While global health officials are turning to an experimental Ebola vaccine to control the ongoing outbreak in the Democratic Republic of Congo, their decision to not immunize pregnant and/or lactating women "unfairly deprives them of the protection they deserve against this deadly disease," according to an op-ed published in STAT.
Here are the op-ed's authors:
- Ruth Faden, PhD, founder of the Baltimore-based Johns Hopkins Berman Institute of Bioethics
- Ruth Karron, MD, director of the Johns Hopkins Vaccine Initiative and the Center for Immunization Research at Baltimore-based Johns Hopkins Bloomberg School of Public Health
- Carleigh Krubiner, PhD, a researcher at the Johns Hopkins Berman Institute of Bioethics
Here are five things to know:
1. The Zaire strain of the Ebola virus, linked to 11,000 deaths in West Africa between 2013-16, has killed 60 percent of those infected in the initial Congo outbreak that started May 8.
2. Merck's experimental vaccine, called rVSV-ZEBOV, proves effective against the current Ebola strain. However, despite the WHO and Congo's successful vaccination strategy, one treatment population is left out: pregnant and lactating women. "From a public health perspective and an ethical perspective, the decision to exclude pregnant and lactating women is utterly indefensible," the authors wrote.
3. The authors acknowledged the limited amount of evidence available to support the vaccine's safety in pregnant women, but said, "what we don't know is dwarfed by what we do know," according to the op-ed. Almost 100 percent of pregnancies among Ebola-infected women end in a miscarriage or neonatal death, according to Birth Defects Research. Women are also more likely to care for sick relatives and, therefore, have a higher likelihood of being infected, the authors said.
4. They cited a previous clinical trial of rVSV-ZEBOV in which 20 pregnant women unintentionally received the vaccine and exhibited no evidence of harm. "[D]uring a high-incidence Ebola outbreak, the catastrophic maternal and fetal mortality rates change the calculus, with the potential benefits of offering the vaccine to pregnant contacts clearly outweighing the potential harms," the authors wrote.
5. Even though rVSV-ZEBOV is a live vaccine, which are not administered to pregnant women, WHO guidelines make an exception for pregnant women at high-risk of contracting yellow fever. The authors argued the same logic should apply to pregnant women at risk of contracting Ebola.
"The DRC ministry of health and the WHO must recognize that women who are pregnant or lactating and who are contacts of Ebola patients must be given equal treatment," the authors concluded. "They are as entitled as any other contacts to the lifesaving benefits of the rVSV-ZEBOV vaccine."