Vaccines are not enough

Usnish Majumdar & Christopher Cai

February 4, 2017

CDC illustration

An illustration of Ebola stigma and treatment, drawn by the CDC.

Co-written with Christopher Cai, a friend and clinical trial coordinator at Massachusetts General Hospital.

Amid much fanfare, an international team of researchers recently reported the final results of the first successful Ebola vaccine trial.

While we should celebrate this result, we must also consider its value to those it was meant to help. Looking ahead, a capable response to future epidemics in West Africa will require both vaccines and sustained commitments to public health infrastructure.

There's no doubt the Ebola vaccine represents a remarkable accomplishment. Beyond remaining scientific concerns, however, there remain many barriers to this vaccine being effective in West Africa. In an article for the Atlantic, Olga Khazan details some of these barriers: Ebola outbreaks are incredibly sporadic, the rVSV vaccine only protects against one of several Ebola strains, vaccines are difficult to administer in an epidemic, and Africans are distrustful of Western healthcare workers after centuries of colonial experimentation. As Khazan notes, even in America only about half of adults get the flu vaccine each year.

Widely publicized investments in experimental vaccine development can obscure a more fundamental problem: Ebola has left already weak health systems weaker. "Weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola's rapid spread," argued Dr. Paul Farmer while he was in Liberia, referring to the lack of health workers, facilities, and even basic infection control equipment. Ironically, as the Ebola vaccine trials were implemented, measles vaccine campaigns were suspended due to disruptions in healthcare services, leaving vulnerable an estimated 1,000,000 children. The World Bank estimates Liberian maternal mortality figures, already among the highest in the world, will double as a result of the epidemic.

To those on the ground, it is well understood that that vaccine development must be combined with a long-term commitment to rebuilding infrastructure and medical training. "The secret to curing West Africa of Ebola is no secret at all." notes Dr. Farmer: West Africa needs staff, stuff, space, and systems.

How can we keep the Ebola crisis - whose aftermath is a daily reality for West Africans today - from fading into a forgotten past? We can celebrate the success of this vaccine and support efforts like the recently-launched vaccine development fund, the Coalition for Epidemic Preparedness Innovations. But we also must note that vaccines are not enough - and that sustained infrastructural commitments in West Africa will be crucial to preparing for future outbreaks.

Already, the political will for these commitments has begun to wane. In early 2016, Congress redirected $500 million dedicated for rebuilding infrastructure in West Africa to emergency Zika funding, with no replenishment in sight. Meanwhile, infrastructural recovery plans in Sierra Leone, Guinea, and Liberia must contend with budget shortfalls.

Clearly, continued public support is needed to ensure that these system-building efforts are adequately and transparently funded. We should continue to support the work of organizations like Partners in Health that have made lasting commitments to rebuilding health systems in West Africa. We should support Oxfam, ONE, and the International Aid Transparency Initiative in holding accountable those (including our own government) who pledged almost $6 billion towards rebuilding health systems at the International Ebola Recovery Conference in 2015. In future epidemics, funding for health system-level responses should be considered with the same urgency as that for vaccines. Without these systems, West Africans will remain vulnerable to future outbreaks, vaccine or not.

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