in medical authorities.As well as testing Ebola vaccines, Sierra Leone, Guinea and Liberia need to prevent outbreaks of other diseases, even as they struggle to rebuild decimated health systems and patch up frayed public trust in medical authorities.
Gavi, the global vaccines alliance, has invested $12.5m (£8.8m) – from a projected $90m package – to rebuild national immunisation systems. But these efforts have been hindered by fears linked to the Ebola epidemic.Gavi, the global vaccines alliance, has invested $12.5m (£8.8m) – from a projected $90m package – to rebuild national immunisation systems. But these efforts have been hindered by fears linked to the Ebola epidemic.
“We now face a race against time to prevent outbreaks of other dangerous diseases by ensuring that children receive the vaccines they need to protect them,” said Dr Seth Berkley, CEO of Gavi. “Rebuilding trust amongst parents and carers is critical.”“We now face a race against time to prevent outbreaks of other dangerous diseases by ensuring that children receive the vaccines they need to protect them,” said Dr Seth Berkley, CEO of Gavi. “Rebuilding trust amongst parents and carers is critical.”
Rumours have circulated that vaccines against measles, pneumonia and diarrhoea could be linked to Ebola. Some parents have refused to get their children immunised and there is also a shortage of health workers to deliver the vaccines.Rumours have circulated that vaccines against measles, pneumonia and diarrhoea could be linked to Ebola. Some parents have refused to get their children immunised and there is also a shortage of health workers to deliver the vaccines.
Related: Watch how the measles outbreak spreads when kids get vaccinated – and when they don't
The WHO estimates that about 600,000 children have missed out on routine immunisations in Sierra Leone, Guinea and Liberia. The results can be fatal.The WHO estimates that about 600,000 children have missed out on routine immunisations in Sierra Leone, Guinea and Liberia. The results can be fatal.
Kadiatu Conteh weeps at the grave of her son, Osman, in Sierra Leone’s capital, Freetown.Kadiatu Conteh weeps at the grave of her son, Osman, in Sierra Leone’s capital, Freetown.
“He got a rash on his skin and was scratching and had a fever. We knew it was measles. He had missed his last vaccination because it was due during the time of Ebola and I was too scared to take him to hospital … Our family had lost 29 people to the disease and we were really scared we’d catch it in the hospital,” she explains.“He got a rash on his skin and was scratching and had a fever. We knew it was measles. He had missed his last vaccination because it was due during the time of Ebola and I was too scared to take him to hospital … Our family had lost 29 people to the disease and we were really scared we’d catch it in the hospital,” she explains.
“A neighbour told me to take him to a traditional healer instead. I did but the next day he got much worse so I did go to the hospital in the end, but it was too late. He died that day.”“A neighbour told me to take him to a traditional healer instead. I did but the next day he got much worse so I did go to the hospital in the end, but it was too late. He died that day.”
Ibrahim Sesay, a community leader in Freetown, is trying to rebuild trust to prevent such tragedies and is about to take part in a polio vaccination drive.Ibrahim Sesay, a community leader in Freetown, is trying to rebuild trust to prevent such tragedies and is about to take part in a polio vaccination drive.
“Some communities are hard to reach because they are deep in the bush and the roads are bad. We have to help the vaccinators find these communities … I know at least three children with polio.”“Some communities are hard to reach because they are deep in the bush and the roads are bad. We have to help the vaccinators find these communities … I know at least three children with polio.”
For Sesay, the Ebola outbreak underscored pre-existing fears. “Even before Ebola there were so many misconceptions about vaccines. Many people think vaccines will reduce the birth rate. Their biggest fear is that when children are vaccinated they … will be sterile.”For Sesay, the Ebola outbreak underscored pre-existing fears. “Even before Ebola there were so many misconceptions about vaccines. Many people think vaccines will reduce the birth rate. Their biggest fear is that when children are vaccinated they … will be sterile.”
For some, the message is getting through. Fatu Mustafa in Freetown has four children and her youngest, 14-month-old Bernadette, was vaccinated against tuberculosis during the Ebola crisis.For some, the message is getting through. Fatu Mustafa in Freetown has four children and her youngest, 14-month-old Bernadette, was vaccinated against tuberculosis during the Ebola crisis.
“I was scared but I knew that it was important she had it. But even so I didn’t allow her to be weighed or anything. I only let the vaccinator touch her, no one else.”“I was scared but I knew that it was important she had it. But even so I didn’t allow her to be weighed or anything. I only let the vaccinator touch her, no one else.”