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Image of Kathleen Donnelly in sunny Burkina Faso.

PATH staffer Kathleen Donnelly followed the launch of a new vaccine to stop epidemic meningitis A in Africa. Photo: PATH/Teresa Guillien.

Reports from the first mass vaccination campaign against epidemic meningitis A

In December 2010, people in Burkina Faso, Mali, and Niger turned out in the millions to receive a new vaccine that can protect them against a disease the regularly erupts in deadly epidemics: meningococcal meningitis A. The vaccine, called MenAfriVac®, is the culmination of nearly a decade of work by the Meningitis Vaccine Project, a partnership of PATH and the World Health Organization. PATH staffer Kathleen Donnelly, a member of our communications team, followed the first week of the mass vaccination campaign in Burkina Faso. Her blog posts from the field follow.

A generation without fear

December 15, 2010, Seattle—Safiatou Ouedraogo, 23, had tried to wait for us. But early on the third day of the country-wide campaign to vaccinate young people in Burkina Faso against epidemic meningitis, Safiatou called her twin two-year-olds, Celie and Celine. Together, they hurried to the local vaccination site, a table set up in the shade of three large trees adjacent to the neighborhood chief’s compound.

Safiatou Ouedraogo with one twin daughter on her lap and the other standing next to her.

Safiatou Ouedraogo at home with her twin daughters, Celie and Celine. Photo: PATH/Gabe Bienczycki.

We had planned to accompany Safiatou and her girls as they were vaccinated later that morning. But as she watched her neighbors set off to get the vaccine, Safiatou decided she couldn’t wait. She wanted the vaccine for her girls, and she wouldn’t be comfortable until they got it.

Meningitis is a killer, she explained when we arrived a couple of hours later. And even if you survive, there are problems, like brain damage and deafness. So, she didn’t want to wait. She wanted to go.

And who would ever blame her?

Dreams for the future

Even back home in Seattle, 7,000 miles away from the meningitis belt, the epidemics that regularly burn through Burkina Faso, Mali, Niger, and 22 other countries have the power to alarm. Thinking back to the remarkably gracious and resilient people I met while following the campaign’s first six days, I can’t help but wonder about their futures.

Will Florence Ouedraogo, deafened by meningitis at age 6, realize her ambition to become an electrician and help bring light to her neighborhood? Will Edwige Nana, whose little brother died from meningitis at age 7, become a customs officer and wear the uniform that she likes so much? Will the five small children that Hasmata Kafando shepherded to her local health center for vaccination—one her own and four the children of her husband’s other wife—grow up to have their own dreams?

Why not?

Nine years ago, when the Meningitis Vaccine Project was getting started, a substantial number of people thought developing a vaccine at a low price specifically for poor countries was impossible. It wasn’t.  

Neither was it easy. As Dr. Tachi Yamada, president of the Bill & Melinda Gates Foundation’s Global Health Program, said during ceremonies marking the vaccination campaign’s launch just over a week ago, solutions like MenAfriVac are only possible with “great resources, commitment, partnership, and resolve.” The launch of the vaccine, he reminded us, shows that solutions to challenges in public health are indeed possible.

Now, he said, it’s time for the world to find the funds to take the vaccine to all the countries of the meningitis belt.

Safiatou Ouedraogo

Safiatou Ouedraogo. Photo: PATH/Gabe Bienczycki.

“For God to bless them both”

If you ask Safiatou Ouedraogo what she wants for her daughters, she’ll answer quietly, “for God to bless them both.” Then, she’ll stop and think, as if reluctant to voice thoughts that might be taken as grandiose. What she’d like, she finally says, is a good life for her children, “one a teacher, one a doctor.”

She smiles shyly. “In my dreams,” she says.

One family, fractured by meningitis

December 10, 2010, Ouagadougou, Burkina Faso—Florence, her youngest, was the first to fall ill, Rosalie Ouedraogo recalls. It was 1994, and the little girl was only six years old. Florence escaped meningitis A with her life, but the disease stole her hearing.

Florence Ouedraogo.

Florence Ouedraogo. Photo: PATH/Gabe Bienczycki.

