MSF calls for broader access to ERVEBO vaccine during Ebola outbreak

MSF is urging the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) to lift restrictions limiting ERVEBO vaccination to research protocols so that available doses can be deployed rapidly to protect those most at risk. MSF is also calling for enough doses to be made available to support a meaningful expansion of vaccination.

ERVEBO is not an experimental vaccine. It is licensed and approved for use against Ebola disease caused by Ebola virus (but not the Bundibugyo virus causing the current outbreak) and has a well-established safety profile from previous Ebola responses in DRC. It is currently authorized for use in individuals aged 1 year and older. 

While ERVEBO was not specifically designed for the Bundibugyo virus, a growing body of scientific evidence suggests it may still help protect people exposed to it. Animal studies and immunological data from research in vaccinated individuals have shown encouraging signs that the immune response triggered by ERVEBO may also recognize and respond to Bundibugyo virus, suggesting that the vaccine could help protect more people at risk right now.

ERVEBO is the only licensed Ebola vaccine available at scale

No licensed vaccine currently exists specifically for Bundibugyo virus. While several candidate vaccines are under study, results are still months away, and they are unlikely to become available in the near term. Additionally, children under 12 are not currently expected to be included in trials of Bundibugyo-specific vaccines, which could further delay evidence generation and potential access for this age group.

“Expanding access to ERVEBO offers the best immediate opportunity to help reduce severe illness and deaths while research on Bundibugyo-specific vaccines continues,” said Guyguy Manangama, epidemiologist and deputy director of operations at MSF. “The absence of a Bundibugyo-specific vaccine should not prevent the use of the only vaccine currently available. Every month spent waiting for dedicated tools leaves health care workers, frontline responders, contacts of confirmed cases, and affected communities exposed to a potentially deadly disease.”

Access to ERVEBO is highly restricted

At present, access to ERVEBO vaccination remains highly restricted. Frontline workers may be vaccinated through cumbersome research protocols or compassionate use mechanisms (a pathway for patients with life-threatening conditions to gain access to investigational medical tools outside of clinical trials), while contacts of people with confirmed Ebola generally only have access through ongoing clinical trials. Because these trials have strict enrollment requirements, only a small fraction of people who could benefit are likely to be included — far fewer than what would be needed for a broader public health response. As a result, many people at risk remain without access to vaccination despite the continued spread of the outbreak.

Evidence supporting the potential role of ERVEBO continues to grow

Between 2018 and 2024, more than 365,000 individuals, including tens of thousands of frontline workers, were vaccinated with ERVEBO in North Kivu and Ituri, the two provinces most impacted by this current outbreak. Retrospective studies are underway.

"MSF teams involved in the Ebola response in DRC have observed encouraging signs among people vaccinated [in prior] Ebola outbreaks, including fewer confirmed cases and indications of lower mortality among those with confirmed infection,” said Etienne Gignoux, epidemiologist and director of the epidemiology department at Epicentre, MSF’s research center.

"In an outbreak, decisions must often be made before the evidence is complete and the tools are ideal,” said Gignoux. “Public health authorities must balance the need for research with the urgent need to save lives.”

Broader vaccination will only be possible if both policy and supply barriers are addressed. The DRC Ministry of Health has already expanded access to ERVEBO through compassionate use mechanisms, but scaling up vaccination will require additional operational resources, updated recommendations from SAGE at its next meeting on November 17, and a much larger release of doses from the global emergency stockpile.

In August, the DRC government, with support from Africa CDC, requested 500,000 doses of ERVEBO through WHO’s International Coordinating Group (ICG) on Vaccine Provision — which includes MSF among its partners — to support a broader vaccination strategy. Only 70,000 doses were released. This shortfall is particularly concerning as the outbreak continues to spread and cases have been reported beyond DRC's borders, raising the prospect of additional vaccination needs in affected and at-risk countries.

MSF is therefore calling on Merck — the manufacturer of ERVEBO — as well as WHO, ICG partners, and global health actors involved in vaccine policy, financing, and allocation, to ensure that enough doses are made available and released to match the scale of public health needs.

Vaccines alone will not stop the outbreak

MSF also stresses that vaccination alone will not bring the outbreak under control. It must complement — not replace — the other essential pillars of the Ebola response. Surveillance, rapid case detection, laboratory diagnosis, contact tracing, quality clinical care, infection prevention and control, safe and dignified burials, community engagement, and support for frontline health workers all urgently need to be strengthened.

More broadly, the current outbreak highlights persistent gaps in global epidemic preparedness. Governments, donors, researchers, and manufacturers must invest in vaccine platforms and manufacturing technologies that can speed up the development, production, and availability of effective and affordable vaccines during emerging outbreaks. Communities facing future epidemics should not be left waiting months or years for disease-specific tools to become available.

For more information, see the MSF Access Campaign briefing, “Vaccines and the 2026 Bundibugyo Ebola Disease Outbreak: Access Gaps and Recommendations,” which examines current vaccine access challenges during the outbreak and proposes recommendations to ensure equitable access to effective vaccines.