On a recent Tuesday afternoon, in the city of Gisenyi, Rubavu district, thousands of travelers' shuffle through the arrival and departure corridor to cross the border into the Democratic Republic of Congo (DRC). It's an ordinary day at the border, as colorful sensitization messages on how to suspect Ebola signs and symptoms light up LED screens in the background. Travelers pass carrying goods like fruit, vegetables, and other products for commerce, while others are simply returning home from a day at school or work.

Beyond the Rubavu one-stop border lies Goma, a city of about two million people in the DRC, and arguably the most active border zones in Rwanda. It is estimated that upwards of 100,000 people cross the two borders that connect Rubavu to Goma each day, as each border serves as a main crossing for trade, work, school, and other commitments, linking those in Rwanda to the DRC and vice versa.

 

SURVEILLANCE STRENGTHENS

In July 2019, the DRC was hit with the second largest Ebola epidemic on record, causing the World Health Organization to declare it a Public Health Emergency of International Concern (PHEIC). That same month, a case was reported and confirmed in the city of Goma. Surveillance response efforts became heightened to prevent the spread of the disease across borders and into Rwanda. Prevention, detection, and response measures were immediately put in place, and screeners were deployed to all border crossings to screen every traveler entering the country.

ThermoScan cameras, which can measure temperature and swiftly alert health officials in the event a traveler presents with a fever were implemented, and handwashing facilities were installed.

 

PREVENTING THE SPREAD OF DISEASE

On 8 December 2019, a new immunization campaign led by the Government of Rwanda in partnership with Johnson & Johnson and it's Janssen Pharmaceutical Companies was announced. Rwanda, through the Ministry of Health and Rwanda Biomedical Centre, together with the DRC, officially launched UMURINZI, Unprecedented Movement to drive a Unified Rwandan Initiative for National ZEBOVAC Immunization, as part of ongoing preparedness and prevention measures to protect the population against the Ebola Virus Disease across borders. The ongoing immunization program aims to protect Rwandan citizens from the Ebola outbreak in the DRC and to help prevent the spread of disease. Various trials of the Ebola vaccine were conducted in different countries, and once completed, with the World Health Organization's Strategic Advisory Group of Experts recommendations, the Rwanda Food and Drug Authority (Rwanda FDA) reviewed the trials and granted conditional approval under exceptional emergency that the Janssen Ebola vaccine is safe and can be administered as a preventative measure.

 

BEHIND THE VACCINE

With the support of Johnson & Johnson, Wellcome Trust, and the UK Department for International Development (DFID), the immunization campaign was launched in Rubavu and Rusizi Districts, and 200,000 vaccine regimens were donated to be administered to those who provide informed consent for the vaccine.

"Most of the people we are vaccinating are from the community around the border who usually cross into the DRC side. We educate each person about the vaccination, the possible side effects, and how to manage if you experience adverse effects following administration", explains Annah Uwamwezi, a Nurse who was deployed to Rubavu's "La Grande Barriere" border to work on the campaign.

Vaccinations are currently provided to populations who cross the border daily between Rwanda and the DRC, and those who live in high risk communities. Following educative sessions including vaccine information and signs and symptoms of Ebola Virus Disease, the vaccine is administed to those aged two years and above in a series of two injections to those who provide informed consent.

The two-dose regimen includes Ad26.ZEBOV as the first dose and MVA-BN-Filo as the second dose. Beneficiaries are reminded through text messages to have the second injection administered 56 days after the first. Currently, about 100 people on average per day visit the vaccination tents at the border to receive their first vaccination, while about 250 people on average per day receive their second dose.

Following administration, the vaccine vial is scanned into the system on a tablet and the number is received by pharmacy. Once vaccinated, the beneficiary must wait in an observation room for a minimum of 15 minutes to ensure he/she has not experienced any adverse effects.
In the event a vaccine beneficiary experiences adverse effects, the vial number can be traced and investigated. In addition, a logging system has been implemented in which beneficiaries that have been reffered to a clinic or hospital to be treated for adverse effects, can be tracked and have their care followed up.

While the vaccine does not provide complete defense against the virus, it will aid in preventing the spread throughout the DRC and to neighboring countries like Rwanda. In addition, prevention measures such a practicing good hygiene and handwashing continue to be strongly encouraged.

"It's a big opportunity to be involved in the campaign, because I know a lot about Ebola. We receive patients of different cultures and beliefs, and I feel like it is improtant be able to educate the community on the vaccine and the myths people have and to encourage them to be as safe as possible, while still living their lives. I see it as an equal opportunity for myself as a Nurse and also for each patient", says Annah.