Three years later, during the largest epidemic of meningitis A ever recorded in the region, it was Rosalie’s son, Xavier, who got sick. He too survived, but was left profoundly deaf and with vision problems. He was 15.

About a year after that, meningitis came for Rosalie’s third child, Diane, then 11 or 12 years old. As they had with the other children, the family took Diane to the hospital, but they arrived too late. Diane, who has other severe physical disabilities, joined her brother and sister in a world of silence.

The Ouedraogo family’s story is one of extreme sorrow; unusual, says Dr. Marc LaForce, director of the Meningitis Vaccine Project, only in that not one of Rosalie Ouedraogo’s children escaped meningitis A.

Darkness in the courtyard

The light has gone when we visit the Ouedraogo family at their home in a residential section of Ouagadougou. We’ve come at night because Florence, now 22, has classes at the CEFISE school until 6 p.m. That’s about the time the sun falls from the sky like an ember, and neighborhoods like the Ouedraogo’s that lack electricity are filled with a darkness that freezes me in place, fearing that if I move I’ll step on someone in the courtyard that four families share.

Florence, Rosalie, and Diane Ouedraogo.

Florence, Rosalie, and Diane Ouedraogo. Photo: PATH/Gabe Bienczycki.

Marc is with us tonight, and after Rosalie, 54, and her two daughters offer us their best seats, he gently asks if the father of the children has gone. Yes, Rosalie replies. He left her after the children fell ill. Marc nods. He’s heard the story before.

Finding a way to live

Xavier, now 28, lives with an uncle and works as a woodcarver, Rosalie says. That leaves the three women to make a life as best they can. Florence is a good student and aspires to become an electrician. She has three more years of schooling before she can take a test to obtain the equivalent of a U.S. high school diploma. Diane, 24, used to attend school, but had to quit three years ago when her disabilities became more than the school could handle.

Rosalie and Diane Ouedraogo weaving a purse from a tangle of bright pink and green strips of plastic.

Rosalie and Diane Ouedraogo weave a purse. Photo: PATH/Gabe Bienczycki.

Now Diane and her mother spend their days embroidering cloth and weaving small purses out of brightly colored plastic strips. Rosalie sells what she can. She touches the large metal cross she wears around her neck. “With the help of God, we manage to survive,” Rosalie says. “We don’t have much, but with God’s help, somehow we make it.”

Spreading the word

December 9, 2010, Saaba, Burkina Faso—Amadou François Dipama is a town crier. Every day between the hours of 3 and 6 p.m., he steadily traverses the streets of Saaba, a suburb of Ouagadougou, by bike or foot, doing the local version of the evening news.

Town crier Amadou François Dipama, holding his bullhorn.

Amadou François Dipama with his bullhorn. Photo: PATH/Gabe Bienczycki.

For a small fee, Amadou, 54, will raise his bullhorn to his weathered lips, flip the switch, and, after a punishing blast of feedback, declaim items of interest to the people of Saaba. He might announce a show, a dance, or a community meeting. Lately, he’s been talking about meningitis A.

Everybody needs to come get the vaccine, Amadou says.

The lure of a new vaccine

To get the word out about Burkina Faso’s campaign to vaccinate everyone between the ages of 1 and 29 with MenAfriVac, public health officials have used modern techniques, such as television and radio announcements. Posters advertising the campaign’s dates—December 6 through 15—are taped to health center walls and vehicles. Some health workers wear ball caps with the campaign’s logo; others have gone house to house to make sure their neighbors know the vaccine is here. And Amadou and his colleagues have been out with the bullhorns.

Village residents lined up under trees.

In line for MenAfriVac in Saaba. Photo: PATH/Gabe Bienczycki.

Whatever they’ve been using in Saaba, it seems to be working. On our way to an early morning visit to the region’s health center, we pass several lines of people. In their hands are the bright white cartes de vaccination, records updated each time they receive a dose.

“No one has said no”

In the area where Amadou brings the news each night, nurse Boubacar Sawadogo, 41, reports that more than three-quarters of the people ages 1 to 29 came to get their vaccination during the first three days of the campaign. That’s much better, he says, then the rates for vaccination against some other diseases.

