Ebola and COVID-19 in DR Congo and Guinea.

As DR Congo and Guinea experience concurrent Ebola and COVID-19 outbreaks, the countries face the challenge of vaccinating people against both. Paul Adepoju reports.

While the few richest countries have most of the COVID-19 vaccine doses, low-income and middle-income countries are beginning to receive doses, especially through the COVAX Facility. One such country is DR Congo, which is also dealing with an Ebola outbreak.

On March 5, more than 1·7 million doses of the Oxford-AstraZeneca COVID-19 vaccine arrived in Kinshasa, the capital of DR Congo. The country's choice of the vaccine stemmed from it meeting existing storage conditions in the country (between 2°C and 8°C). About 1 month earlier, on Feb 7, DR Congo announced that a new case of Ebola had been detected in Butembo, a city in North Kivu province, where a previous outbreak was declared over in June, 2020. A week after DR Congo's announcement, another Ebola outbreak was announced in Guinea. As of March 6, the Ebola outbreak in Guinea had resulted in 18 cases and nine deaths, and that in DR Congo had resulted in 11 cases and four deaths. On this occasion, both countries have access to Ebola vaccines; DR Congo had thousands of doses left over from its last Ebola outbreak, while Guinea had received tens of thousands of Ebola vaccine doses from WHO and the USA. As of March 6, official data show that in DR Congo, 643 contacts of Ebola virus disease patients have been identified, of whom 87% are being monitored, and 1083 people have been vaccinated. In Guinea, 81% of the 427 identified contacts are being monitored, and 1804 people have received the Ebola vaccine.

Christian Happi, director of the African Center of Excellence for Genomics of Infectious Diseases, told The Lancet Infectious Diseases that even though Guinea and DR Congo are dealing with Ebola and COVID-19 outbreaks at the same time, the diseases are different from epidemiological and aetiological perspectives: “COVID-19 spreads faster and is less fatal, while Ebola spreads slowly and is more fatal.” As of March 8, DR Congo had recorded 26 049 confirmed cases of COVID-19 and 711 deaths, thus giving a case fatality rate (CFR) of about 2·7%. Available epidemiological data for the country's 12th Ebola outbreak within the same period showed a CFR of 36%. For Guinea, the country's COVID-19 CFR is about 0·6%, whereas that of Ebola is 50%.

John Nkenkasong, director of the Africa Centres for Disease Control and Prevention, told The Lancet Infectious Diseases that for both Ebola and COVID-19, the existence of efficacious vaccines will go a long way in reducing spread and fatality. But he added that the targets for the exercises are different: for Ebola, the two countries are striving to quickly identify individuals most at risk and conduct ring vaccination, whereas for COVID-19, the countries are looking to vaccinate as many people as possible within a very short period of time. “For COVID-19, the goal is to vaccinate up to 70% of the population in order to achieve herd immunity, which is important for us to start talking about getting back to normal”, Nkenkasong told The Lancet Infectious Diseases.

In spite of the uniqueness of the respective diseases, experts argue that there are several overlaps. According to Happi, personal hygiene recommendations for both diseases are similar. Frontline health workers are disproportionately affected by Ebola, and are also first in line to receive the COVID-19 vaccine. DR Congo and Guinea are using the Ebola vaccination efforts to test run their preparedness for the introduction of COVID-19 vaccines in the respective countries. Bachir Kanté, counsellor in charge of mission at Guinea's Ministry of Health and Public Hygiene, noted that the country's COVID-19 response is relying heavily on capabilities the country has acquired during the previous Ebola outbreak in 2014–16. Moreover, the choice of COVID-19 vaccine ensured that the existing cold storage system could be adapted for both vaccines.

With the initiation of Ebola vaccination exercises in both countries, Kanté said they are able to quickly tackle any problem that could arise from vaccine hesitancy. “With this opportunity to hold a vaccination exercise before rolling out the COVID-19 vaccines, we have a great chance to inform the people and lay the groundwork for a full scale exercise.”

But Ifeanyi Nsofor, chief executive officer of EpiAFRIC, an African health consultancy group, argued the return of Ebola outbreaks to both countries suggested wide gaps still exist in the health-care systems of several African countries. He added that both countries dealing with several outbreaks could make response more difficult as fatigue could easily set in, thus making public health measures unable to achieve set goals. “When you're dealing with the same thing all the time, response becomes a bit challenging. You see some people begin to default, you see that people begin to question personal liberties versus community goals. People can get tired and want to move on with their lives. This can quickly complicate control efforts”, Nsofor told The Lancet Infectious Diseases.