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Ebola vaccine trial in Sierra Leone battles against fear and logistics …

Mohamed Conteh was very worried when he was offered the Ebola vaccine[1] after a new case was confirmed in Sierra Leone s Tonkolili district in January.

His uncle, a health worker, had come into contact with the victim, making Mohamed vulnerable. The 25-year-old student did not know what to expect from the vaccine and was scared of falling ill.

I wasn t confident but my uncle had already taken the vaccine and this gave me courage. In the end I decided to have it because I thought it was better than falling sick with Ebola[2], he says. Mohamed was among 126 people in Tonkolili to be injected with the vaccine[3] as part of a secondary ring vaccination campaign initiated after the latest death. This campaign was an extension of the first large-scale efficacy trial[4] involving 30,000 people across affected west African nations. The Tonkolili participants included 47 people aged between six and 75 who had had direct contact with the 22-year-old woman who died. The other 79 people, like Mohamed, were secondary contacts and potentially vulnerable.
[5]

Related: Sierra Leone: we save lives of women in childbirth while fighting Ebola | Benjamin Black[6]

Daniel Conteh, Mohamed s uncle, took part in a trial in October and now encourages others.

I had been directly exposed to the virus so I wasn t scared about the vaccine because I knew that I needed it. I did worry that because it hadn t been properly trialled something might go wrong, but I thought it was better to have it. I m able to tell other people they will be fine if they are vaccinated too.

Dr Augustine Jimmisa, the district s medical officer, says the biggest challenge for the trial was overcoming negative perceptions.

People are scared that a substance is being given to them to make them sick. There was a lot of suspicion and rumours that we wanted to introduce Ebola to the area. Using community mobilisers we explained the process, but it wasn t easy for people to accept it.

Other obstacles relate to underdevelopment in a country that ranks 181st out of 188 countries in the UN human development index[7] (pdf). Dr Tamba Manye, who works for the World Health Organisation[8] (WHO) in Tonkolili, says logistics need to be improved before the unlicensed vaccine can be made more widely available.

There is no cold chain facility in Sierra Leone that can deal with the vaccine because it has to be stored at minus 80. The only facility is in Guinea, so we had to fly the vaccines from there. The vaccination process is still quite limited if we have another outbreak.
[9]

Manye is monitoring participants for side effects. We are looking for headaches, fever, rashes etc. We have had a couple of adverse events and two participants who came up with a fever but they were treated for malaria and got better. Mohamed s experience speaks volumes about the knowledge gaps and logistical challenges involved in trials.

Isatu Fornah, 40, holds up her Ebola vaccination certificate in Magburaka, Sierra Leone.

We hadn t been told before we had the vaccine that we would suffer from anything. We were only told afterwards that this would be the case. The people who gave us the vaccines came from Guinea. They were French and couldn t speak with us very clearly so they never told us what to expect. For the first two or three days my side, joints and head were very sore and I had a fever. But then my system started to cope and since then I ve had no problems.

More than 28,600 people[10] across west Africa have been infected during the Ebola outbreak and more than 11,300 have died. At least 17,000 survivors are still dealing with health complications[11] and social stigma.

As well as testing Ebola vaccines, Sierra Leone, Guinea and Liberia need to prevent outbreaks of other diseases, even as they struggle to rebuild decimated health systems and patch up frayed public trust in medical authorities. Gavi, the global vaccines alliance, has invested $12.5m ( 8.8m) from a projected $90m package[12] to rebuild national immunisation systems[13]. But these efforts have been hindered by fears linked to the Ebola epidemic.

We now face a race against time to prevent outbreaks of other dangerous diseases by ensuring that children receive the vaccines they need to protect them, said Dr Seth Berkley, CEO of Gavi. Rebuilding trust amongst parents and carers is critical. Rumours have circulated that vaccines against measles, pneumonia and diarrhoea could be linked to Ebola. Some parents have refused to get their children immunised and there is also a shortage of health workers to deliver the vaccines.

Related: Watch how the measles outbreak spreads when kids get vaccinated and when they don’t[14]

The WHO estimates that about 600,000 children have missed out on routine immunisations in Sierra Leone[15], Guinea and Liberia. The results can be fatal. Kadiatu Conteh weeps at the grave of her son, Osman, in Sierra Leone s capital, Freetown.

He got a rash on his skin and was scratching and had a fever. We knew it was measles. He had missed his last vaccination because it was due during the time of Ebola and I was too scared to take him to hospital Our family had lost 29 people to the disease and we were really scared we d catch it in the hospital, she explains.

A neighbour told me to take him to a traditional healer instead. I did but the next day he got much worse so I did go to the hospital in the end, but it was too late. He died that day.