“For this vaccine, no one has said no,” Boubacar says. “People are all for it. They know [meningitis] is a serious disease.”

Assana Sawadogo holding a vaccination card, with her toddler son at her knee.

Assana Sawadogo, 22, and her son Abdoul Djalil Kafando, 2, with a carte de vaccination. Photo: PATH/Gabe Bienczycki.

Meningitis, then silence

December 8, 2010, CEFISE school, Ouagadougou, Burkina Faso—Alidou Ouedraogo can’t remember when meningitis stole his hearing. He frowns slightly as he watches his teacher’s fingers spell out the question in sign language. He gently touches his head, to indicate he’s thinking. Then he signs, “When I was very small.”

Alidou Ouedraogo, holding his drawing of a world without meningitis.

Alidou Ouedraogo with his drawing of a world without meningitis. View a slideshow of his and his classmates' drawings. Photo: PATH/Gabe Bienczycki.

Alidou is 19 now, nearly through his schooling at the Integrated Education and Training Center of Deaf and Hearers in his hometown of Ouagadougou. The school, which is known by its French acronym, CEFISE, has been his refuge for 16 years—ever since Madame Thérèse P. Kafando let Alidou’s family know that his future did not have to be one of isolation and low expectations.

“Before, people believed they couldn’t learn,” Thérèse says, recalling the school’s early days more than 30 years ago. “People believed they were just stupid.” A sly smile crosses her face. “You know,” she continues, “when the first kids from the school went to the university, it was just great.”

A world of possibilities

Thérèse Kafando standing in front of a chalkboard.

Madame Thérèse Kafando, director of the school. Photo: PATH/Gabe Bienczycki.

Thérèse helped her late husband, Pastor Abel Kafando, build the school from 19 students in 1988 to about 3,500 today. From the start, CEFISE has accepted an exuberant mix of deaf and hearing children on the theory that they help each other learn. Today, about 450 of her students are deaf, Thérèse says. At least 80 percent of those students, she estimates, are deaf because of meningitis.

In a bright yellow dress and chartreuse sling-backs, she crosses the school’s bustling dirt courtyard, dispensing correction or affection to students depending on need. On this third day of a countrywide vaccination campaign, the five-year-olds are lined up between the corridors separating the primary grades, each one holding a record of vaccination and ready to receive MenAfriVac.

Students in CEFISE's schoolyard.

At the CEFISE school, 80 percent of deaf students have had meningitis. Photo: PATH/Gabe Bienczycki.

If a similar vaccine had been available close to 20 years ago, would Alidou’s world be different now? It’s a question he sees no sense in pondering, choosing instead to look ahead. He is interested in electricity and how it works. He would like to go to the university. He doesn’t know which career he’ll choose.

“Right now I can’t tell you,” he signs. “There are many, many things I can do.”

Where everyone fears meningitis

December 7, 2010, Koubri, Burkina Faso—If you get this disease, Ida Tapsoba tells me, it’s a very big problem.

It’s the second day of Burkina Faso’s MenAfriVac vaccination campaign. Ida, 29, is standing in line to get the new vaccine at the health center in Koubri, a village about 15 kilometers south of Ouagadougou. Wrapped tight to her back is Ariane, her 13-month-old daughter.

Getting meningitis is a problem because treating a sick child can consume a third of a family’s disposable income; because even survivors are at risk of serious disabilities like brain damage and hearing loss; because one in ten people who get the disease die, typically within a day or two of falling sick. Ida and her neighbors are aware of these things, and they know epidemic meningitis is to be feared.

Crowd outside the health clinic in Koubri.

The people of Koubri village, in line for MenAfriVac. Photo: PATH/Gabe Bienczycki.

Doma Guere, a nurse who began working at the center just after the last epidemic wave of meningitis passed in 2007, agrees with Ida. There is no one in the village, he says, who is not afraid of meningitis. “People panic when they hear there may be one or two confirmed cases of meningitis,” he says. “If anyone has a fever or a belly ache they bring him here because they are so afraid it’s meningitis.”

