Raging Floods Isolate Villages in South Sudan, Hopes for Hepatitis E Vaccination Dashed

In the remote villages of Fangak county, northern South Sudan, a pioneering vaccination drive is underway to combat a spate of hepatitis E cases. However, the effort is being severely hampered by repeated flooding, which has turned villages into islands and cut off populations from healthcare. World Health Organization-recommended vaccines are being used for the first time during the acute stage of a hepatitis E outbreak, but the mission is facing extreme logistical challenges.

MSF, the charity operating the vaccination drive, has reported 21 deaths and treated over 500 people infected with hepatitis E in the past nine months. Yet, the true scale of the outbreak remains unknown, as the majority of people in the region are isolated and cannot access healthcare. Hospitalized patients are seen as a lucky few, as many more are likely to have succumbed to the disease without medical attention.

Hepatitis E spreads through contaminated water, has no cure, and is particularly deadly for pregnant women. Although rare in developed countries, it infects over 20 million people annually in poorer nations where sanitation is lacking. The charity is facing the additional challenge of shipping vaccines from China, where they are produced, due to the remoteness of the region.

To reach 12,000 women aged 16 to 45 by June, MSF must navigate eight-hour boat trips to some of the affected villages. The hospital in Old Fangak, Jonglei state, can only be reached by boat or plane, highlighting the enormity of the challenge. In Fangak county, limited access to even basic healthcare is a significant issue, making it difficult for MSF to gauge the true extent of the outbreak.

The repeated flooding in Fangak has also exacerbated malaria rates, as mosquitoes thrive in stagnant floodwaters. Damage to crops and livestock has contributed to child malnutrition, which is at alarming levels in Jonglei state. In 2023, there were 130,000 cases of child malnutrition in the region, with MSF attributing this to the devastating effects of repeated flooding and crop losses.

As MSF struggles to contain the outbreak, the charity is also grappling with the high cost of vaccines, which is a significant barrier to wider vaccination. The hepatitis E vaccine was recommended for use by WHO in 2015 but has only been used once before, in South Sudan’s Bentiu displacement camp in 2022. Despite these challenges, MSF remains committed to protecting the people of Fangak county from this deadly disease.