Sierra Leone’s Ministry of Health launched a nationwide preventive Ebola vaccination campaign. Starting on Dec. 5, 2024, the three-week effort aimed at protecting 20,000 frontline workers against the Ebola virus. While similar higher-coverage campaigns were conducted in Guinea-Bissau (2021), Uganda and the Democratic Republic of Congo (2022), this initiative is the first of its kind in West Africa. Gavi, the Vaccine Alliance, provided a single dose of the Ervebo vaccine to frontline workers, with training, technical assistance and logistical support from the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF).

In an interview with The Borgen Project, Francisco Luquero, Gavi’s Head of High-Impact Outbreaks, highlighted the importance of the initiative. “The campaign’s impact will be significant to strengthen the country’s preparedness for future outbreaks by protecting frontline workers.”

Campaign Successes

The nationwide campaign targeted various at-risk communities, including health care professionals and first responders such as ambulance and motorcycle drivers. Village hunters were also vaccinated to prevent the spread of the Ebola virus from animals to humans. Luquero told The Borgen Project that Gavi achieved 94% coverage among the target group of 20,000 frontline workers. 

“Health care workers expressed satisfaction with the campaign, recognizing its importance in protecting themselves and their communities from future outbreaks,” says Luquero. He also stated that vaccine confidence and awareness also improved due to information provided about the vaccine’s benefits and side effects, as well as guidance on what to do in case of Adverse Events Following Immunization (AEFI). Gavi noted that these information dissemination efforts, along with “robust logistical support” from WHO and UNICEF, were crucial to the campaign’s successful rollout.

Ebola 2014 – 2016 Outbreak

The 2014 Ebola virus epidemic began in Guinea. It spread to at least 10 other countries, firstly through neighboring Liberia and Sierra Leone. With no vaccine available at the time of the outbreak, health care workers were limited in their response capacities. The epidemic resulted in 28,000 confirmed infections and approximately 11,000 deaths, making the outbreak “the deadliest in history.” Sierra Leone was the hardest-hit country, accounting for an estimated 36% of recorded deaths and losing 7% of its medical personnel.

Ebola Vaccinations

Gavi funded a stockpile of half a million doses of Ervebo in 2021, just three years after WHO and the European Medicines Agency approved the vaccine. The majority of the vaccines are allocated for preventive Ebola vaccination campaigns similar to the one in Sierra Leone, targeting at-risk communities. About 5% of the remaining stockpile is reserved for emergency outbreaks. This distribution is due to Ebola outbreaks being relatively uncommon and not having a large enough stockpile to cover entire populations.

WHO defines at-risk persons through a ring vaccination strategy, which “captures a social network of individuals and locations” comprising around 150 people per vaccination ring. To be included in a preventive Ebola vaccination campaign, one must either be a frontline worker or have in the last 21 days:

• Lived in the same household or been in close contact with an infected person displaying symptoms of the virus,
• Had physical contact with an infected person’s “body, body fluids, linen or clothes.”
• Being a neighbor or family member (including extended family) “at the closest geographic boundary of all contacts.”
• Or lived in the same residence as anyone else included within the vaccination circle.

For the Future

Following the campaign in Sierra Leone, Luquero shared that Gavi plans to improve several aspects of its vaccination efforts. “Key lessons include enhancing vaccine confidence, strengthening case management protocols for adverse events, and improving supply chain and data management.” Indeed, a total of 18 countries are eligible for a preventive Ebola vaccination campaign, with the Central African Republic expected to be the next to participate.

Although the likelihood of Ebola epidemics is low, vaccinated persons must continue to take precautions to protect themselves from infection. This includes avoiding direct contact with the bodies, bodily fluids and clothing of infected individuals. Additionally, Sierra Leone would also need to improve its population’s access to clean water, sanitation and hygiene (WASH) to help mitigate the risk of the virus spreading.

While the vaccine does not eliminate the threat of an Ebola virus outbreak, these preventive vaccination campaigns can fortify health care systems and enhance community preparedness in case the virus spreads in endemic regions.

– Nesreen Yousfi

Nesreen is based in Watford, Hertfordshire, UK and focuses on Good News and Politics for The Borgen Project.

Photo: Flickr