African ministers to introduce vaccine for meningitis epidemics

Health ministers from countries of the African Meningitis Belt are to introduce a highly promising candidate meningitis vaccine. The vaccine is designed to prevent periodic epidemics of the disease in these countries.

Ministers attending the meeting at the World Health Organisation (WHO) 's 58th Regional Committee for Africa held in Yaounde, Cameroon, in September, adopted the Yaounde Declaration, committing themselves to several actions. They agreed to prepare comprehensive meningitis control plans, including the introduction of the new vaccine to implement meningitis control strategies; to undertake joint action vis-à-vis the threat; to improve information exchange for epidemic response and to contribute financially to activities to control epidemics.

"Several hundred million persons are at risk of meningitis in 25 African countries. The new vaccine is the result of a deliberate effort to get ahead of these epidemics, at a price affordable in Africa. With this vaccine, countries can move away from a reactive response to emergencies towards elimination of the epidemic threat," said WHO director-general Dr Margaret Chan. She added that WHO will provide technical support for introduction of the vaccine.

The candidate vaccine has several advantages. Priced at just US$ 0.40 per dose, the vaccine produces in both adults and toddlers a higher immune response than the currently available vaccine. In addition, the new vaccine provides long-term protection and induces immunity in certain non-vaccinated persons who live in proximity of those who are immunised, leading to broad community protection.

The meningitis prevention and control strategy that affected countries will implement entails introducing the new meningococcal A conjugate vaccine to immunise a population of approximately 250 million 1 to 29 year-olds and 23 million infants living in 25 African countries from 2009-10 to 2015. It also requires ensuring that adequate quantities of the currently available meningococcal polysaccharide vaccines are available for epidemic response.

Investment for the vaccine has come from GAVI Alliance - a public-private partnership of major stakeholders in immunisation including WHO, UNICEF, the World Bank, developing country and donor governments, the vaccine industry research and technical agencies, civil society and the Bill & Melinda Gates Foundation.

Investment has totalled US$55m (b43m) towards a meningitis stockpile.

The new product, conjugate meningococcal A vaccine - MenAfriVac - was developed through the Meningitis Vaccine Project a product development partnership between WHO and the Program for Appropriate Technology in Health (PATH), a non-governmental organisation.

"This is a major development in the prevention and control of cerebro-spinal meningitis in the Sahel countries that will reduce the risk of epidemics currently killing thousands of people in the meningitis belt," said Dr Luis Gomes Sambo, director of the WHO regional office for Africa.

The new vaccine is expected to be introduced starting in 2009-10 in Burkina Faso and will be phased into an additional 24 countries between 2010 and 2015, with GAVI support. GAVI funding will also go towards ensuring sufficient stocks of the current vaccine are available for epidemic response during the introduction of MenAfriVac.

The "meningitis belt" countries include 430 million people, living in the area stretching east to west across the continent from Senegal to Ethiopia are at risk of this bacterial disease. Even with antibiotic treatment, at least 10% of patients die and up to 20% have serious permanent health problems as a result of the disease.

A Phase I clinical trial in adults aged 18 to 35 years was successfully completed in India. Phase II clinical trials of the candidate vaccine have been completed in The Gambia and Mali and showed almost 20 times higher antibody levels in one to two year olds, compared to the existing polysaccharide vaccine. (Follow-up of this trial is ongoing). Phase II/III clinical trials have been successfully completed in two to 29 year olds in The Gambia, Mali and Senegal.

An additional large phase III trial will be conducted in India and Mali in early 2009. A phase II study in infants began in Ghana in late August with results expected in 2010. The results of these trials may allow indications for use in infants to be extended.

The vaccine is expected to be licensed in India in the course of early 2009, and to be submitted for WHO evaluation shortly thereafter. African countries may also register the vaccine during 2009 to allow early introduction.