Because it is not yet licensed, the Merck & Co vaccine has been offered to Congo under a “compassionate use” protocol agreed by national and international health and ethics authorities.

This means fully informed, signed consent is needed from every person who wants the shot. And in the current Ebola outbreak, that makes logistical, cultural and language barriers the ultimate challenges, global health specialists say.

The hurdles illustrate how hard it can be to move from laboratory to real life, especially in remote communities with no functioning health systems. The Congo outbreak is a chance to reality-test a vaccine against a disease epidemic that can’t be replicated in controlled environments.

“This is going to need a highly sophisticated operation in one of the most difficult places on earth,” said Peter Salama, the World Health Organization’s deputy director-general for emergency preparedness and response.

“It’s very hot and very humid, and we’re talking about hundreds of kilometers of densely forested areas.”

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