Today could be the beginning of the end of a deadly and disabling epidemic of bacterial disease that, for reasons not fully understood, occasionally burns an exceptionally tragic swath across central sub-Saharan Africa from Senegal to Ethiopia.
The “meningitis belt.”
Starting today, PATH, the World Health Organization and a host of other partners begin fanning out across Burkina Faso, then to Mali and Niger to launch a massive vaccination campaign initially targeting 20 million people with the broader aim — if it gets fully funded — of ending these epidemics in 22 more countries and erasing this stripe of death and destruction.
“When these major meningitis outbreaks occur in these communities, it’s terrifying and everyone just stays inside … they just shut down,” said Dr. Marc LaForce, director of the Meningitis Vaccine Project.
Meningitis can be caused by any number of things. The term simply means an inflammation of the brain and spinal cord, an inflammation that can kill, cause brain damage, deafen or otherwise disable. In Africa’s meningitis belt, LaForce explained, the cause is a particular bacteria known as meningococcal A.
Meningitis can occur anywhere, but not like in the meningitis belt, LaForce said.
In 1996, LaForce noted, an estimated 25,000 people were killed by the seasonal meningitis outbreak. It’s not clear why this bacterial scourge occasionally wreaks such havoc in Africa during the dry season between January and April, he said, but the epidemics have lately been more frequent and covering more ground.
Medicins Sans Frontieres (aka Doctors without Borders) is among those groups assisting with the meningitis vaccine roll-out that starts today. MSF calls this project a “revolutionary” change for the better, noting:
A huge amount of energy and resources has to go into combating the disease each year, from sending out teams to detect cases, to treating people and organizing the vaccination campaign, so it’s totally draining. Psychologically, financially, and physically, these epidemics are devastating for the communities involved.
This is an outbreak nobody talks about. West Africa faces one of the worst meningitis epidemics in many years, with near 2000 deaths and more than 56000 cases reported! Flickr, Teseum – https://flic.kr/p/6ogosr
Wait, so what’s the big deal here if they were already vaccinating every year in response to these outbreaks? Why did it take nearly a decade, from start to finish, for LaForce and his team to come up with this vaccine?
The answer to these two questions is perhaps what makes PATH’s Meningitis Vaccine Project so potentially revolutionary.
The problem with the current vaccine strategy (as described by MSF) is that it’s reactive, with drug makers tailoring the vaccine to match the bacterial strains of the outbreak. The vaccine LaForce and his team set out to make in 2001 needed to be broadly preventive, proactive — and it needed to be very cheap to be feasible for use in these poor countries.
AS NPR’s Richard Knox put it, they needed a vaccine designed specifically for the meningitis belt, for poor countries.
“The price was going to be critical,” LaForce said. “It helped us determine what we could and couldn’t do.”
Basically, he said, all they had at the beginning was an idea — here’s what we need to stop this. Initial project funding came in from the Gates Foundation, WHO agreed to collaborate, the FDA shared vaccine data (intellectual property), further epidemiological and clinical studies were done and drug maker Serum Institute of India agreed to manufacture the vaccine at the lowest possible cost.
As a result, this new vaccine (called MenAfriVac) costs 50 cents. It’s broadly protective, LaForce said, and can be expected to provide immunity for 10 to 15 years. Once they get everyone in the meningitis belt vaccinated — all those from one to 29 years old — LaForce says there should be enough “community immunity” to break this cycle of massive meningitis epidemics.
Eliminating meningitis outbreaks from these countries, he said, will serve to strengthen the overall public health systems by relieving them of this tremendous seasonal threat and health burden.
“I do think this is a model approach that, while not applicable for every vaccine, could be used for others such as a simpler pneumococcal vaccine or typhoid,” LaForce says. What’s revolutionary about this particular vaccine, he said, is that it was created for a health need that would otherwise have been neglected.
But again, as a few have noted, this project will not fully succeed unless there is complete buy-in across the meningitis belt. This week’s roll-out aims to reach 20 million people but something like 250 million are in need of the vaccine.
As Dr. Orin Levine, a vaccine expert, wrote in a recent HuffPo blog post:
The single biggest obstacle to stamping out bacterial meningitis in Africa is the lack of funds to purchase these vaccines. There is also a need for better delivery systems in some areas, and improved disease surveillance everywhere — but these obstacles don’t really come into play if there is no money to buy the vaccines in the first place.
Sarah Boseley, of the Guardian, recently wrote a piece about the difficulty of getting donors to fully fund these vaccine programs for the poor and also of getting big pharma to make the vaccines. Boseley notes these were two problems the Meningitis Vaccine Project appears to have solved by keeping the vaccine dirt cheap and having it manufactured by emerging market drug makers:
A massive breakthrough looks to have been made in ending the meningitis A epidemics in Africa, which kill thousands of young people every year. A vaccine called MenAfriVac has been developed and will be launched in Burkina Faso on December 6 through collaboration between the WHO, an NGO called PATH in Seattle and the Serum Institute of India. This vaccine will cost just $0.50 a dose.
