The Democratic Republic of the Congo in Central Africa is the second largest country on the continent after Algeria, the largest in Sub-Saharan Africa by area, and the 11th largest in the world.
With a population of over 78 million, DRC is the most populated Francophone country, the fourth most populated country in Africa, and the 16th in the world.
If these are beautiful data to be proud of, the following ones are something to be ashamed of, or at best, outraged against.
Violence against women there is so legendary and has been so shamelessly normalized that 74.8% of women agreed in a 2013–2014 DHS survey that a husband is justified in beating his wife in certain circumstances.
There, mass rapes, sexual violence and sexual slavery have been used for decades as a weapon of war by the Armed Forces of the Democratic Republic of the Congo and armed groups in the eastern part of the country.
The eastern part of the country in particular has been described as the “rape capital of the world” and the prevalence of sexual violence there described as the worst in the world.
Now, a new report says things are even worse for pregnant women.
Many pregnant women are being denied life-saving vaccines right now in the Democratic Republic of the Congo, the report says, even as health care responders battle the ongoing Ebola outbreak.
In plain language, as other people are being vaccinated against one of the world’s deadliest diseases, pregnant women, who are already facing choking challenges in DRC, are being excluded, and literally left to die.
This is not an isolated case in DRC or elsewhere in Africa as the practice is widespread.
Recent epidemics of Zika, Lassa Fever, and Hepatitis E have shown how infectious disease outbreaks can severely – and at times uniquely – affect the health of pregnant women and their offspring.
Despite a significantly higher risk of serious disease and death, vaccines against these devastating diseases are rarely developed and approved for pregnant women.
Pregnant women are often denied vaccines for the fear of endangering their lives, and that of their unborn babies.
Changing institutional and government practices to make vaccines available for pregnant women in an epidemic is one of 22 long overdue recommendations contained in the new report released on Thursday.
The report, Pregnant Woman & Vaccines Against Emerging Epidemic Threats: Ethics Guidance for Preparedness, Research and Response, was issued by the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group – a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy.
The report aims to ensure that pregnant women are no longer excluded from receiving vaccines against emerging infectious diseases.
“The self-perpetuating cycle of excluding pregnant women from research and from the benefits of vaccination must end,” said Carleigh Krubiner, a lead author of the report jointly appointed at the Johns Hopkins Berman Institute of Bioethics and the Center for Global Development.
“With global efforts now underway to develop a range of vaccines against devastating epidemic threats, we have to make sure pregnant women are on the agenda, so they will never again be left unprotected in the face of future outbreaks.”
The report lays out concrete steps for equitably addressing the needs of pregnant women in public health preparedness, vaccine research and development, and the deployment of vaccines during epidemics. Its recommendations include:
· During an epidemic, the default should be to offer vaccines to pregnant women—not the reverse.
· Vaccines that can be safely given to pregnant women need to be developed. For these vaccines, evaluation in pregnancy needs to occur as early in the clinical development process as possible.
· During an epidemic, decisions about whether pregnant women will be offered vaccines should consider not only any potential risks of the vaccine but also, and importantly, the risks pregnant women and their babies face if vaccine is denied.
· All decisions about inclusion or exclusion of pregnant women should be informed by those with the relevant expertise in maternal and neonatal health as well as in vaccinology and virology.
· The perspectives of pregnant women themselves should inform vaccine research and deployment decisions that may mean life or death for them and/or their babies.
“The way we have treated pregnant women in vaccine research and deployment is utterly unacceptable. Business as usual cannot be permitted to continue,” said Ruth R. Faden, a lead author of the report and founding director of the Johns Hopkins Berman Institute of Bioethics.
“Ensuring that pregnant women affected by outbreaks have safe and effective vaccines is not only a matter of justice and health equity, it’s also critical to the public health response.”
That pregnant women affected by the ongoing Ebola crisis in the Democratic Republic of the Congo are not being offered vaccine demonstrates how urgent and serious the consequences are of the status quo exclusions of pregnant women from vaccine research and delivery. In recent UNICEF interviews, pregnant women “clearly articulated that they wanted to choose whether to be vaccinated or not.” As one woman said, ‘now there is no option, you just send us to death.’”
“As we continue to develop new vaccines against pathogens with serious and often lethal consequences in pregnancy, pregnant women must be on the agenda every step of the way,” said Ruth A. Karron, a lead author of the report and director of the Center for Immunization Research and the Johns Hopkins Vaccine Initiative at Johns Hopkins Bloomberg School of Public Health. “We simply can’t continue to fail pregnant women as we develop new vaccines against emerging threats. We need to generate an evidence base for safe and effective use of these vaccines during pregnancy.”