A somber listing

Ida Tapsoba with her infant daughter, Ariane, strapped to her back.

Ida Tapsoba and her daughter Ariane Zangre. Photo: PATH/Gabe Bienczycki.

Approach anyone standing in line for vaccine on a pleasantly warm afternoon in this friendly village. Ask if they know someone who has been sickened by meningitis. They will answer you politely: A friend killed at age 17. An aunt who survived, but who is now deaf.  A sister’s 10-year-old boy, dead. A little brother, taken at age 7.

Ask Ida: does she know anyone who has had meningitis?

She nods somberly. Yes, she says, her own son got sick during the last epidemic outbreak. He was just a year old.

Brace yourself, and ask as respectfully as you can: what happened?

Ida draws a breath. She felt desolated, she says. She was extremely anxious. The sickness lasted three days. But on the fourth day, her son improved, and he survived. He’s four years old now, in good health, and got the new vaccine yesterday.

By now Ida is at the head of the line, and she and Ariane are about to be vaccinated.

Ida smiles.

Launch day video

December 6, 2010—Amid the fanfare of the launch of the new meningitis vaccine, young children become the first to be vaccinated with MenAfriVac and to live without fear of epidemic meningitis.

Video: PATH.

A big day for Burkina: vaccinations begin

by Kathleen Donnelly, senior publications associate, PATH

December 6, 2010, Burkina Faso—Today is a big day for Burkina Faso, World Health Organization Director General Margaret Chan tells the crowd gathered to celebrate the launch of a new vaccine against what she calls the “most feared” disease in Africa: epidemic meningitis. “And today, with the launch of this new vaccine,” Dr. Chan says, “Africa is getting the best technology that the world, working together, can offer.”

For the schoolchildren of Ouagadougou, where the first mass vaccination campaign began this morning at about 11:30, it’s a big day for another reason. It’s a morning off from school to witness history.

A group of girls, smiling broadly with their arms around each other.

A few of the invited guests. Photo: PATH/Gabe Bienczycki.

Hundreds of them are ranged around the edges of the Place de la Nation, the massive central square where Dr. Chan and other dignitaries are speaking. After the speeches end, the first children will be plucked from the crowd, placed on laps, and pricked using the BD SoloShot™ syringe, developed at PATH. With one short shot, they’ll be on their way toward immunization against a disease with a long and cruel history in the three countries where vaccinations begin this month: Burkina Faso, Mali, and Niger.

The Place de la Nation is dressed for a party, and the children have caught the spirit. They gawk at the scarlet-caped soldiers standing along the red carpet that leads to the grandstand for special guests. Some shimmy when a traditional drumming group takes the bunting-wrapped stage to entertain. Every few minutes, another exuberant child breaks free of his or her school chums and careers across the plaza—sandals flapping—bound on some essential mission that inevitably ends at an adult’s hand directing them back to their assigned spot.

Problems are for solving

Meanwhile, the mood is more dignified but no less joyous at the podium where the superstars of global health mark the occasion. Dr. Marc LaForce, director of Meningitis Vaccine Project (MVP) is there. So is Dr. Christopher Elias, president and CEO of PATH. In his speech, Dr. Tachi Yamada, President of the Global Health Program at the Bill & Melinda Gates Foundation, which funded MVP, says the success of the project tells the world that with great resources, commitment, partnership, and resolve, we can take on any problem.

Dozens of health workers under a tent with insulated boxes of vaccine.

Health workers await their clients. Photo: PATH/Gabe Bienczycki.

After Burkina Faso’s president, Blaise Campaoré, addresses the crowd—and waves to the children as he leaves the podium—a ripple runs through the kids standing in one especially excited sector. The honored guests file out of the grandstand, and a line-up of young children begins to make its way to the tented area where dozens of health workers in white coats sit behind tables laden with gray coolers holding vaccine. Within minutes, there’s a crush of photographers as the first few children get their shots.

Three-year-old Pitroipa Boukaré.

Pitroipa Boukaré, recovered from her shot, observes the vaccination campaign. Photo: PATH/Amy MacIver.

