This case study investigates local perspectives on the experimental vaccine deployment during the 2018 Ebola epidemic in Equateur Province, Democratic Republic of the Congo. Declared on 8 May 2018, the outbreak emerged simultaneously in two rural health zones and quickly reached the provincial capital of Mbandaka, a city of more than 1.2 million inhabitants located on the banks of the Congo River. It was the first Ebola outbreak in which an experimental vaccine (Merck’s rVSV-ZEBOV-GP) was deployed. The vaccine was approved for compassionate use according to the WHO’s Expanded Access Framework and administered according to ring vaccination protocol: it was offered to direct contacts of confirmed Ebola patients, as well as to the direct contacts of these contacts and to frontline workers considered to be most at risk of contracting the virus (including medical personnel, community health workers, burial teams and traditional healers).
Despite concerns that communities may be resistant to an experimental vaccine, its implementation appears to have been successful. Most media coverage about the vaccine's deployment was triumphalist, referring to the vaccine as a "game-changer" and "a paradigm shift" and crediting its deployment as one of the major contributing factors in breaking the chain of transmission and containing the outbreak in just seven weeks (the epidemic was declared over on 24 July 2018). However, while the vaccine deployment appears to have had a positive trajectory overall, there is a lack of research into how the vaccine was perceived by different communities in rural and urban areas, and a limited understanding about attitudes towards vaccination from those both inside and outside the ring. Furthermore, pregnant and breastfeeding women were initially included in the ring, but later excluded due to safety concerns, and little follow-up research has been conducted to examine the physical, mental and social consequences experienced by vaccinated women. Finally, while overall vaccine uptake was encouraging, certain marginalized ethnic groups were reluctant to be vaccinated, and little research has been conducted to
interrogate the reasons for this.
By conducting longitudinal ethnographic research in the immediate aftermath of the epidemic (between August 2018 and August 2019), this case study aims to explore local-level perspectives on experimental vaccine deployment, and to prioritize the perspectives of women and marginalized ethnic groups. The project will (1) explore the acceptability of the vaccine and its deployment method among both vaccinated and unvaccinated people in the affected health zones; (2) explore the successes and barriers to delivery of the vaccine from the perspectives of communities, health care workers and local and international agencies; (3) situate the emergency vaccination in the context of broader routine immunization and vaccine campaigns in the region; (4) situate it in the broader political and economic context of the epidemic and response; and (5) examine vaccine hesitancy with attention to gender and to the historical marginalization of certain populations by national and international public health systems.
The project aims to provide new empirical evidence that can inform current and future Ebola outbreaks in the DRC and elsewhere, and to contribute to our broader understanding of vaccine introduction during emergency response.