Africa needs more vaccines to fight meningitis
MENINGITIS may be poised for a ferocious comeback in Africa, aid organisations are warning, and vaccine manufacturers must step up production if an outbreak is to be averted.
Meningitis is caused by one of several strains of the bacteria Neisseria meningitidis.
A vaccine introduced five years ago has all but defeated meningitis A infections in Africa. But infections with another strain, Type C, are on the rise.
Some experts fear the new strain will explode next year, while others say too little is known to predict its course reliably.
Meningitis C vaccines exist, but are expensive: $20 an injection is the lowest price offered thus far to an international public health consortium, led by the World Health Organisation (WHO), which stockpiles vaccines for emergencies.
The consortium, the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control, needs 5-million doses. To be effective, they must be shipped and injected before January, when meningitis usually returns to Africa.
Unless there is a surge of donor money or huge price cuts, the consortium’s experts do not hold out much hope.
“If we don’t get the doses, we’ll be having a really hard time,” says Dr William Perea, co-ordinator of the WHO’s epidemic diseases control unit.
The global vaccine industry is fragile. Because of mergers and acquisitions, only four major pharmaceutical companies — GlaxoSmithKline, Sanofi-Pasteur, Merck and Pfizer — still make vaccines for diseases other than flu. They are primarily interested in serving wealthy countries, where they can charge $100 or more a dose. As a result, there are too few factories to supply the vaccines poor countries need and little competition to drive down prices.
“Vaccine pricing has traditionally been much more secretive than drug pricing,” says Kate Elder, vaccines policy adviser at Doctors Without Borders.
“When we survey companies, they never tell us how they arrive at prices.”
State-owned factories in India, Brazil, Cuba and elsewhere also manufacture meningitis vaccines. While they can sometimes be paid to make more than their own countries need, many are reliant on old technology and hampered by government bureaucracies.
A low-priced vaccine against meningitis C and four other strains of the infection is being developed in India, but will need at least another five years of testing.
Meningitis used to strike thousands of Africans every year. In 1997, meningitis made 250,000 ill and killed 25,000.
Survivors also suffer. A quarter are left brain-damaged, paralysed, prone to seizures or without limbs that had to be amputated. In African schools for the deaf, most students are meningitis victims.
Type A bacteria were once responsible for more than 80% of Africa’s meningitis cases, but that infection is being vanquished by a new vaccine, MenAfriVac, which was introduced in 2010 by the WHO, the Bill & Melinda Gates Foundation and Path, a Seattle health technology group. More than 220-million doses against Type A, made by the Serum Institute of India for 50c each, have been injected.
But that success has had an alarming coda. Two years ago, a new Type C strain appeared, a genetic variant from the previous Type C. In April 6,000 people went down with the disease in Niger, causing nearly 500 deaths.
“Very few people in Niger didn’t know somebody who’d gotten ill or died in the past,” says Dr Sarah Meyer, an epidemiologist for the US Centers for Disease Control and Prevention, who helped fight the outbreak. “People prayed for rains to start, and rushed to the pharmacy for vaccines.”
Experts are now debating what will happen when the harmattan winds return to Africa’s meningitis belt, which stretches from the Atlantic Coast to Ethiopia.
Experts at the WHO and Doctors Without Borders fear the new strain will spread. But others say it is impossible to predict.
“The idea that there is a death knell sounding for these countries is exaggerated,” says Dr Marc LaForce, a meningitis expert who led the development of MenAfriVac.