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Lining up for hope—and a meningitis vaccine

June 15, 2018 by PATH

Children in Burkina Faso celebrate the meningitis A vaccine launch. Photo: PATH/Gabe Bienczycki

The 2010 MenAfriVac® vaccine launch in Burkina Faso was a cause for celebration—it marked a turning point in Africa’s history with meningococcal meningitis. Photo: PATH/Gabe Bienczycki

In 2010, more than 10 million people in Burkina Faso lined up to receive the first licensed doses of MenAfriVac® and changed the course of meningitis in sub-Saharan Africa.

In just ten days, nearly every person in the country between 1 and 29 years old was vaccinated against group A meningococcal meningitis. At the time, it was the most prevalent form of the disease in Africa. Since then, MenAfriVac® has been delivered to more than 284 million people, virtually eliminating group A meningitis wherever it’s been introduced.

Developed and introduced in a record amount of time through an innovative partnership between PATH, the World Health Organization (WHO), and Serum Institute of India Pvt. Ltd. (SIIPL), MenAfriVac® has helped lift the cloud of fear hovering over people throughout the meningitis belt.

The culmination of nine years of work, the vaccine’s turn from concept to reality was heralded with the excitement of a national celebration; everyone attended the vaccine launch in Burkina Faso, from village mothers seeking to protect their children to the president celebrating African ingenuity.

MenAfriVac® also demonstrates the remarkable power of vaccines as public health tools, and what can be accomplished when need becomes idea becomes action.

An African plague

Meningitis—a serious infection of the thin lining surrounding the brain and spinal cord—has many causes. Viral cases typically resolve without treatment. Bacterial cases, however, can cause death within hours and mostly attacks infants, children, and young adults. Without treatment, 50 percent of those infected die within days. Those who survive the infection often suffer severe, lifelong disabilities such as deafness or paralysis.

With more than one million cases reported since 1988 and tens of thousands of deaths to its name, meningococcal meningitis is a scourge on people living in Africa’s sub-Saharan meningitis belt, which stretches across 26 countries from Senegal to Ethiopia. Every year, people living in these countries face meningococcal meningitis epidemics during the dry season from January to June. Epidemics can reach massive proportions, placing enormous burdens on local health systems and inflicting damage that remains long after the disease passes.

Until recently, reactive, emergency mass vaccination campaigns were the only defense for African nations suffering meningitis epidemics. But they were a stop-gap, not a solution; these campaigns used polysaccharide vaccines that provide relatively short-lived protection and don’t promote herd immunity, among other issues, leaving people vulnerable year after year.

Africa needed a new solution.

From the lab to the arm

Following the particularly devastating group A meningitis epidemic of 1996–1997 (which sickened more than 250,000 people and killed more than 25,000), African leaders called for a low-cost vaccine that would permanently put an end to group A meningitis epidemics in Africa.

PATH was listening. In 2001, we partnered with WHO to get to work. Despite the size of past epidemics, no multinational vaccine manufacturer was willing to make a vaccine at a price African governments could afford. SIIPL, however, agreed to produce the vaccine for less than US$0.50 per dose—the price set by African health ministers. Together, we created a new group A meningitis vaccine in record time.

“ MenAfriVac® demonstrates the remarkable power of vaccines as public health tools, and what can be accomplished when need becomes idea becomes action. ”

This was no easy feat. PATH and our partners had to develop the new vaccine under rigorous regulatory and technical rules; organize numerous clinical studies to test the safety and effectiveness of the vaccine; strengthen countries’ abilities to host clinical studies; build understanding and interest among meningitis belt populations; and support delivery of the vaccine once it was licensed for use.

That vaccine— MenAfriVac®—is the first vaccine to be developed specifically for Africa. In addition to its relatively low cost, MenAfriVac® promotes community immunity by reducing the bacteria carried in the nose and throat and interrupting the chain of transmission. MenAfriVac® also provides relatively long-term protection, which prevents group A meningitis epidemics before they start, and it can be delivered outside of the cold chain, providing access to even the most remote communities.

The introduction of MenAfriVac® in 2010 via mass vaccination campaigns has had an immediate and dramatic impact in breaking the cycle of group A meningitis epidemics. By 2020, the vaccine is expected to protect more than 400 million people—preventing 1 million cases of meningitis A, 150,000 deaths, and 250,000 cases of severe disability.

For years, meningitis paralyzed entire villages under the weight of sprawling illness, overburdened health systems, and economic hardship. For years, African nations resigned themselves to a reality marred by tragedy. But a vaccine—an idea, a call for help—changed all of that.

Toward a world without meningitis

To ensure group A meningitis epidemics remain a thing of the past, MenAfriVac® is now being introduced in countries across the meningitis belt as part of routine childhood immunization programs. Clinical studies are also examining the level of protection those vaccinated retain over time.

But Africa’s meningitis story doesn’t end with MenAfriVac®. Other kinds of non-A meningococcal meningitis can cause epidemics, including serogroups C, W, X, and Y. In fact, ongoing outbreaks caused by groups C and W in Niger and Nigeria caused more than 14,000 cases in 2017 alone. Such epidemics are illustrative of the unpredictable nature of the disease. Group C meningitis hadn’t been seen in decades, yet here it is.

We're once again partnering with SIIPL, this time to develop an affordable meningococcal conjugate vaccine against serogroups A, C, W, X, and Y. The vaccine candidate began early-stage clinical trials in 2016 and has the potential to eliminate meningococcal meningitis from Africa once and for all.

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