Ibrahim Sesay, a community leader in Freetown, is trying to rebuild trust to prevent such tragedies and is about to take part in a polio vaccination drive.
[16]

Some communities are hard to reach because they are deep in the bush and the roads are bad. We have to help the vaccinators find these communities I know at least three children with polio. For Sesay, the Ebola outbreak underscored pre-existing fears. Even before Ebola there were so many misconceptions about vaccines. Many people think vaccines will reduce the birth rate. Their biggest fear is that when children are vaccinated they will be sterile.

For some, the message is getting through. Fatu Mustafa in Freetown has four children and her youngest, 14-month-old Bernadette, was vaccinated against tuberculosis during the Ebola crisis.

I was scared but I knew that it was important she had it. But even so I didn t allow her to be weighed or anything. I only let the vaccinator touch her, no one else.

References

  1. ^ Ebola vaccine (www.who.int)
  2. ^ Ebola (www.theguardian.com)
  3. ^ be injected with the vaccine (www.who.int)
  4. ^ first large-scale efficacy trial (www.who.int)
  5. ^ 22-year-old woman who died (www.theguardian.com)
  6. ^ Sierra Leone: we save lives of women in childbirth while fighting Ebola | Benjamin Black (www.theguardian.com)
  7. ^ 181st out of 188 countries in the UN human development index (hdr.undp.org)
  8. ^ World Health Organisation (www.who.int)
  9. ^ Sierra Leone (www.theguardian.com)
  10. ^ More than 28,600 people (www.cdc.gov)
  11. ^ 17,000 survivors are still dealing with health complications (www.theguardian.com)
  12. ^ from a projected $90m package (www.gavi.org)
  13. ^ to rebuild national immunisation systems (www.gavi.org)
  14. ^ Watch how the measles outbreak spreads when kids get vaccinated and when they don’t (www.theguardian.com)
  15. ^ have missed out on routine immunisations in Sierra Leone (www.afro.who.int)
  16. ^ polio vaccination drive (cocorioko.info)

ShelterBox's £1 million response to plea for Fiji 'to get back on its …

On the day that the United Nations and the Fiji Government have launched an emergency appeal to help islanders recover from Cyclone Winston, UK-based ShelterBox unveils its biggest response ever to a storm disaster in the South Pacific

With aid already delivered to six outlying islands, over 2,000 ShelterBoxes en route from storage in Australia and Dubai, superyachts and local Rotarians reaching out to the hard-to-reach, and thousands of solar light units on their way to islanders without electricity Cornwall-based ShelterBox expects its response to Fiji s cyclone disaster to be one of its biggest Pacific storm mobilisations on record, with resources of over 1 million already committed. A team from ShelterBox New Zealand and the USA was on the ground as soon as flights resumed after the cyclone struck on 20 and 21 February. The most powerful storm ever recorded to make landfall in the South Pacific, Cyclone Winston left over 40 dead, a path of destruction across hundreds of Fijian islands, an estimated 24,000 houses damaged or destroyed, and life-sustaining food crops flattened. Since that weekend assessments have confirmed fears of a shortage of clean water, medical supplies and shelter. A state of natural disaster was declared by the Fiji Government, and they put a call out for international aid. Today they have gone a stage further, issuing with the UN a plea for 38.6 million US Dollars to add to the relief efforts already underway. 50,000 people are now thought to be in need of assistance, many of them still without aid, communications and power almost two weeks after the storm.

Prime Minister of Fiji, Voreqe Bainimarama, said at today’s launch of the appeal, With our tenacity and the generosity of UN member states, we must work together to meet the unprecedented need that Cyclone Winston has left in its wake. We look to the world to assist Fiji to fully get back on its feet. Sune Gudnitz, Head of the United Nations Pacific Office for the Coordination of Humanitarian Affairs, explained, There is a critical need for the construction of emergency shelter in the worst hit areas with more than 50,000 people temporarily displaced. Hospitals and medical facilities have been destroyed or damaged, and water sources are contaminated. There is a huge demand for debris clearance and a need for the rapid provision of clean water and sanitation services to reduce the spread of disease. The UN s Humanitarian Coordinator, Osnat Lubrani, added, The Fijian Government deserves praise for its strong leadership throughout the early stages of this complex response but with 40 per cent of the population affected there is now an urgent need for international support to fund critical activities over the next three months.

Shelter, health, food, water, sanitation and hygiene, education and protection have been identified as urgent needs. ShelterBox, experts in emergency shelter and with a range of aid either already in place or on its way, is working with a range of partners across the islands. Among them is Sea Mercy, a US agency which uses superyachts and catamarans to deliver aid and medicines to Fijian islands via its base in Port Denerau. They are often able to land craft close inshore or on beaches, to reach families whose properties took the full coastal force of the storm. In recent days they have delivered ShelterBoxes to Makogai Island, Viwa, Bitiki, Kubulau, Taveuni. ShelterBox Operations Co-ordinator Phil Duloy says, Everywhere our teams look there are signs of the severity of this storm. There is massive damage to crops, boats, and fishing equipment, so there will be an urgent need for food, as well as seeds and fishing supplies.

