DRC’s Scant Defenses Against Yellow Fever

Luc Kishabongo Mwina, right, with one of his WHO colleagues.
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Image courtesy of Amy Maxmen

KAHEMBA, DEMOCRATIC REPUBLIC OF CONGO—Last week, a few doctors from WHO drove for 2 days on rugged roads to reach this dusty town close to the Angolan border. They came to discuss yellow fever, a hemorrhagic disease spread by mosquitoes, which makes most people feel like they have the flu. However, 15% of people infected will develop jaundice, and perhaps half of those die in about a week.

Their concern: Spillover to DRC from Angola’s ongoing yellow fever epidemic.

Last December, a single case of yellow fever was reported in Angola’s capital city. As of July 8, Angola reported 3,552 suspected cases, and 355 reported deaths from the disease. And yellow fever had spread as people moved. Men working in Angola’s mines frequently travel across rickety bridges to their homes in the DRC—to towns like Kahemba.

A young health district officer in Kahemba, Jean-Paul Sefu, told me they had 62 suspected cases in the region. In DRC as a whole, there have been 1,307 suspected cases as of July 8. However, the vast majority of cases still need to be confirmed with molecular diagnostic tests.

As that happens, the WHO officials are trying to spread balanced messages. On a sunny morning in Kahemba on July 6, I met Luc Kishabongo Mwina, a Congolese WHO medical officer, who told me, “We’ve come to explain what yellow fever is, how we will try to detect it, and at the same time, we want to tell people not to panic.”

What Mwina’s team is not doing is giving Kahemba residents the very good yellow fever vaccine—the one I received prior to coming to DRC. One month ago, the WHO made plans for mass vaccinations in several Congolese regions near Angola, including Kahemba town. They’d also like to vaccinate millions of people in the capital of Kinshasa where tight living quarters could speed an outbreak. But the vaccination campaigns, announced June 26, have yet to launch.

First, it’s hard to get vaccines to places like Kahemba. To arrive there requires days of driving on bone-crunching, unpaved roads, sandier than Waikiki Beach. Even on the poorly paved highway outside of the capital Kinshasa, dozens of flipped trucks line the steeply curved and seriously pot-holed street. Their passengers sleep in the shade beneath the vehicles, sometimes waiting for days for spare car parts to reach them. What’s more, these drives occur in relentless heat, through towns without electricity, and the yellow fever vaccine must be kept cold.

Second, the WHO ran out of vaccines after delivering 18 million doses to Angola, the DRC, and Uganda earlier this year. Not expecting outbreaks of this scale, the global stockpile, funded by the Vaccine Alliance Gavi, reserves just 6 million doses for emergency use per year. Matshidiso Moeti, the WHO Regional Director for Africa, has said, the “WHO is working with partners and vaccine manufacturers to increase vaccine production and replenish the emergency stockpile currently being used for this outbreak.”

But as of July 10, yellow fever vaccines intended for several regions in DRC had yet to appear. As a stopgap measure, the WHO and national authorities are contemplating the giving people half the dose. According to a WHO advisory group, even 1/5th of the standard dose prevents yellow fever for a year—however they are not positive about how children would respond to a minimal amount. Kids, with their weaker immune responses, might require more vaccine.

The director of the National Institute of Biomedical Research in Kinshasa, Muyembe Tamfum, sighed when I asked him about the choice to either not vaccinate, or to do so imperfectly. “It’s a big question,” he said. “And even then, the big problem is the cold chain.”

In a country largely without roads, without gas stations, without electricity, even a technologically perfect solution is not enough.
 

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