Claire Dawson
The Ebola virus is a rare but severe illness in humans, with a 50% fatality rate. Currently, there are two licensed vaccines against Orthoebolavirus zairense, the virus that causes Ebola. The first vaccine to be approved in the US was rVSV-ZEBOV in December 2019, and it has since been approved in several other countries. The second vaccine, Zabdeno (Ad26.ZEBOV) and Mvabea (MVA-BN-Filo), is administered in two doses. The International Coordinating Group on Vaccine Provision established an Ebola vaccine stockpile in 2021, which has shipped over 145,000 doses as of 2023. While no vaccine is 100% effective, the rVSV-ZEBOV vaccine has shown an overall effectiveness of 84% against Ebola.
| Characteristics | Values |
|---|---|
| Number of licensed vaccines | 2 |
| Names of licensed vaccines | Ervebo, Zabdeno and Mvabea |
| Countries that have approved the Ervebo vaccine | Burundi, Central African Republic, the Democratic Republic of the Congo, Ghana, Guinea, Rwanda, Uganda, Zambia, the United States, and countries in the European Union |
| Type of vaccine | 1-dose |
| Number of doses in the ICG stockpile as of December 2023 | 518,890 |
| Number of doses shipped from the ICG stockpile since 2021 | 145,690 |
| Percentage of doses from the current stockpile scheduled to expire in 2024 | 40% |
| Number of doses administered in Guinea in 2015 | 16,000 |
| Number of doses administered in the Democratic Republic of the Congo during the 2018-2020 outbreak | 345,000 |
| Number of participants in the Phase 2 randomized, placebo-controlled clinical trial of the vaccine in Liberia during the 2014-2016 outbreak | 1500 |
| Effectiveness of the VSV-EBOV vaccine | 95-100% |
| Effectiveness of the rVSV-ZEBOV vaccine in the Democratic Republic of the Congo during the 2018-2020 outbreak | 84% |
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What You'll Learn
The two licensed Ebola vaccines
There are two licensed Ebola vaccines: Ervebo and Zabdeno-Mvabea. Ervebo, also known as rVSV-ZEBOV or VSV-EBOV, was the first vaccine to be approved in the United States in December 2019. It was also approved by the European Medicines Agency and the World Health Organization in November 2019 and is now approved in several other countries. Ervebo is manufactured by Merck and is indicated for use in adults over 18 years of age, excluding pregnant and lactating women. However, during the 2018-2020 Ebola outbreak in the Democratic Republic of Congo, it was used in children over 6 months old and in pregnant and lactating women under a compassionate use protocol. The vaccine is safe and effective in preventing the Zaire Ebolavirus, one of the viruses that cause Ebola disease.
Zabdeno (Ad26.ZEBOV) and Mvabea (MVA-BN-Filo) is a two-dose vaccine regimen developed by Johnson & Johnson's Janssen Pharmaceutical company. It was approved for medical use in the European Union in July 2020 and granted marketing authorization by the European Medicines Agency in May 2020. The vaccine is recommended for individuals 1 year and older, with the second dose administered approximately 8 weeks after the first. This vaccine regimen has been studied in clinical trials involving thousands of participants and has been shown to be safe and effective in inducing an immune response against the Ebola virus.
Both vaccines have played a critical role in outbreak response and preventing the spread of Ebola. Ervebo has been used extensively in Ebola outbreaks, including in Guinea in 2015 and during the 2018-2020 outbreaks in the Democratic Republic of Congo, protecting hundreds of thousands of people. The Strategic Advisory Group of Experts on Immunization recommended the use of a global stockpile of Ervebo during Ebola outbreaks, which was established in 2021 by the International Coordinating Group on Vaccine Provision. This stockpile ensures timely and equitable access to vaccine doses for future outbreaks.
