Pregnant women to be given Ebola vaccine in WHO policy U-turn

A Congolese health worker administers Ebola vaccine during the current outbreak of the disease - REUTERS
A Congolese health worker administers Ebola vaccine during the current outbreak of the disease - REUTERS

Pregnant and breastfeeding women will be given the experimental Ebola vaccine, marking a U-turn in World Health Organization (WHO) policy.

A meeting of the WHO's expert vaccine advisory group reversed a previous decision to deny pregnant women the vaccine because there was not enough evidence of its safety.

Pregnant women are usually excluded from all immunisation campaigns because vaccines against infectious diseases like Ebola are rarely tested or approved for use in pregnant women.

This approach has led to anger among some that women are being put at unnecessarily risk during the current Ebola outbreak in the Democratic Republic of Congo (DRC). Studies of previous outbreaks show that between 80 and 90 per cent of all pregnant women who contracted the disease died. Very few babies of Ebola-affected mothers have survived.

But the latest recommendations from WHO's Strategic Advisory Group of Experts (Sage) on immunisation said that because of the severity of the outbreak pregnant women should be included in the campaign, as long as they and their babies are monitored.

In a statement, Sage said: "As recommended by the ethics committee, every effort must be made to collect data on the safety of the vaccine in these populations, including a documentation of the pregnancy outcomes.

"Sage advises that the use of rVSV-ZEBOV-GP vaccine in pregnant women currently remains limited to the Ebola virus disease outbreak affected areas in DRC and should be continuously evaluated based on the emerging data on the safety and efficacy of the vaccine in this target population. This careful review of the emerging safety data is needed to inform vaccine recommendations for future outbreaks."

WHO and other international agencies are struggling to control the outbreak of Ebola in DRC, where there have been 840 cases of the disease since last August, including 537 deaths. There have been fewer cases of the virus in the last week, although WHO says that the outbreak is continuing with "moderate intensity".

Ring vaccination - where the contacts and contacts of contacts of those who have infected the disease are given the vaccine - has been a vital part of Ebola control measures and was seen as a key reason why an outbreak earlier in 2018 DRC was quickly contained.

Last year a report from an international group of experts called for pregnant women to be included in vaccine development and campaigns.

It said the exclusion of pregnant women from vaccine research and development was unacceptable and “business as usual simply cannot continue”.

Carleigh Krubiner, one of the authors of that report, welcomed WHO's policy reversal.

“This policy change will enable pregnant and lactating women to benefit from the protection the vaccine offers against Ebola infection, safeguarding their lives while also protecting their babies, families, and communities.

"It will also provide a critical opportunity to advance the evidence base on the rVSV-ZEBOV vaccine so that decision makers in the future will be able to make informed decisions about how best to protect their populations, including pregnant women, in the event of an outbreak,” she said.

She added that pregnant women should no longer be left out of vaccine development strategies. "With global efforts now underway to develop a range of vaccines against devastating epidemic threats, we have to make sure pregnant women are on the agenda, so they will never again be left unprotected in the face of future outbreaks.”

Sage also recommended that the vaccine be given to health care workers in areas neighbouring the outbreaks because of the high risk of disease spread.

Protect yourself and your family by learning more about Global Health Security