London School of Hygiene & Tropical Medicine

As we approach the one-year mark of the world’s second largest-ever Ebola outbreak—with nearly 2,500 cases and more than 1,600 deaths in the Democratic Republic of the Congo (DRC)—there is no evidence that the end of this devastating epidemic is in sight. Rather, there is a real risk that this epidemic could further expand, as illustrated by the recent case of a pastor with Ebola disease traveling from Butembo to the major border city of Goma, alongside the ever-present risk of another Ebola outbreak emerging in the DRC or elsewhere.

We at LSHTM commend the major efforts of all local, national, and international actors who are tirelessly working to save lives in North Kivu and Ituri. While these efforts have certainly helped slow the disease’s spread, a change in strategy and intensified efforts are urgently needed. From stronger community engagement, to strengthened diagnosis and real time sequencing, to ring vaccination and primary prevention through broader vaccination in the community - we must use every possible approach. This is why we very much regret the recent decision of the DRC Minister of Health to rule out the deployment of a second vaccine.

It is hard to understand why such a decision was taken, going so far as to ban any research on investigational Ebola vaccines in the country during this outbreak. The DRC has been a leader in innovation during Ebola outbreaks, and should remain at the forefront of research and innovation in this area. Whereas it is imperative to intensify the current ring vaccination strategy with the experimental Merck vaccine, it is clear that, up to now, this strategy has not been able to stop the epidemic. Deployment under study conditions of a second experimental vaccine would have the dual-benefit of supporting the ongoing response and improving preparedness for future outbreaks.

The Johnson & Johnson (J&J) investigational Ebola vaccine regimen has been tested in more than 6000 persons and is safe. Although it has not been used in previous outbreaks, and thus demonstration of efficacy in humans is lacking, it has shown outstanding safety and immunogenicity in humans and is highly protective against Ebola challenge in non-human primates. In line with the recommendations of the World Health Organization (WHO) SAGE Committee, a consortium including LSHTM is ready to work with local and national authorities in DRC, together with our Congolese and international partners, to deploy up to 1.5 million J&J vaccine regimens to test the vaccine, support the ongoing response, and bring an additional tool into the armamentarium against Ebola.

We urge national and international actors to significantly increase support to contain this devastating Ebola epidemic, while ensuring the funding reaches those in need and contributes to work at the community level, which is vital in the face of such a complex epidemic. LSHTM will continue to support epidemic control efforts and to strengthen preparedness for future epidemics, including the coordinated deployment of both the Merck and J&J vaccine, and trust the Minister’s decision be reconsidered.

This is a critical juncture in the Ebola response. Let us join forces to intensify current efforts and employ all of the tools and approaches at our disposal. There is no easy solution to this incredibly complex outbreak. We hope that today’s high-level meeting convened by WHO and the United Nations is a catalyst for improved coordination, high-level political support, and urgent unified action.