At 100 Days – where do Ebola financing and outbreak countermeasures stand?

Financing
As of 23 August, the WHO—Africa CDC finance tracker shows pledges of US$1.3 billion and disbursements of US$333.3 million against a continental plan costed at US$518 million to the end of November. The tracker shows disbursement flows from financing partners to receiving governments or institutions and the geographical target for the funding. On 20 August, Africa CDC reported some US$758 million released, and it is unclear why this differs from the joint tracker.

The “research, knowledge management and access to MCMs” estimated budget of US$67.7 million attracted US$213.6 million in pledges, and as per the data on the tracker as of 23 August, US$80.2 million of that has been disbursed. Risk communication and community engagement require US$46.6 million and has received US$24.2 million.

The IPC, WASH and Safe and Dignified Burials pillar has seen US$23.3 million disbursed against a budget of US$49.1 million. Case Management and Clinical Care is the lowest funded pillar, with only US$753,200 disbursed against an estimated requirement of US$66.5 million. The United States has announced more than US$512 million and says publicly that it is the largest donor to this response, but that funding is not tracked on the WHO–Africa CDC platform and cannot be reconciled with published figures. As with much other donor funding, it is unclear how much is new and how much is reprogrammed, and how much is directly available for the response in the DRC.Vaccines
CEPI is supporting four vaccine candidates. Two have entered first-in-human trials: the University of Oxford’s ChAdOx1 BDBV, which began in Oxford on 13 July, and Moderna’s mRNA-1469, which dosed its first participant on 3 August in Canada. Two further candidates, from IAVI and Public Health Vaccines, both using the rVSV platform, remain in preclinical development.

On 31 July, WHO’s technical advisory group recommended that Ervebo – the licensed Zaire ebolavirus vaccine – be included in a Phase 3 study in this outbreak on evidence of possible cross-protection. On 20 August, WHO announced the DRC would receive 70,000 Ervebo doses including 50,000 for compassionate use for front-line health workers, and 20,000 for a Phase 3 clinical trial to understand the impact of the vaccine on the Bundibugyo virus.

Therapeutics
Two therapeutic trials are also enrolling. The PARTNERS trial, sponsored by WHO with the DRC Ministry of Public Health, ALIMA and MSF, is testing the monoclonal antibody MBP134 (Mapp Biopharmaceutical) and the antiviral remdesivir (Gilead) in confirmed patients, and had enrolled 100 people by 12 August. EBO-PEP, led by INRB Kinshasa with ANRS/Inserm and ALIMA, is testing the oral antiviral obeldesivir as post-exposure prophylaxis in contacts of confirmed cases.

Diagnostics
On 2 July, the first Bundibugyo-specific diagnostic received WHO Emergency Use Listing. A platform to validate the performance of laboratory-based, near-point-of-care and antigen rapid diagnostic tests now exists, led by WHO and Africa CDC, with PATH, FIND and CHAI and support from Unitaid.

Published access commitments
Moderna has committed to 500,000 vaccine doses for low- and middle-income countries at access pricing, and Oxford has committed to “affordable supply”. Gavi has committed up to US$50 million, with US$10 million for outbreak response and protection of routine immunisation and US$40 million for accelerating access to investigational doses and any future approved vaccines. An additional US$7 million has been committed for the Ervebo vaccines. Unitaid has also announced US$3.4 million to support rapid access to diagnostics and therapeutics.