Mar­ket­ing the Ebola vac­cine Tribal lead­ers quell sus­pi­cions of mod­ern medicine in ru­ral ar­eas

The Washington Times Weekly - - Geopolitics - BY TOM HOW­ELL JR.

Ebola had just killed thou­sands of peo­ple in Liberia, and the U.S.-backed pitch to sign lo­cals up for a vac­cine trial must have seemed like a tough sell: Take part of the very virus that had dev­as­tated the re­gion, com­bine it with a sep­a­rate, harm­less virus, and in­ject it into vol­un­teers with the hope they de­velop Ebola an­ti­bod­ies.

But some cre­ative mar­ket­ing, bru­tal hon­esty and good will built up from months of life­sav­ing hu­man­i­tar­ian ef­forts paid off, with more than 1,500 vol­un­teers now tak­ing part in a vac­cine study run out of Re­demp­tion Hos­pi­tal in Mon­rovia, the cap­i­tal.

“It was much eas­ier than I thought it was go­ing to be,” said Dr. Cliff Lane of the Na­tional In­sti­tutes of Health and co­prin­ci­pal in­ves­ti­ga­tor on the PRE­VAIL trial, a part­ner­ship be­tween the U.S. and Liberia’s Min­istry of Health. “We had sup­port from the gov­ern­ment. We had sup­port from the U.S. gov­ern­ment. We had sup­port from the com­mu­nity who re­ally un­der­stood this was im­por­tant.”

A year af­ter the Ebola epi­demic swept through West Africa, claim­ing more than 11,000 lives and spread­ing panic across the globe, the dis­ease’s spread has slowed dra­mat­i­cally.

Of­fi­cials re­ported only two cases in Guinea and one case in Sierra Leone for the week end­ing Wed­nes­day. Neigh­bor­ing Liberia was de­clared Ebola-free on May 9, although sev­eral new cases in early sum­mer put the coun­try on high alert.

Fear of another out­break re­mains high, and health of­fi­cials are scram­bling to try to de­velop a vac­cine in ad­vance of another out­break, hop­ing to take ad­van­tage of chang­ing at­ti­tudes that have made it pos­si­ble to find vol­un­teers in each of the three most-af­fected coun­tries.

Each of the ma­jor stud­ies is us­ing a vac­cine, known in lab-speak as rVSV-ZEBOV, that was de­vel­oped by the Public Health Agency of Canada and li­censed to NewLink Ge­net­ics Corp., which col­lab­o­rated with phar­ma­ceu­ti­cal gi­ant Merck.

Early re­turns from Guinea’s vac­cine test are promis­ing, though very pre­lim­i­nary.

But the abil­ity to get the tri­als up and run­ning is al­ready a vic­tory, the sci­en­tists say.

In Sierra Leone, re­searchers from the Cen­ters for Dis­ease Con­trol signed up more than 8,000 front-line Ebola work­ers — from nurses to burial crews — to test the vac­cine.

The CDC team no­ticed early on that the term “Ebola vac­cine” sounded scary, so from then on it was an “Ebola-preven­tion vac­cine.”

But they were can­did about what might or might not hap­pen.

“We worked hard to not over­promise. We said we don’t know if this vac­cine works or not,” said Dr. Anne Schuchat, di­rec­tor of the Na­tional Cen­ter for Im­mu­niza­tion and Res­pi­ra­tory Dis­eases at the CDC, which ran dozens of meet­ings in five dis­tricts through­out the coun­try.

In Guinea, where the World Health Or­ga­ni­za­tion is run­ning a vac­cine trial, par­tic­i­pants are not paid for their trou­ble. That ac­tu­ally drew peo­ple in, be­cause the mere no­tion of pay­ment tends to arouse sus­pi­cion, said Dr. Marie-Paule Kieny, an as­sis­tant di­rec­tor-gen­eral at WHO.

For Liberi­ans it was im­por­tant that sci­en­tists cared about their in­put and that noth­ing would be forced on them.

“Help­ing them un­der­stand that what we were do­ing was re­search, not clin­i­cal care, and that par­tic­i­pa­tion was en­tirely vol­un­tary was very im­por­tant,” Dr. Lane said.

