· > BMJ 2010; 341:c6736 doi: 10.1136/bmj.c6736 (Published 24 November 2010)
Cite this as: BMJ 2010; 341:c6736 http://www.bmj.com/content/341/bmj.c6736.full
New meningococcal A vaccine is being introduced into Africa
1. Susan Mayor
+ Author Affiliations
A new conjugate vaccine against meningococcal A costing only $0.5 (£0.3; €0.4) a dose that has been developed for use in Africa is about to be introduced for the first time in a national vaccination programme in Burkina Faso, researchers announced.
The campaign to vaccinate all children and young adults from the ages of 1 to 29 years with the vaccine, MenAfriVac, will begin in Burkina Faso on 6 December 2010. Niger and Mali will follow with similar vaccination campaigns.
Countries in the so called meningitis belt in sub-Saharan Africa—from Senegal in the west to Somalia in the east—have had regular epidemics of meningococcal meningitis for the past century. Almost all of the major outbreaks are caused by group A Neisseria menigitidis.
Until now, the only measure to reduce the impact has been reactive vaccination programmes with polysaccharide vaccines, but these provide protection for only about one year and not the long-lasting cover required for a preventive vaccination programme.
Jean-Marie Okwo-Bele, director of immunization, vaccines and biologicals with the World Health Organization, said, “Having this new vaccine is a huge accomplishment in public health because it will affect the lives of 450 million people who are at risk of this disease and who live in the well documented African meningitis belt.” He estimated that widespread use of the vaccine would prevent 50 000 cases of meningitis each year, and the resulting disability the infection causes, and 5000 deaths.
A major epidemic in 1996-7 of more than 250 000 cases of meningococcal meningitis and 25 000 deaths prompted the search for a more effective preventive vaccine. This resulted in the Meningitis Vaccine Project in 2001, a partnership between the World Health Organization and PATH (an international non-profit organisation) funded by the Bill and Melinda Gates Foundation.
The Meningitis Vaccine Project has adopted a new paradigm for developing vaccines for low income countries. It started with research in Africa to understand the constraints previously limiting the development of new vaccines in countries in the meningitis belt. African public health officials emphasised vaccine price as a key component and suggested that unless a new vaccine cost less than $0.5 per dose, it would not be sustainable.
The project brought together a consortium in which different companies and organisations provided the technical expertise to develop the vaccine, supplied basic materials and manufactured the vaccine at an affordable price. The US National Institutes of Health transferred the technology to synthesise the conjugate vaccine to the Serum Institute of India, and a Dutch company provides the vaccine constituents.
“MenAfriVac has been developed specifically for Africa—to provide protection against meningitis A, the commonest form of the disease in African countries, and at an affordable price,” said Mark LaForce, director of the PATH Meningitis Vaccine Project.
“The fact that the project to develop this vaccine was tailored to the needs of the meningitis belt in Africa at a price that they could pay, is a real breakthrough and should be used for other problems of this sort,” said Cathy Hewison, medical adviser with Médecins Sans Frontières (MSF).
Tido von Schoen-Angerer, MSF Campaign for Access to Essential Medicines, pointed out, “This model is dramatically different to the usual patent-based, profit driven model. Its developers have succeeded in tailoring the product to suit developing country medical needs, and keeping the vaccine affordable. This is a contrast to the blockbuster vaccines developed by the largest commercial developers for Western markets, that fetch extremely high prices and aren’t produced with developing country needs in mind.”
Dr LaForce said that at least 70% of the population in meningitis belt countries would need to receive at least one dose of the new vaccine to establish herd immunity. After the initial catch-up vaccination programme in each country, regular campaigns will be needed to vaccinate new birth cohorts.
Clinical trials with MenAfriVac have shown the vaccine is safe and highly immunogenic, achieving 95% protection, Dr LaForce reported. Protection lasts for 10-15 years, but long-term surveillance studies will establish whether a booster dose is needed to maintain immunity.
MSF welcomed the vaccination campaigns in Burkina Faso, Niger, and Mali but called for further funding to extend provision to other African countries. So far, the Global Alliance for Vaccines and Immunisation has only committed to helping pay for vaccines in the first three countries and no donor has offered financing for campaigns elsewhere, the charity warned. “For the rest of the countries in the meningitis belt it’s up to each country to find its own finances,” said Dr Hewison
(My thanks to Dr Felix Konotey-Ahulu for kindly sending me this story)