A newly developed vaccine is on track to conquer a disease that, in recent years, has killed, deafened or caused brain damage in tens of thousands of people in sub-Saharan Africa. Since 2010, 220 million people have been vaccinated against meningitis A in what's called the "meningitis belt," 26 countries stretching from Senegal and Mauritania to Ethiopia and Kenya. The findings were reported this week in a special collection of 29 articles in the journal Clinical Infectious Diseases.
"We're seeing a game-changer in global health with a new vaccine that has the potential to move toward elimination of this disease," says Steve Davis, president and CEO of PATH, an international nonprofit organization that, with partners including the World Health Organization, the Bill and Melinda Gates Foundation, and African government officials, worked to research, develop and deliver a meningitis A vaccine. (As readers of this blog may know, the Gates Foundation is also a funder of NPR.)
For at least a century, sub-Saharan Africa has had the world's highest rates of Meningitis A, a severe infection of the thin lining of the brain and spinal cord. It's an airborne disease that kills about 10 percent of patients, most of them infants, children and young adults. Among survivors, about 1 in 5 suffer severe brain damage or deafness. There are five types of meningitis. Meningitis A is rare in other parts of the world, but epidemics have occurred in Africa regularly, about every 8 to 12 years, according to PATH. It's not clear exactly why, though environmental factors like dust, humidity and drought likely play a role.
When an epidemic spread through the region in 1996, some 250,000 people got sick and 25,000 died. "It's one of the things that parents fear the most — more fearsome than malaria — because if kids didn't die, they would be neurologically damaged," says Davis.
After that epidemic, health ministers and other African leaders approached WHO and asked for help. The Meningitis Vaccine Project was set in motion in 2001 to develop a vaccine tailor-made to prevent meningitis A — and at a price developing nations could afford.
"It began with this: It's got to be less than 50 cents per unit," says Davis. The poor countries of the region would never be able to afford a higher price, regardless of how effective a vaccine might be. "I think the real first here is that this is a case study of inserting price early in the product requirement."
Large pharmaceutical companies in wealthy countries were unwilling to take on what they saw as an unprofitable project — the manufacture of a vaccine that would be sold for less than 50 cents a dose. But a pharmaceutical company based in the developing world, the Serum Institute of India, with help from foundations and international aid organizations, joined the effort and was able to produce a high volume of vaccine for under 50 cents per inoculation, says Davis.
Less than ten years after the Meningitis Vaccine Project began, the first patients lined up in Burkina Faso for their shots. The new vaccine, called MenAfriVac, was an improvement over earlier vaccines that could only be delivered after epidemics had started and had a short window of protection. Scientists have found that patients who received the new vaccine had protective antibodies in their system five years later. "I don't know if it was a record breaker because it's hard to pinpoint exactly when everything started," Davis says, "but it's a very short timeline compared to most vaccines."
Davis says at least three things worked in favor of this global success story. The political will was there: Many African nations lead the charge to get something done about Meningitis A. Education efforts by community leaders, religious leaders and tribal elders spread the word that the vaccine was safe and effective. And because almost everyone in the meningitis belt had seen children and family members suffer from the disease, people were willing — even eager — to be vaccinated in the hope of ending the fearsome disease.
In 2010 Burkina Faso became the first country to immunize its population against the disease. A PATH video shows people arriving at vaccination centers by bicycle, motorbike and on foot to wait in long lines. Children cried at the jab to their arm, but the adults who held them beamed in seeming relief.
Sixteen countries within the meningitis belt have vaccinated more than 220 million people, and the immunization program is being rolled out to the other ten countries of the susceptible region.
WHO, in a press release, has called the program a "stunning success" but cautioned that the job is not yet done. "If we let our guard down, these diseases will severely rebound," said Dr. Marie-Pierre Preziosi of WHO, a member of the team that developed the vaccine.
To keep the disease at bay, new babies will need to be vaccinated and those already immunized must be monitored to see how long immunity lasts, says Davis. Sustaining the effort is the next challenge. Countries with relatively advanced health care systems, like Ghana, are already making plans to include Meningitis A among routine vaccinations, says Davis. That's more difficult for poorer countries or those devastated by Ebola. "We've got to keep the momentum alive to take this success," says Davis, "and turn it into a more routine process of ongoing, routine immunizations."