Canada's experimental new Ebola vaccine has been so effective in halting the lethal disease that it should be expanded to five million people in high-risk regions of West Africa, but a looming shortage of the vaccine could severely curtail its success, says the Ebola czar in one of the worst-afflicted countries.
Clinical trials have raised hopes that the Canadian vaccine could be crucial in helping end the Ebola crisis, with early results showing it has been 100-per-cent effective in its first trials in Guinea, the impoverished West African country where the latest outbreak began in December, 2013. But with fresh cases of Ebola still stubbornly persisting in Guinea this month, health workers are rapidly depleting their supplies of the vaccine, according to Sakoba Keita, national co-ordinator of the Ebola response in Guinea.
"If we don't expand the vaccine program, we'll have more Ebola cases," Dr. Keita told The Globe and Mail in an interview at his office in Guinea's national Ebola co-ordination centre.
"Only about 3,500 doses of the vaccine are remaining, and we have no source of funding to get more. It will run out soon. That's our problem now. We wish Canada would help us to get more of the vaccine."
The vaccine known as rVSV-EBOV, developed by scientists at Canada's National Microbiology Laboratory in Winnipeg over a 15-year period and currently licensed to Merck and Co., has been hailed as a "game changer" and potential "silver bullet" in the fight against Ebola.
The vaccine is still undergoing trials among people at risk of Ebola infection in Guinea after the impressive early results were announced in late July. But the current vaccine program is scheduled to end in late October, at a time when it should be massively expanded to protect as many as five million people, Dr. Keita said.
"We have confidence in this vaccine," he said. "In most areas where we have used it, Ebola has completely disappeared, thanks to the vaccine."
Guinea was "ground zero" for the world's worst Ebola outbreak, which has infected more than 28,200 people and killed more than 11,300 in the past 18 months, mostly in the three West African countries of Liberia, Guinea and Sierra Leone. The outbreak has been declared over in Liberia, but new cases have kept occurring in Guinea and Sierra Leone, including a new case in Conakry on Sept. 19 and a death of a young girl in a Guinean village on Sept. 16.
In the slums of Conakry, Guinea's capital, dozens of health workers descend on the homes of anyone infected with Ebola, persuading their family members and neighbours to be vaccinated and monitored. It is often a difficult task, since there is widespread suspicion of the vaccine in a country where rumours and fear have long hampered the Ebola response. But after initial hesitation and resistance, many Guineans have become fervent believers in the vaccine.
"I'm trying to convince everyone to take it," says Nouhu Barrie, a security guard who lives in the same housing compound where two people recently died of Ebola, in a low-income Conakry neighbourhood known as Dar-es-Salam.
On the day after the first Ebola death in his compound, all of the neighbours refused to be vaccinated, fearing that the injection could give them the disease, he said. "But the next day everyone took it, and there wasn't enough of the vaccine for others who wanted to take it."
He supports Dr. Keita's idea for a huge rollout of the vaccine across the country. "At the beginning of the crisis, they told us there was no cure. But if you take this vaccine, you'll be safe from Ebola. If you meet someone with Ebola, you won't get it. People believe in it now."
Dr. Keita said his country has received only about 10,000 doses of the Ebola vaccine. So far about 2,000 front-line health workers have been vaccinated, and a further 3,000 vaccinations were given to those who came into contact with Ebola-infected people, he said, while another 1,500 doses were sent to neighbouring Sierra Leone last month when new cases occurred there.
After the National Microbiology Laboratory developed the vaccine, the federal government licensed it to NewLink, an Iowa biotechnology company, which in turn licensed the world rights to Merck & Co. for $50-million (U.S.) and royalties. But the Canadian government has continued to support the vaccine's human trials, funding the production of hundreds of vials last year.
Two federal agencies, the Public Health Agency of Canada and the International Development Research Centre, have been supporting the vaccine trials in Guinea. But when asked about Dr. Keita's request for Canadian support for a major expansion of the vaccine program, neither of the Canadian agencies would comment. Nor would the Foreign Affairs department.
An IDCR spokeswoman, Jocelyn Sweet, said the IDRC is pleased by the "potential indications" that the vaccine is effective. But she struck a cautious note. "It is early in the trial process, and the effectiveness of the strategy remains to be confirmed," she said in an e-mail. "If it is established that this strategy does contribute to stopping new cases from arising from contacts of patients, this would mean that the vaccine could be used to help prevent future outbreaks more quickly than regular public health and other control measures alone."