In August 2018, the WHO evaluated several drugs used to treat EVD, including Remdesivir, ZMapp, atoltivimab/maftivimab/odesivimab, ansuvimab and favipiravir. The drug ansuvimab (which is a monoclonal antibody) was deployed for the first time to treat infected individuals during this EVD outbreak. In November 2018, the DRC gave approval to start randomized clinical trials for EVD treatment. On 12 August 2019, it was announced that two clinical trial medications were found to improve the rate of survival in those infected by EVD: atoltivimab/maftivimab/odesivimab, a cocktail of three monoclonal Ebola antibodies, and ansuvimab. These two will be further used in therapy; when used shortly after infection they were found to have a 90% survival rate. ZMapp and Remdesivir were subsequently discontinued. In October 2020, the U.S. Food and Drug Administration (FDA) approved atoltivimab/maftivimab/odesivimab with an indication for the treatment of infection caused by Zaire ebolavirus. Vaccination Number of vaccinated people in the epidemic area DRC On 8 August 2018, the process of vaccination began with rVSV-ZEBOV Ebola vaccine. While several studies have shown the vaccine to be safe and protective against the virus, additional research is needed before it can be licensed. Consequently, the WHO reported that it was being used under a ring vaccination strategy with what is known as "compassionate use" to protect persons at highest risk of the Ebola outbreak, i.e. contacts of those infected, contacts of those contacts, and front-line medical personnel. As of 15 September, according to the WHO, almost a quarter of a million individuals had been vaccinated in the outbreak. On 20 September 2019 it was reported that a second vaccine by Johnson & Johnson would be introduced in the current EVD epidemic in the DRC. In November 2019, the World Health Organization prequalified an Ebola vaccine, rVSV-ZEBOV, for the first time. As of 22 February 2020, a total of 297,275 people had been vaccinated since the start of the outbreak. By 21 June 2020, 303,905 people had been vaccinated with rVSV-ZEBOV and 20,339 were given the initial dose of Ad26-ZEBOV/MVA-BN-FILO. Vaccination has helped to contain the epidemic, though military attacks and community resistance have complicated distribution of the vaccines. Pregnant and lactating women Based on a lack of evidence about the safety of the vaccine during pregnancy, the DRC ministry of health and the WHO decided to cease vaccinating women who were pregnant or lactating. Some authorities criticized this decision as ethically "utterly indefensible". They noted that as caregivers of the sick, pregnant and lactating women are more likely to contract Ebola. They also noted that since it is known that almost 100% of pregnant women who contract Ebola will die, a safety concern should not be a deciding factor. As of June 2019, pregnant and lactating women were also being vaccinated. Vaccine stockpile The DRC Ministry of Public Health reported on 16 August 2018 that 316 individuals had been vaccinated. On 24 August, the DRC indicated it had vaccinated 2,957 individuals, including 1,422 in Mabalako against the Ebola virus. By late October, more than 20,000 individuals had been vaccinated. In December, Dr. Peter Salama, who is Deputy Director-General of Emergency Preparedness and Response for WHO, reported that the current 300,000 vaccine stockpile might not be enough to contain the EVD outbreak, especially since it takes several months to make more of the Zaire EVD vaccine (rVSV-ZEBOV). On 11 December, it was reported that Beni only had 4,290 doses of vaccine in stock. As of August 2019, Merck & Co, the producers of the vaccine in use, reported a stockpile sufficient for 500,000 individuals, with more in production. Effectiveness In April 2019, the WHO published the preliminary results of its research, in association with the DRC's Institut National pour la Recherche Biomedicale, into the effectiveness of the ring vaccination program, including data from 93,965 at-risk people who had been vaccinated. WHO stated that the rVSV-ZEBOV-GP vaccine had been 97.5% effective at stopping Ebola transmission. The vaccine had also reduced mortality among those who were infected after vaccination. The ring vaccination strategy was effective at reducing EVD in contacts of contacts (tertiary cases), with only two such cases being reported. Treatment centres In August 2018, the Mangina Ebola Treatment Center was reported to be operational. A fourth Ebola Treatment Center (after those in Mangina, Beni and Butembo) was inaugurated in September in Makeke in the Mandima Health Zone of Ituri Province. Makeke is less than five kilometers from Mangina along a well-traveled local road; the site had been proposed in August when it appeared that a second Ebola Treatment Center would be needed in the area, and space was insufficient in Mangina itself to accommodate one. By mid-September, however, there had been only two additional cases in the Mandima Health Zone, and only sporadic cases were being reported in the Mabalako Health Zone. In February 2019, it was reported that attacks at treatment centers had been carried out in Butembo and Katwa. The motives behind the attacks were unclear. Due to the violence, international aid organizations had to stop their work in the two communities. In April, an epidemiologist from WHO was killed and two health workers injured in a militia attack on Butembo University Hospital in Katwa. In May, WHO's health emergencies chief said insecurity had become a "major impediment" to controlling the outbreak. He reported that since January there had been 42 attacks on health facilities and 85 health workers had been wounded or killed. "Every time we have managed to regain control over the virus and contain its spread, we have suffered major, major security events. We are anticipating a scenario of continued intense transmission". Healthcare workers Health workers must wear personal protection equipment during treatment of those affected by the virus. On 3 September 2018, WHO stated that 16 health workers had contracted the virus. On 10 December, the WHO reported that the current DRC outbreak had led to 49 healthcare workers contracting the Ebola virus, and 15 had died. As of 30 April 2019, there have been 92 health care workers in the DRC infected with EVD, of which 33 had died. With false rumors being spread by word-of-mouth and social media, residents remain mistrustful and fearful of health care workers. In January 2020, it was reported that there had been nearly 400 attacks on medical workers since the outbreak began in 2018.
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