  In the context of the ongoing Ebola epidemic in DRC, active conflict and
community distrust are undermining control efforts, including vaccination
strategies. In this paper, we employed an individual-level stochastic
structured transmission model to assess the impact of vaccination strategies on
epidemic control in the context of variable levels of household
inaccessibility. We found that a ring vaccination strategy of close contacts
would not be effective for containing the epidemic in the context of
significant delays to vaccinating contacts even for low levels of household
inaccessibility and evaluate the impact of a supplemental community vaccination
strategy. For lower levels of inaccessibility, the probability of epidemic
containment increases over time. For higher levels of inaccessibility, even the
combined ring and community vaccination strategies are not expected to contain
the epidemic even though they help lower incidence levels, which saves lives,
makes the epidemic easier to contain and reduces spread to other communities.
We found that ring vaccination is effective for containing an outbreak until
the levels of inaccessibility exceeds approximately 10%, a combined ring and
community vaccination strategy is effective until the levels of inaccessibility
exceeds approximately 50%. Our findings underscore the need to enhance
community engagement to public health interventions.
