EBODAC

The EBODAC project sought to ensure that Ebola vaccines would be accepted by local communities to ensure high uptake of vaccines and maximise protection against the virus. The vaccine that was under development within the IMI EBOVAC projects was a two-dose vaccine regimen, meaning that citizens would have to be vaccinated not once but twice to ensure maximum protection. Stigma surrounding Ebola, a general suspicion of vaccines in the community as well as a negative historical, socio-economic and cultural background meant that vaccine uptake was likely to be a challenge.

As part of the EBOLA+ programme, several clinical trials for the potential vaccine were planned in Sierra Leone. EBODAC supported enrolment in the EBOVAC-Salone study (a phase 2B safety and immunogenicity trial) and the PREVAC study.

The EBODAC project leveraged a strong, local-focused communication strategy to drive uptake. Social scientists and researchers engaged with the community to understand the main fears and potential motivating factors. They learned that the communities where vaccines were to be rolled out were not homogenous so an understanding of the cultural context, the leadership roles, power dynamics and community structure was essential. The communication strategy had to be robust and strong enough to tackle widespread myths, including a belief that the vaccine was a decoy to steal blood from the community to be sold abroad.

The researchers learned that motivators for joining the trial included sacrifice and citizenship, access to healthcare, curiosity and hope for an effective vaccine against Ebola. Knowledge of these motivating factors helped to inform the communications campaign going forwards. Community dialogue was essential and the project used local artists to create posters to highlight key messages, such as one informing people that participation in clinical trials for the new vaccine were entirely voluntary.

Because many African citizens do not have identity cards, biometric testing was necessary to ensure that one person did not receive two doses of the first vaccine instead of receiving the first dose and the second booster. In Sierra Leone, iris scanning and fingerprinting were used, and during the project a new and improved methodology was developed using a handheld iris scanner and a mobile tablet. This was an improvement because the previous system involved having the participant’s face touching a screen, which was not ideal during an infectious disease outbreak. The new mobile tablet and handheld iris scanner were found to be useful for everyone over the age of three. These biometric identification tools were later customised by the WHO for use in their Covid -19 vaccine evaluation study.

To increase the numbers of participants who would come back and receive the second dose, the EBODAC project developed the Mobile Technology for Community Health Platform, a tool that was used to send automated, participant-specific audio message reminders about clinic visits to participants in local languages.

Capacity building and training programmes were rolled out in Sierra Leone to ensure that there were enough skills on the ground to administer vaccines. A mobile training programme sent training modules via pre-recorded audio messages in local languages through mobile phones. The trainee would then listen to the training and use the keypad to respond to quiz questions. One example of a training delivered in this way was a  mental health training programme which trained 50 000 health workers.

EBODAC developed a tool that governments could use to assess their preparedness for Ebola, called the Gap Analysis Tool. It was used by the Ministry of Health in Rwanda ahead of a large-scale Ebola vaccination programme, and was a great success, with 94% of participants returning to the vaccination centres to receive their second dose.

A digital platform called Vxnaid was set up to support vaccine administration and efficient vaccination campaigns in Africa as a result of the EBODAC project. It was later used to support vaccination campaigns against COVID-19.

Lessons learned from EBODAC as a whole were compiled into an online training tool and guidebook.  An educational module for use in public health, medical and nursing schools in the US, Europe, Asia, Latin America and Africa was also developed. More information on EBODAC can be found here.