The Zabdeno-Mvabea vaccine, while effective, is not suitable for outbreak response due to the time delay between the two doses. Instead, it is recommended for individuals at imminent risk of Ebola exposure, such as healthcare professionals and those living in or visiting areas with ongoing Ebola outbreaks. A booster dose of Zabdeno may be considered if more than four months have passed since the second dose.
The development and availability of these vaccines have significantly contributed to global efforts to control and prevent Ebola outbreaks, protect high-risk individuals, and reduce the impact of this deadly disease.
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The ICG Ebola vaccine stockpile
The stockpile was created to ensure equitable, rapid access to vaccines during an Ebola outbreak. The ICG's mandate is to respond to outbreaks and break the transmission of diseases as soon as possible to save lives. The targeted overall delivery time from the stockpile to countries is seven days. The Strategic Advisory Group of Experts on Immunization recommends the use of the 1-dose ERVEBO vaccine during Ebola outbreaks.
The ICG has approved requests for targeted preventive vaccination of high-risk groups, including healthcare workers and frontline workers in countries at risk of Ebola outbreaks.
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Preventative Ebola vaccination
Ebola virus disease (Ebola) is a rare but severe illness in humans, with an average case fatality rate of approximately 50%. The use of a vaccine is one of several strategies to control an Ebola outbreak. Other important components include early detection of new Ebola infections, isolating patients, safely burying the dead, and engaging communities in the Ebola response.
There are currently two licensed Ebola vaccines: Ervebo and Zabdeno/Mvabea. Ervebo was licensed in November 2019 by the European Medicines Agency and the World Health Organization (WHO), and in December 2019 by the United States Food and Drug Administration. It is recommended for use during an outbreak to protect individuals at the highest risk of contracting Ebola, particularly in areas with ongoing outbreaks. Ervebo is indicated for adults over 18 years of age and is not recommended for pregnant and lactating women. However, during the 2018-2020 outbreak in the Democratic Republic of the Congo, the vaccine was used in children over 6 months old and pregnant and lactating women under a compassionate use protocol.
Zabdeno/Mvabea is a two-dose vaccine that was approved in May 2020 for individuals 1 year and older. It is recommended for preventive vaccination in areas at lower risk for Ebola or neighboring outbreak zones. This vaccine was studied in a total of 3,367 individuals across Europe, Africa, and the United States, demonstrating its safety and ability to induce an immune response.
In 2021, a global stockpile of Ervebo was established by the International Coordinating Group (ICG) on Vaccine Provision to ensure timely and equitable access to vaccine doses during Ebola outbreaks. As of December 2023, the ICG stockpile holds 518,890 doses, with 40% scheduled to expire in 2024. Most of the doses shipped from the stockpile have been repurposed for preventive vaccination of high-risk groups, including healthcare workers and frontline workers in countries at risk of Ebola outbreaks.
While vaccination is an important tool in the fight against Ebola, it is essential to understand that no vaccine is 100% effective. Even after vaccination, individuals should continue to take precautions to protect themselves from infection, such as avoiding contact with bodily fluids and personal items of infected individuals.
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Ervebo vaccine usage
The Ervebo vaccine, also known as rVSV-ZEBOV, is a vaccine designed to protect against the Zaire ebolavirus. It was developed by the Public Health Agency of Canada, with development subsequently taken over by Merck Inc. The vaccine is based on the vesicular stomatitis virus, which was genetically modified to express a surface glycoprotein of the Zaire Ebola virus.
The Ervebo vaccine is recommended by the Strategic Advisory Group of Experts on Immunization as part of a broader set of Ebola outbreak response tools. It is safe and protective and can be used during an outbreak to protect those at the highest risk of contracting the Ebola virus under a “ring vaccination” strategy. The vaccine is indicated for adults over 18 years of age, although it has also been approved for use in children 12 months of age and older. However, it is not recommended for pregnant and lactating women.
