At least 21 lives have been lost following an outbreak of Hepatitis E in South Sudan, Doctors Without Borders have said.
According to MSF, 501 cases of hepatitis E have been treated while the majority of those who have died are women.
In response to the deadly outbreak, MSF has launched a vaccination campaign in collaboration with the Ministry of Health to provide protection to women and girls of reproductive age who are at greatest risk of death from the disease.
The vaccination campaign, the first to be conducted during the acute stages of an active outbreak and in such a remote and isolated part of South Sudan, is intended to prevent further loss of life.
“Hepatitis E is a waterborne disease that can be fatal,” explains Mamman Mustapha, MSF’s Head of Mission in South Sudan.
“Around 20 million people become infected every year and of these, three million people experience symptoms that require treatment."
The vaccine was developed in 2012 and has been approved for use in emergency settings by the World Health Organization (WHO) since 2015.
However, despite this, it has only ever been used once before.
This was in 2022 when MSF carried out a world-first by using the vaccine in a mass vaccination campaign in the Bentiu internally displaced persons camp in South Sudan.
At that time, the outbreak had been ongoing for more than two years.
The vaccine was used to provide future protection to over 25,000 people.
This latest campaign in Fangak County builds on the experience in Bentiu but is being administered in a vastly different context.
“Fangak County is situated in an extremely remote part of northern South Sudan on the Sudd marshes – a vast area of wetland dotted with small communities, where people have exceptionally limited access to even the most basic of health care,” Mustapha said.
“Even getting our routine childhood vaccinations to Old Fangak is a challenge. It is only possible to reach the hospital by boat using the river Nile or by air."
Life was already hard in Fangak County even before hepatitis E began to claim people’s lives.
Over the past four years, recurrent flooding has destroyed people’s crops and drowned their cattle.
Villages that were previously accessible by foot have become islands and people now have no choice but to use canoes to get from one place to another.
Cases of malaria have increased because the floodwaters have not receded and pools of stagnant water have created the perfect breeding ground for mosquitoes.
At the same time, cases of malnutrition have risen as people have had to change their diets, either learning to fish or resorting to eating waterlilies to survive.
Now, they are facing a new threat as hepatitis E spreads through the water that they drink and rely on for survival.
"Reaching a health facility was already hard for people in this harsh environment, now the flooding has made it is even more difficult,” Mustapha said.
“For many, an eight-hour journey by canoe is the only way to get to one, and it is likely that many do not attempt the journey due to the cost of transport and the long distance.”
An additional challenge is the limited availability of the vaccine and its high cost.
Production is licensed to only one manufacturer in China and it is not produced in large quantities.
It is also bulky compared to other vaccines and therefore difficult to transport and store especially in hard-to-reach areas like Old Fangak.
These challenges represent significant barriers when it comes to responding to disease outbreaks in emergency settings like South Sudan.
MSF is calling on these barriers to be lifted so that far greater numbers of people can be protected, particularly women and girls of childbearing age who remain the population group that is most at risk.
