Following comments from CDC director Robert Redfield (Friday 15 March) that establishing control over the ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC) could take up to a year or longer,

Christopher J. Pace, Director of Infectious Diseases at GlobalData, a leading data and analytics company, offers his view on the challenges associated with controlling infectious diseases outbreaks:

‘‘The CDC director’s bleak outlook on controlling the ongoing Ebola outbreak in the DRC, which contrasts with the WHO’s more optimistic stance, is not an indictment of the performance of Merck’s V920 (rVSV-ZEBOV), which has been found to be highly immunogenic after being administered to over 63,000 people. Rather, it acknowledges formidable challenges independent of a safe and effective vaccine, such as identifying close contacts of known cases and successfully gaining the local community’s trust.

“According to GlobalData’s report: ‘Vaccines for Emerging Infectious Diseases: Funding, R&D, and Global Partnership Strategies,’ vaccine effectiveness is heavily influenced by the unique circumstances surrounding each infectious diseases outbreak, including cultural and social barriers to crisis management—which in this case includes the DRC outbreak occurring in an active combat zone. Recently, treatment centers in Butembo and Katwa have come under attack and have been partially destroyed by fires, severely hampering the efforts of response workers in the area.

“Vaccines are not a silver bullet solution to preventing and controlling infectious diseases outbreaks. An integrated approach run by a centralized decision-making body, which combines a targeted immunization campaign, fundraising efforts, and careful negotiations with community gatekeepers to keep misinformation and fear at bay, represents the only path to achieving disease eradication. This strategy requires a long-term outlook and recognizes that the challenges in controlling outbreaks extend beyond simply having clinical tools at your disposal.”