The vaccine has been used under "expanded access" or "compassionate use" for 16,000 people in Guinea in 2015 and for 345,000 people during the 2018-2020 outbreaks in the Democratic Republic of the Congo. It has also been used extensively in the Kivu Ebola epidemic under a compassionate use protocol. During the 2014-2016 outbreak in Guinea, a randomized cluster vaccination study found that no one who received immediate vaccination with Ervebo developed Ebola disease 10 or more days after vaccination.
In 2021, a global stockpile of Ervebo was established by the International Coordinating Group on Vaccine Provision to ensure equitable, timely, and targeted access to vaccine doses for future Ebola outbreaks. As of December 2023, the stockpile holds 518,890 doses, with 145,690 doses shipped since 2021. However, due to the absence of large Ebola outbreaks since 2021, most of these doses have been repurposed for preventive vaccination of high-risk groups.
It is important to note that no vaccine is 100% effective, and individuals who receive the Ervebo vaccine should continue to take precautions to protect themselves from Ebola infection. Additionally, the vaccine may be less effective in immunocompromised individuals, and those with a history of severe allergic reactions to any component of the vaccine, including rice protein, should not receive it.
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The development of the Ebola vaccine
The story of the Ebola vaccine began with a research team at the University of Texas-Austin, who, in 2014, reported the development of a nasal spray Ebola vaccine. This vaccine was found to be more effective than injection in non-human primate studies. However, further development of this vaccine stalled due to a lack of funding. Despite this early setback, other organisations continued the quest for an Ebola vaccine.
In 2014, the Biomedical Advanced Research and Development Authority (BARDA) entered into a multimillion-dollar contract with Mapp Biopharmaceutical to accelerate the development of ZMapp, a drug for Ebola treatment. Additionally, companies such as GlaxoSmithKline, NewLink Genetics, Johnson & Johnson, and Bavarian Nordic were also expected to develop Ebola vaccines.
A significant breakthrough came with the development of the VSV-EBOV vaccine, which was found to be 95-100% effective against the Ebola virus in a study conducted in Guinea during the 2014-2016 outbreak. This vaccine, also known as rVSV-ZEBOV or Ervebo, is based on the vesicular stomatitis virus, which was genetically modified to express a surface glycoprotein of the Zaire Ebola virus. The vaccine was developed by the Public Health Agency of Canada, with development subsequently taken over by Merck Inc.
In November 2019, the European Commission granted conditional marketing authorisation for the VSV-EBOV vaccine, and it received prequalification from the World Health Organization (WHO) within 48 hours, making it the fastest vaccine prequalification process in WHO history. The vaccine was then approved for medical use in the United States and Europe in December 2019.
Since then, the vaccine has been used extensively during Ebola outbreaks, including in the Democratic Republic of the Congo, Guinea, and the Kivu Ebola epidemic. It has proven effective in preventing infections and reducing hospitalizations and deaths during outbreaks. The development of the Ebola vaccine is an ongoing process, with continuous research and improvements being made to ensure the safety and effectiveness of the vaccine.
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Frequently asked questions
I am unable to provide the exact number of hospitals that hold the Ebola vaccine. However, the vaccine is available and has been used in several countries, including the Democratic Republic of Congo, Guinea, Burundi, Central African Republic, Ghana, Rwanda, Uganda, and Zambia.
The Ebola vaccine has shown effectiveness in providing protection against the virus. A study conducted in the Democratic Republic of Congo (DRC) found that the rVSV-ZEBOV vaccine, also known as Ervebo, was 84% effective in preventing Ebola infection.
The Ebola vaccine is recommended for individuals at high risk of exposure to the virus, such as healthcare professionals and those living in or visiting areas with ongoing Ebola outbreaks.
Yes, mild to moderate side effects may occur within seven days of receiving the Ebola vaccine. These side effects include pain, swelling, and redness at the injection site, headache, fever, muscle pain, tiredness, and joint pain.
While the Ebola vaccine provides a significant level of protection, no vaccine is 100% effective. It is still important to follow preventive measures, such as avoiding contact with bodily fluids and personal items of infected individuals, even after receiving the vaccine.
