Rodrigo Costa Pereira (Bio-Manguinhos)
In December 2015 a yellow fever epidemic began in the outskirts of Luanda, capital and largest city of Angola. It quickly spread to the country's 18 provinces, which in that month alone recorded 360 deaths due to the disease. Given this scenario, and seen the outbreak spread to neighboring countries as the Democratic Republic of Congo (DRC) - which recorded almost 100 deaths - and Uganda, the World Health Organization (WHO) began a major mobilization against the epidemic in February. Counting on emergency aid from laboratories that produce the yellow fever vaccine, an immunization campaign began in African countries. The Immunobiological Technology Institute (Bio-Manguinhos/Fiocruz) was one of the laboratories involved.
In early May, representatives of WHO and Path, a health NGO acting globally, visited the Institute to discuss improvements to vaccine manufacturing processes and to study the possibility of providing more doses. “They have consulted producing countries and asked for the highest possible number of doses", says the manager of the Department of Market Relations of Bio-Manguinhos, Denise Lobo. The WHO distributed around 18 million doses in 2016, out of which 5.6 million were provided by Bio-Manguinhos.
This amount helped immunizing more than 13 million Angolans according to the WHO. “The reduction in cases is due to the vaccination. All efforts have been made to respond to the epidemic, to bring a reduction of cases. We were able to vaccinate at least 13.3 million people. The country intends to vaccinate the entire population aged six months or more. In total, 25 million people will be vaccinated,” emphasizes the WHO representative in Angola, Hernando Agudelo Agudelo.
To meet this goal, the WHO keeps counting on Bio-Manguinhos and other laboratories. Over the last months, the Institute has been counting - heavily - on the teams involved in the vaccine production. These areas have been showing a very high level of commitment and turning the competences being worked in the unit into foundations for overcoming.
The Yellow Fever Laboratory (IFA) produces the active pharmaceutical ingredient (API), the main component of the vaccine formulation, and has increased the work rhythm which required an extra effort of its 39 employees. “We need to thaw the virus to deliver to the Formulation Division (Difor). The increased demand there means a natural reflex on us. We are really making an extra effort,” says Caroline Moura Ramirez, manager of Lafam. On the other hand, she says that this emergency situation was an opportunity. People are having the real dimension of their work for public health. “It was also a motivational matter. I showed the teams how important our work is. The commitment necessary to fulfill the mission has been truly shown,” she said.
Working with planning was also important to Lafam, which maintains a strategic inventory of API. However, production in this period has run very fast, which requires keeping the inventory high and “preferably working to increase it,” according to Caroline.
Difor has also prepared after being informed by the Board about the emergency in Africa. “When the WHO gave the alerts, an alignment meeting was held to know how we would meet the need. The Board asked the responsible areas to assess the impact of our activities. We organized an inputs planning and have been making everything we can,” declares the head of the Division, Daniele Alves de Oliveira.
For her, raising awareness of the teams to focus on the emergency response of the outbreak, and, if necessary, with people in production - in scale system - from Monday to Sunday was important. “We are working on the maximum capacity of our facilities. What enters into production has to come out as quickly as possible to meet the necessary deliveries.” This includes the documentation and quality control, which has required as much or more than the production. “The documentation often takes more than the production process itself. The National Institute of Quality Control in Health (INCQS/Fiocruz) has given speed to expedite the releases and we need to be aligned in order to avoid delays,” explains Daniele.
The rhythm has also been accelerated in the area that tests the strength of the yellow fever vaccine. Despite also working with the triple viral, poliomyelitis and rotavirus vaccines, all ten employees of the Strength Section (Sepot), part of the Laboratory of Microbiological Control, are now focused on yellow fever. “Delivering these batches is essential. They are all very committed, know about the importance of our work, which is to ensure immunization for the person being vaccinated. We are always concerned about giving the best,” says the head of Sepot, Carina de Lima dos Santos, who works closely with the team of the Cell Bank Control Section (SBCEL) that produces the cells with which they work, and whose demand also increased in the period.
Other sectors are also involved and are key players in reversing the epidemiological picture in Africa. Each employee is committed to producing and delivering vaccines and this results in the preservation of the life of thousands of human beings.