The Meningitis Vaccine Project - frequently asked questions

Meningitis is an infection of the meninges, the thin lining that surrounds the brain and the spinal cord. It is usually caused by a virus or bacterium (meningococcus). It is transmitted through droplets of respiratory or throat secretions. Bacterial meningitis, such as meningococcal disease, can be very serious because it evolves rapidly and can kill in a few hours. Even with appropriate treatment, around10% of patients die, and up to 20% of survivors have serious permanent health problems as a result of the disease (deafness, epilepsy, cerebral palsy or mental retardation).

Sub-Saharan Africa has been experiencing explosive and repeated meningococcal epidemics for more than a hundred years. Group A meningococcus is the main cause of meningitis epidemics and accounts for an estimated 80% to 85% of all cases. These deadly epidemics occur at intervals of 7–14 years in the 25 countries of the "meningitis belt," a strip of land that extends from Senegal in the west to Ethiopia in the east. Around 450 million people in this area are at risk of disease.

More than one million cases of meningitis have been reported in Africa since 1988. In 1996-1997, the largest epidemic wave ever recorded swept across Africa, causing more than 250 000 cases and 25 000 deaths.

If introduced in all 25 countries of the African meningitis belt, this vaccine is expected to eliminate the primary cause of epidemic meningitis, meningococcal A, from the entire region, with an estimated 150 000 young lives saved by 2015.

Contrary to polysaccharide vaccines that are used currently to control epidemics after they have begun, the new conjugate vaccine will be offered to prevent epidemics. Key advantages of the new vaccine over existing polysaccharide vaccines are:

• it induces a higher and more sustainable immune response against the most prominent strain in the most affected age groups, from 1-29 years;
• it is expected to confer long-term protection not only for those who receive the vaccine, but on family members and others who would otherwise have been exposed to meningitis, given reduced transmission:
• it will be available at a lower price than other meningococcal vaccines, and significantly lower than other cutting-edge vaccines recently introduced in Africa; and
• it is expected to be particularly effective in protecting children under two years of age, who do not respond to conventional polysaccharide vaccines.

No, MenAfriVac will only protect again disease caused by the group A meningococcus—the main cause of meningitis epidemics in Africa, accounting for about 80 to 85 percent of all cases. Meningitis cases caused by other groups, such as W135, X and C, also occur. Vaccines for other groups are either not yet available (X) or far too expensive for African countries (C, W, or Y in various combinations). However, it is hoped that a combination of ongoing research and development efforts and tiered pricing will contribute to making these vaccines available to developing countries in the future.

The new vaccine was developed through the Meningitis Vaccine Project (MVP), a product development partnership between WHO and PATH, an international non-profit organization. The project included transfer of technology for manufacture of the vaccine from CBER/FDA to the Serum Institute of India Ltd. The project was set up in 2001 with core funding from the Bill & Melinda Gates Foundation. The overall mission of the MVP is to eliminate meningitis as a public health problem in sub-Saharan Africa through the development, testing, introduction, and widespread use of conjugate meningococcal vaccines.

Clinical trials, beginning in 2005, have been carried out in the Gambia, Ghana, India, Mali and Senegal and have shown the vaccine to be safe and highly immunogenic.

The vaccine will be sold at less than 50US¢ per dose, a price low enough to promote widespread uptake throughout the affected region.

Country-wide vaccination in Burkina Faso, Mali, and Niger is scheduled to start in December. The campaign in Burkina Faso is expected to be completed by the end of this year. The campaigns in Mali and Niger are expected to finish in 2011. It is hoped that all countries in the meningitis belt will be using the vaccine by 2015.

The goal of introducing the meningococcal A conjugate vaccine through mass vaccination campaigns of 1 to 29 year olds (the age group most at risk) is to immediately and drastically reduce carriage and transmission of the bacteria in order to rapidly reduce rates of death and illness caused by the disease. Because large population groups will be vaccinated in a short period of time, the benefits of immunization should be quickly visible; their impact is expected to be considerable.

It is expected that future birth cohorts will be protected either through vaccination within the EPI schedule or through follow-up mass campaigns targeting 1-4 year-olds every five years.

Because of the prevalence of meningitis A in the population and the role it plays as a major cause of epidemics, controlling meningitis A has become an important public health priority in Africa. Countries in the meningitis belt have been eager to host the clinical trials of the vaccine and have contributed significantly to their success. The same enthusiasm now fuels introduction of the vaccine throughout the region. The first three countries to introduce MenAfriVac are contributing financially as much as national budgets allow.

It is estimated that introduction of the vaccine in all meningitis belt countries will require the mobilization from donor governments and others of an additional US$ 475 million.

It is hoped that the international community will supplement the national budgets of introducing countries to ensure that this funding gap is met.

A very conservative estimate, looking only at treatment and vaccination, is probably a minimum of around US$20 million in an average year in Africa's meningitis belt. This does not include the expected economic impact of saving lives and preventing disabilities caused by epidemic meningitis. Nor does it include the expected impact of freeing up resources for essential health services, which are usually put on hold during the six to seven months of an epidemic.

In addition to actively seeking funding that will guarantee vaccine introduction throughout the whole meningitis belt, MVP is working closely both with governments and institutions in the African region, and international partners, to monitor the effect of the new vaccine on the ground. The project is also conducting further clinical research to inform policy, in particular for infants, to determine how best to integrate the meningococcal A conjugate vaccine into existing routine immunization programmes in Africa.