Meningitis A vaccine support

School children holding immunisation cards in Nigeria. It is one of 21 countries that have launched meningitis A campaigns with support from Gavi.
Credit: Gavi/2011/Ed Harris.

MENINGITIS A VIRTUALLY ELIMINATED

Gavi-supported meningitis A vaccine campaigns have reached more than 279 million children and young adults in 21 countries in the “meningitis belt”, which stretches across 26 countries in Africa. Those supported so far are: Benin, Burkina Faso, Cameroon, the Central African Republic, Chad, Côte d’Ivoire, the Democratic Republic of the Congo, Ethiopia, the Gambia, Ghana, Guinea, Guinea-Bissau, Mali, Mauritania, the Niger, Nigeria, Senegal, South Sudan, the Sudan, Togo and Uganda.

The impact has been dramatic: the number of recorded epidemics in the meningitis belt have dropped to their lowest-ever level.

To sustain this progress in the long term, we started supporting routine immunisation with meningitis A vaccine in 2016. Since then, seven countries have added the vaccine to their national schedules – five in 2017 alone. Many more have expressed interest in introducing it in the next few years.

This means that 50% of the countries in the meningitis belt are on track to roll out the vaccine in the near future.

By the end of 2017, over three million children had been immunised with the meningitis A vaccine through routine immunisation programmes.

Gavi also funds catch-up campaigns to cover children who are born after a mass campaign has taken place.

EMERGENCY STOCKPILE

Gavi contributes to an emergency stockpile to fund vaccines to respond to outbreaks of both meningitis A and other meningococcal disease strains. Since its setup, 21 million doses have been distributed. In 2017, vaccines from the Gavi-funded stockpiles were used to control large-scale epidemics of meningitis C in Niger and Nigeria, among others.

DISEASE BURDEN

Meningococcal meningitis is most prevalent in the sub-Saharan “meningitis belt”. This area stretches from Senegal in the West to Ethiopia in the East, with an at-risk population of about 450 million.

Epidemics occur in the dry season, from December to June. An epidemic wave can last two to three years, dying out during the intervening rainy seasons. Those at highest risk of infection are infants, children and young adults.

Meningococcal meningitis can kill within hours. 10% of those infected die within two days even when antibiotics are available. One in four survivors are left with permanent disabilities such as paralysis, blindness, hearing loss, seizures and intellectual disability.

CONTINUED EPIDEMICS

While Gavi-supported campaigns and routine introductions have significantly decreased meningitis A outbreaks in vaccinated countries, other meningococcal strains (including C, W, and Y) continue to cause epidemics across the meningitis belt.

A new hyper-invasive strain of meningococcal meningitis serogroup C is spreading across western parts of Africa, increasing the risk of outbreaks. The number of suspected meningitis cases increased from just over 18,000 in 2016 to more than 29,000 in 2017 – mainly caused by serogroup C.

SOCIAL AND ECONOMIC IMPACT

Meningitis has a significant social and economic impact. A study conducted in Burkina Faso in 2006/2007 found that households spent US$ 90 per meningitis case. This is equal to about 34% (or four months’ worth) of the average household income.

When the disease caused disabilities, household expenses increased to as much as US$ 154 per case. Also, many people were afraid to socialise or work during an epidemic for fear of catching the disease.

MENINGITIS VACCINE PROJECT

The Meningitis Vaccine Project is a partnership between WHO and PATH. It was set up in 2001 with core funding from the Bill & Melinda Gates Foundation.

Its mission: to develop a vaccine at a price low enough – US$ 0.40 per dose – to enable widespread use in Africa. This was to ensure that epidemics such as the 1996–97 outbreak, which caused 25,000 deaths, would never happen again.

Manufacturers in industrialised countries could not produce the vaccine at such a low price. Instead, the consortium carried out the research itself. It then contracted the Serum Institute of India in Pune to make the vaccine.

The vaccine was developed in record time, at less than one tenth of the cost of a typical new vaccine.

Gavi now also supports countries to introduce the vaccine into their routine systems. This will ensure that future generations are protected.

GAVI FUNDING SUPPORT

In the 26 countries where meningitis A is endemic, Gavi currently supports:

Preventive campaigns

Countries receive support for preventive campaigns on a one-dose vaccination schedule. They also get support for injection supplies. Countries receiving support for preventive campaigns do not receive a vaccine introduction grant. Gavi provides US$ 0.65 per individual in the target population to help cover operational costs.

Introduction into the routine immunisation system

The vaccine should be introduced into the routine schedule within 1-5 years after the preventive campaign.¹ This will help to prevent future outbreaks.

Gavi provides support for a one-dose meningitis A vaccination schedule and injection supplies. Countries receive a one-time vaccine introduction grant for additional introduction costs.

Mini catch-up campaigns

Gavi also supports simultaneous one-time “mini catch-up” campaigns, targeting babies born between the preventive campaign and the routine introduction of the vaccine.

Meningitis emergency stockpile

Gavi contributes to an emergency stockpile to control outbreaks in the meningitis belt. The stockpile can include meningitis A as well as other serotypes, depending on the cause of the outbreak (men AC; men ACW/ACYW).

The International Coordinating Group, hosted by WHO, coordinates the meningitis emergency stockpile.

Controlled temperature chain (CTC)

Countries can get support to use a controlled temperature chain strategy in their meningitis A campaigns. WHO channels this funding.