Meningitis A vaccine support

School children holding immunisation cards in Nigeria. It is one of 19 countries that have launched meningitis A campaigns with support from Gavi.
Credit: Gavi/2011/Ed Harris.

EPIDEMICS REACH LOWEST-EVER RECORDED LEVELS

Gavi-supported meningitis A vaccine campaigns have reached more than 268 million children and young adults in 19 countries in the “meningitis belt”, which stretches across 26 countries in Africa. Those supported so far are: Benin, Burkina Faso, Cameroon, 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 and Togo.

On average, the campaigns have reached more than 85% of those at risk of contracting the disease. The impact has been dramatic: the number of recorded epidemics in the meningitis belt have dropped to their lowest-ever level.

After 1.8 million people received one dose of the vaccine in three regions of Chad, meningitis rates fell by 94%. Also, there were no new cases in children aged less than 1 year or in adults older than 29 years. This highlights the positive impact even among those not vaccinated.

In 2016, Gavi started supporting routine vaccination of children aged 9–18 months. By December 2016,  two countries – Ghana and the Sudan – had introduced the vaccine into their routine programmes. Gavi also funds catch-up campaigns to cover children who are born after a mass campaign has taken place.

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

Gavi contributes to a meningitis emergency stockpile to fund vaccines to respond to these outbreaks. In 2016, Togo received more than 500,000 Gavi-funded vaccine doses from the stockpile to combat an outbreak of meningococcal W disease.

Meningococcal meningitis is a bacterial form of meningitis – a serious infection of the thin lining that surrounds the brain and spinal cord.

The majority of meningococcal infections are caused by serogroups A, B, C, W or Y. Before mass immunisation campaigns started in 2010, serogroup A meningococcus represented 80–85% of all cases in Africa. Since then, the proportion of meningitis A has declined dramatically.

MENINGITIS BELT

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.

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, this increased to as much as US$ 154. 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.

In 2008, the Gavi Board approved support to immunise all meningitis belt countries by 2016. With high vaccination coverage among people below 30 years of age, epidemics could be eliminated from the meningitis belt.

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. These target 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.