Huge gains on meningitis A in Africa could be under threat, warns WHO

A five-year-old in Uganda carries her baby cousin. The country is one of 10 in the ‘meningitis belt’ in sub-Saharan Africa that still need to fully implement the vaccination campaign against meningitis A. Photograph: Alamy

Success of campaign that has almost rid 26 African countries of the disease could be at risk if vaccine not given routinely, says World Health Organisation

The “dramatic gains” made by a vaccination campaign that has almost rid 26 African countries of meningitis A could be undermined if the pioneering vaccine used is not included in routine childhood immunisation rounds, health experts have warned.

The vaccine, MenAfriVac, was created to fight epidemics of the deadly disease, which used to kill or disable thousands of people each year across the “meningitis belt” that runs through a swath of sub-Saharan African countries, from Senegal to Ethiopia

Because it is cheap – costing less than $0.50 a dose – and doesn’t need to be stored in fridges or iceboxes, the vaccine has nearly eliminated the disease, which is a bacterial infection of the thin lining around the brain and spinal cord.

MenAfriVac was developed by the World Health Organisation (WHO) and Path, a non-profit global health group, in response to the 1996 outbreak of meningitis A that killed 25,000 people and infected more than 250,00 over the course of a few months. 

Five years after the vaccine was launched, 220 million people between the ages of one and 29 have been vaccinated in 16 of the 26 countries in the belt: BeninBurkina FasoCameroonChadIvory CoastEthiopiathe GambiaGhanaGuineaMaliMauritaniaNigerNigeriaSenegalSudan and Togo

Meningitis A has disappeared wherever the vaccine has been used, and in 2013 just four laboratory-confirmed cases were reported across the belt.

But despite the vaccine’s success, scientists say that the disease could easily recur within the next two decades if the vaccine is not rolled out more widely.

The other 10 countries in the belt – BurundiCentral African Republicthe Democratic Republic of the CongoEritreaGuinea BissauKenyaRwandaSouth SudanTanzania and Uganda – still need to fully implement vaccination campaigns.

“We have nearly eliminated meningitis A epidemics from Africa, but the fact is the job is not yet done,” said Dr Jean-Marie Okwo-Bele, director of immunisation, vaccines and biologicals at WHO. “Our dramatic gains against meningitis A through mass vaccination campaigns will be jeopardised unless countries maintain a high level of protection by incorporating the meningitis A vaccine into their routine childhood immunisation schedules.”

The WHO says one-off vaccination campaigns are not enough to stave off epidemics such as meningitis A; according to one modelling study, countries that fail to follow up with a subsequent immunisation programme can expect to see “catastrophic resurgences in disease” after approximately 15 years.

Not only is it cheaper to immunise children rather than vaccinate people in response to outbreaks of the disease, say researchers, MenAfriVac also yields additional physical benefits – another study found that neonatal cases of tetanus have fallen by a quarter in countries where there has been comprehensive vaccination.

“Countries now need to decide how best to sustain the protection that initial mass vaccination campaigns provided,” said Dr Marie-Pierre Préziosi of WHO, who was a director of the project that developed the vaccine. “Our experience from other vaccine-preventable diseases has shown that if we let our guard down, these diseases will severely rebound.”

Steve Davis, president and CEO of Path, said the world could not afford to slip into complacency after so much progress had been made so quickly.

“Our partnership allowed us to develop an affordable, tailor-made vaccine for use against meningitis A in sub-Saharan Africa in record time and at less than one-tenth the cost of a typical new vaccine,” he said. “The global community should not risk squandering this amazing life-saving investment.”