The Government of Fiji and humanitarian partners are striving to provide temporary classrooms with water, sanitation and learning materials so that young people can re-start their education and return to some sort of normality. Medical centres and hospitals have also been damaged.

ShelterBox has experience of dealing with this type of emergency response, but this is on a challenging scale: the affected population lives across literally hundreds of inhabited islands. Our teams are hard at work assessing needs and distributing aid to minimise the lasting effects of this massive disaster.

NOTES TO EDITORS

An infographic produced by the United Nations on the scale of the disaster is here.[1]

People can donate to ShelterBox by phone on 0300 0300 500 during business hours, or any time online at www.shelterbox.org[2]

References

  1. ^ here. (reliefweb.int)
  2. ^ www.shelterbox.org (www.shelterbox.org)

Today in History: Slave Importation Ceased

Two hundred and nine years ago this week on March 2, 1807, The United States Congress passed

The Act Prohibiting Importation of Slaves.

by William Doc Halliday

Slavery itself can be documented at least as far back as 594 BC when Athenians utilized enslaved peoples from outside the (historical) Attica region which enabled them to become prosperous. Beginning in the second century BC, the Roman Empire is also documented using enslaved people. Slavery had existed in Europe from Classical times and continued after the collapse of the Roman Empire. Slaves remained common in Europe throughout the early medieval period. Slavery became increasingly uncommon in Northern Europe and, by the 11th and 12th centuries, had virtually been eradicated in the North. Serfdom did persist in the North well into the early modern period. In Southern and Eastern Europe, slavery remained a normal part of society and the economy. As trade across the Mediterranean and the Atlantic seaboard expanded, it meant that African slaves began to appear in southern European countries well before the discovery of the Americas in 1492. Beginning in about the 8th century, an Arab-run slave trade flourished, with much of this activity taking place in East Africa, Arabia, and the Indian Ocean. Many African societies also had forms of slavery. At least by 1452 Portugal was using African slaves on a sugar plantation on the island of Madeira. In June of that year, Pope Nicholas V issued a papal bull authorizing the Portuguese to conquer and reduce the station of any non-Christians (specifically Muslims and pagans) to slaves.

The Portuguese completed the first transatlantic slave voyage from Africa to the Americas in 1526. Ship owners and their Captains considered the slaves freight that was to be transported to the Americas as quickly, and of course as cheaply as possible. The Atlantic slave traders led by the Portuguese, Brits, French, Spanish, and Dutch established bases on the African coast where they purchased African slaves from local African leaders. In his book, The Black Diaspora: Five Centuries of the Black Experience Outside Africa 1995, Ronald Segal states that 11,863,000 slaves were transported across the Atlantic Ocean to the Americas. In his book Slavery: A World History 1993, Milton Meltzer states the mortality rate during the voyage as 12.5%. In 1619, the Dutch brought 19 or 20 captured slaves to the Jamestown colony in Virginia. Slavery spread throughout the colonies. In his book In the Matter of Color: Race and the American Legal Process: The Colonial Period 1975, A. Leon Higginbotham documents that in 1641, the Massachusetts Bay Colony became the first of the colonies to authorize slavery by law. In writing the Declaration of Independence, Thomas Jefferson asserted that King George III was violating the rights of life and liberty of the people by making them a part of the execrable commerce of slavery. It is ironic that Jefferson and other slaveholders were striving to find some way out of a practice that had marked commerce in the colonies for a century and a half. Most of the colonies were inclined to accept a ban on the importation of slaves, but South Carolina and Georgia would not accept a quick end to the Atlantic slave trade. As a result, the lengthy list of charges against the monarch in the declaration did not include slave trading.

Without mentioning slave trading, Article I, Section 9 of the United States Constitution that was adopted in September of 1787, asserted that a certain migration or importation of people would not be prohibited prior to the year 1808. While Congress could not prohibit the importation of slaves until 1808, the Third Congress regulated it in 1794. They prohibited the use of ports for ship building and outfitting for the trade in the Slave Trade Act . Additional legislation in 1800 and 1803, sought to discourage the trade by limiting investment in import trading and barring importation into states that had abolished slavery, which most in the northern states had done by that time. Two hundred and nine years ago today, on March 2, 1807, The United States Congress passed The Act Prohibiting Importation of Slaves. This law disallowed the importation of new slaves into this country beginning in 1808. This was just eight days after Britain had abolished the slave trade in that nation. Britain finally abolished slavery itself in 1833.

William Doc Halliday is a historian and writer who lives in Texas. He can be reached at

References

  1. ^

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