The slow, steady battle for Guineans’ trust in the Ebola vaccine

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The vaccinators stepped down a narrow alley, between mossy walls, and ventured into the tiny dirt courtyard where half a dozen families were preparing meals and washing dishes. Among them was the grieving family of Fatmata, a 10-year-old girl who had died of Ebola a day earlier.

The health workers tried gently to persuade the families to agree to an experimental new Canadian vaccine. "We're not here to cause you any trouble," a doctor reassured them. But the residents, suspicious and fearful, refused to be vaccinated. Some shut their doors. "They are here with the powder to spray us with the virus," one woman muttered angrily.

It took four days of regular visits by doctors and community leaders before the families finally agreed to roll up their sleeves for the shot in their shoulder. Even here in Guinea, the West African country where the world's deadliest Ebola epidemic began, many people are nervous and mistrustful of the vaccine.

Yet slowly they are being won over. While some resistance remains, the wild rumours are fading. In early trials, the vaccine is proving to be a life-saving breakthrough, with a stunning 100-per-cent effectiveness rate. And now the vaccine program, originally limited to front-line health workers and adult contacts of Ebola victims, is expanding to include children as young as 6.

"We think the vaccine is good for our health," says Houissatou Sangare, grandmother of a 13-year-old girl who is currently being treated for Ebola in Conakry, the capital of Guinea.

She lives about 50 metres down the street from Fatmata's family in a Conakry shantytown known as Dar-es-Salaam. When two of her family members died of Ebola and her granddaughter was infected by the virus this month, she agreed to take the vaccine, and so did the rest of her family and neighbours. Now they are firm believers in it.

Ebola has infected more than 28,200 people and killed more than 11,000 since the latest outbreak began in southeastern Guinea in December, 2013. While the outbreak has now been contained, sporadic cases are still occurring in Guinea and Sierra Leone, and officials in Guinea are calling for a massive expansion of the vaccine to halt the outbreak completely.

This won't be easy. The vaccine has to be stored in specialized energy-intensive freezers at a consistent temperature of minus 80 degrees – a tough challenge in an impoverished country where electricity is unreliable. "It's a nightmare, very complicated," says one health worker.

There are also regulatory and licensing hurdles to be cleared before the vaccinations can be expanded beyond the clinical trials. Much of the trial data are still unconfirmed because the decline in the Ebola outbreak has made it difficult to get enough cases to study. The duration of the vaccine's effectiveness, for example, is still unknown.

The Canadian vaccine, known as VSV-EBOV, was developed by scientists at the National Microbiology Laboratory in Winnipeg over a 15-year period. It has been licensed to Merck and Co., but Canada remains involved in supporting the clinical trials. According to the early results announced in July, the vaccine was given to 2,014 people who had contact with 48 Ebola-infected people in Guinea and none of them developed the virus after a 10-day window for the vaccine to become effective.

But the trials have been arduous. Ebola has been cloaked in fear and rumours for so long, and its destructive power is so notorious, that many Guineans are fearful that the vaccine could somehow spread the virus.

Health workers are resorting to intense campaigning and unorthodox methods to persuade people to take the vaccine. They are recruiting local chiefs and religious leaders, including imams and pastors, to try to reassure anyone who seems nervous. They even get the religious leaders and health officials to take the vaccine themselves, in front of those who hesitate, to show that it is safe.

"People always ask me if I took the vaccine," says Dr. Aboubacar Soumah, primary investigator for the portion of the vaccine trial that targets front-line health workers. "If I said I hadn't taken it, nobody would listen to my advice. So I took it."

Guinea's national Ebola co-ordinator, Dr. Sakoba Keita, agreed to take the vaccine while television cameras were rolling. But his wife and mother misunderstood what was happening and thought he was being injected with the virus. "They panicked," he recalls. His mother was especially alarmed. "They want to kill my son!" she told people.

Sponsors of the vaccine trials cannot give inducements to anyone who receives the injection, since it could taint the results. So they provide only the equivalent of a few dollars for transportation, a beverage and a sandwich. And they spend up to an hour with each participant to explain the potential risks and side effects.

In a clinic in Conakry, a nurse named Oumou agreed to be vaccinated, but 13 of her 15 colleagues refused. When she told a friend that she would take the vaccine, her friend bade her a gloomy farewell, convinced she would die. "But I didn't hesitate," Oumou says. "I like my health and I want to protect myself. I'm very happy that I'm protected now."

Even in the government's national Ebola co-ordination centre, which is supposed to spearhead the battle against Ebola, most of the communications staff have refused to take the vaccine. "It's an experimental drug, so it should be for laboratory animals," scoffs Fodé Tass Sylla, main spokesman for the centre. "What if I took the drug and died? We should never experiment on our brothers and sisters. Would the Prime Minister of Canada allow a drug to be tested on him?"

Another spokesman, Dr. Mohamed Kone, says he was the only communications officer at the Ebola co-ordination centre who agreed to take the vaccine. "I'm a medical doctor, and I believe in the truth of the vaccine," he said. "I trust that it will protect me from Ebola. But there is a crisis of confidence between the population and the medical profession. Whenever there is any small rumour, people trust the rumour immediately."

Guinea and Sierra Leone are now in the final – and most difficult – phase of the fight against Ebola. The World Health Organization is convinced that the current outbreak can be eliminated by the end of this year. To be declared free of Ebola, the two countries need to go 42 days without a new case. This month, Guinea reached an unprecedented 14 days without a new case, winning praise from the WHO – and then it had to start again from zero when new cases emerged.

The case of Fatmata, the 10-year-old girl in the Conakry shantytown, was a vivid illustration that errors are still occurring in the surveillance system, allowing Ebola to persist. Fatmata fell sick on Sept. 6, and she lived just 50 metres from the Ebola victims in Ms. Sangare's family on the same street. Yet she was never suspected of having Ebola and was never placed on the "contact list" for testing.

Instead, a week after she became ill, her family sent her home to their village in a remote corner of Guinea, where she died a couple of days later. Now health workers are scrambling to track down and vaccinate an estimated 160 people who had contact with her.

"People are disappointed in all the things that went wrong," said Laurence Sailly, emergency co-ordinator at the Guinea office of Médecins sans Frontières (Doctors Without Borders).

"With all the things that were put in place, all the training and everything, we still recognized we had a case only when she was dead, and that's a failure. There will be an internal investigation to try to understand what went wrong. It's not acceptable that we find a case of Ebola only when she is dead."