It’s an amaz­ing turn­around from early in the epi­demic, when Western health work­ers faced skep­ti­cism and even vi­o­lence in re­mote ar­eas, where vil­lagers had seen loved ones scooped up by out­siders in an am­bu­lance and never saw them again. Burial teams with full-body out­fits and sprayers looked alien to them. Some even thought Western­ers were pump­ing Ebola into their wells, or that lo­cal gov­ern­ments were trumping up the virus as a ploy for in­ter­na­tional aid.

Piet deVries, who works for Global Com­mu­ni­ties, an aid group aligned with the U.S. Agency for In­ter­na­tional De­vel­op­ment — which shifted its ef­forts from wa­ter and san­i­ta­tion projects to the Ebola fight — said when he went to River Cess in Liberia in Oc­to­ber, his lodg­ings were stoned.

“There were all kinds of ru­mors. It’s a coun­try where ru­mor is one of the big­gest ways com­mu­ni­ca­tion hap­pens,” said Brett Sedgewick, an ad­viser for Global Com­mu­ni­ties.

To counter re­sis­tance, work­ers set up lines of con­tact be­tween tra­di­tional lead­ers and county health of­fi­cers — chan­nels that hadn’t ex­isted be­fore.

In Guinea of­fi­cials tapped into Africans tra­di­tions — no pam­phlets or flashy advertising — and “talked, talked, talked” to re­li­gious lead­ers and imams about the study, Dr. Kieny said.

Only 10 com­mu­ni­ties out of 100 re­fused the vac­cine teams and, in gath­er­ing con­sent from in­di­vid­ual en­rollees, 70 per­cent of them agreed to par­tic­i­pate.

Two weeks ago, the WHO an­nounced quite promis­ing, though pre­lim­i­nary, re­sults from its trial, which tracked clus­ters of Ebola pa­tients’ con­tacts and con­tacts of those con­tacts — a strat­egy that forms a pro­tec­tive “ring” around at-risk pop­u­la­tions and worked to erad­i­cate small­pox in the 1970s.

Forty-eight of the ring clus­ters were ran­domly se­lected to get the vac­cine im­me­di­ately, while 42 were vac­ci­nated 21 days later.

While re­searchers found 16 cases of Ebola among the de­layed group, not a sin­gle con­tact who re­ceived an im­me­di­ate dose of the vac­cine — a sin­gle in­jec­tion into the arm — de­vel­oped Ebola af­ter 10 days, the study’s cut­off for de­vel­op­ing im­mu­nity from the in­jec­tion, ac­cord­ing to find­ings pub­lished July 31 in the pres­ti­gious med­i­cal jour­nal The Lancet.

“We have to see — we could still have a vac­ci­nated per­son who has a case,” Dr. Kieny said. “But for the time be­ing, it is still zero.”

While each of the tri­als in the three coun­tries is test­ing the same vac­cine, they are fill­ing dif­fer­ent niches.

The Sierra Leone trial will ex­am­ine the ef­fi­cacy of the vac­cine over time in health care and other front-line work­ers — some are given the vac­cine im­me­di­ately and some six months later — while the Liberian ef­fort is a “clas­si­cal” ap­proach to clin­i­cal re­search with a con­trol group given a placebo with no ther­a­peu­tic ef­fect, mean­ing it is a “dou­ble-blind” trial in which nei­ther vol­un­teers nor staff know whether a vac­cine or placebo was given.

The Liberia trial is also us­ing a sec­ond vac­cine, de­vel­oped by NIH sci­en­tists and the Glax­oSmithK­line com­pany, that em­ploys a chim­panzee-de­rived cold virus.

Dr. Lane said earn­ing the back­ing of the host coun­try — the Liberi­ans kicked off the study with a for­mal in­vite to the U.S. Depart­ment of Health and Hu­man Ser­vices — and lo­cal am­bas­sadors helped “enor­mously,” as re­searchers en­gaged with res­i­dents at town hall-style meet­ings.

“That’s not to say there wasn’t crit­i­cism or com­plaints,” he added. “The media there was like the media here.”

Some­times a hic­cup amounted to lit­tle more than mis­placed lingo. In a coun­try where tem­per­a­tures rarely dip be­low 70 de­grees, Dr. Lane found him­self re­fer­ring to the piece of the virus taken from Ebola’s outer coat, which is used in the vac­cine, as taken from the “shirt.”

“In Liberia,” he said, “there aren’t a lot of peo­ple wear­ing coats.”

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.