Médecins Sans Frontières (MSF) has called for the establishment of an international, independent committee to manage Ebola vaccine stocks and their use in the Democratic Republic of Congo (DRC), saying it will help them prevent the spread of the deadly virus.

The humanitarian organization has criticized the World Health Organization’s for its “strict limits” on the number of doses used in the field, saying their life-saving work is hindered by a “rigid system which is hard to comprehend.”

In an interview with Global Citizen, WHO spokesperson Tarik Jašarević says the organization is “not limiting access to vaccine but rather implementing a strategy recommended by an independent advisory body of experts and as agreed with the government of the DRC and partners.”

He also reiterated the WHO’s commitment to combating Ebola, saying that aside from the government of the DRC, “no one wants to bring this epidemic to an end more than WHO,” citing that the WHO has deployed more people to the DRC than any other international organization, including MSF.

There are 3,200 cases of Ebola, and 2,142 deaths due to the virus in the DRC, according to MSF. The current outbreak is the 10th — and biggest — outbreak in the country and was declared a public health emergency of international concern by the WHO.

Over 230,000 people have been vaccinated against Ebola since the August 2018 outbreak, according to the WHO’s latest bulletin. Despite this, MSF says there are challenges in reaching some of the people who need the vaccine the most due to restrictions placed on them by the WHO.

Joseph Musakane, an activity manager with MSF, says the organization wants more flexibility in “responding faster to health zones with confirmed Ebola cases, but are currently limited to a [fixed] number of daily doses and working in pre-allocated vaccination sites.”

MSF is providing pharmaceutical company Merck’s vaccine called rVSV-ZEBOV-GP, which is said to provide effective protection against Ebola by 95%, after 10 days.

MSF says the WHO’s reasons on limiting the vaccine have been unclear. The vaccine is yet to be registered and approved by the U.S. Food and Drug Administration, although it was recently granted priority review status. Due to the seriousness of the Ebola crisis in the DRC, Merck shipped investigational doses to the country. 

“We'd like to broaden our vaccination strategy and be more flexible in responding faster to health zones with confirmed Ebola cases, but are currently limited to a fix number of daily doses” said MSF activity manager Joseph Musakane.https://t.co/ZPgZrw67f0

— MSF International (@MSF) October 5, 2019

Currently, 500 to 1,000 people are being vaccinated per day. MSF wants to increase this to 2,000 to 2,5000 people, saying the vaccine is safe and effective, there are enough doses, and their teams are ready to administer an extended vaccination coverage. 

“Symptomatic patients with fever, diarrhoea, or vomiting are infectious and should be isolated and treated as fast [as] possible. Yet throughout North Kivu, the average time span from suspecting to diagnosing an Ebola case is five days, during which patients often travel and visit several health centres,” MSF says.

In addition to this, due to the restricted use and investigational status (meaning, it’s being used in clinical trials and is not yet available to the general public) of the vaccine, MSF is using a ring approach to administer it. This means the organization’s current vaccine campaign focuses on targeting direct and indirect contacts of probable and confirmed Ebola cases, or frontline workers like doctors and humanitarian staff.

The flaw in this approach has been an inability to track high-risk individuals in need of vaccination. 

According to MSF: “Throughout the outbreak, national surveillance teams only managed to trace a quarter of known and probable Ebola contacts, while a majority remains unidentified or is never followed up.” 

However, the WHO defends the use of this ring approach. 

“We are … using a proven ring vaccination strategy. We have evolved and adapted that strategy over time based on ongoing discussions and feedback from the DRC government and partners,” Jašarević says. 

MSF says the mortality of the outbreak in the DRC is around 67%, which is comparable with that of the Ebola outbreak in West Africa in 2014 to 2016, prior to the use of vaccines in preventing the virus. 

In addition to these challenges, there are persistent fears and misconceptions around the vaccine, with some believing it can cause impotence, mental illness, or even Ebola itself. 

However, Dr. Isabelle Defourny, MSF director of operations, says, “When people are aware of the vaccine, the vast majority of them want to be vaccinated.”