Pitroipa Boukaré, a three-year-old pixie with an expression befitting the seriousness of the occasion, receives one of the first doses. The sting is a shock, and she cries. But soon she is comforted, and gently placed on the rosy pink pavement to make way for the next child.

Her mother is nearby, but Pitroipa stands her ground, eyes wide as she watches, along with the world, the beginning of the end of epidemic meningitis.

SoloShot is a trademark of BD.

First day in the field

by Kathleen Donnelly, senior publications associate, PATH

December 5, 2010, Burkina Faso—Dr. Marc LaForce, director of the Meningitis Vaccine Project (MVP), is in a great mood.

We’re stuffed side-by-side in a Toyota van ferrying 13 assorted journalists, PATH staffers, and visiting MVP partners to a regional health center in the city of Kaya, about 100 kilometers northeast of Ouagadougou. Our driver taps the horn and nips by boys driving heavily loaded donkey carts and women walking with the stately grace that comes from carrying a load of cassava on one’s head. At a stand by the side of the road, a someone is selling bright red slices of watermelon. Another offers bananas. A half-dozen more wave placards offering phone cards.

“It’s the culmination of ten years of work,” Marc says, speaking of the December 6 start of countrywide vaccinations using MenAfriVac, the new vaccine developed through the project. “And, hopefully, it’s the beginning of the end of epidemic meningitis in the meningitis belt.”

In the front seat, Dr. Christopher Elias, president and CEO of PATH, nods in agreement as Marc recalls the partnerships that made vaccine development and delivery a reality—starting tomorrow. Ask either man if he ever thought this day would come, and you quickly realize you’ve got the question backward. Better to ask if they ever doubted they’d be here, standing on the threshold of vaccine introduction.

“No, no, no!” says Marc happily. “I never had any doubt.”

Dr. Marc LaForce stands in front of a stucco building on a sunny day.

Dr. Marc LaForce, director of  MVP, is a happy man these days. Photo: PATH/ Gabe Bienczycki.

Friends in the right places

One of the reasons for their certainty comes from dedicated collaborators you’ve read about in these pages before—notably PATH’s partner in MVP, the World Health Organization, and the vaccine’s manufacturer, the Serum Institute of India, Ltd. But in the small cities and towns of the meningitis belt, Drs. LaForce and Elias know there are other crucial partners: the people who make sure their neighbors get the vaccine.

Our van pulls into the red dirt drive of the regional health center in Kaya, and we extract ourselves to meet Dr. Matheiu Boutgma, director of the center. He greets us by recalling the hectic ten days last September when his staff helped vaccinate the 400,000 people in Burkina Faso who got MenAfriVac.

These kinds of trial runs are crucial to the successful mass introduction of a vaccine, and they require a prodigious amount of advance work. Dr. Boutgma’s staff, for example, used every means they could think of—announcements on television and radio, visits to mosques and gathering places—to get the word out to people about a new vaccine that could protect them from meningitis for a decade or more, and that might one day end epidemics.

 “The people were really mobilized.” he says. “They loved the idea, and they showed up.”

“A very good thing”

Man in white coat sitting with small cooler.

Kassoum Paré, a nurse and head of the Korsimoro health center, with a cooler used to transport vaccine. Photo: PATH/Gabe Bienczycki.

Heading back to Ouagadougou, we pull off the main road to visit the health center in the village of Korsimoro, a tidy collection of stucco and mud brick buildings set off with the turquoise blue shutters that seem typical here. In September, 20 workers from Korsimoro vaccinated more than 11,000 people. They’d travel in teams of four, driving to remote locations on motorcycles. The temperature-sensitive vaccine, packed into picnic coolers, was strapped on the back.

Emmanuel Ouisnoma and T. Aimée Saouadogu are health center volunteers and respected elders in their communities. They went house-to-house, if that’s what it took, to get people to offer their arms for vaccination. And then they managed the crowds that showed up.

Most people in his community understand the importance of this particular vaccine, says Ouisnoma.  “They know it’s a disease that kills. The fact that you have now a vaccine that protects for ten years, that’s something really special.”

Tomorrow, vaccinations begin for the rest of the country.

You’re going where?

by Kathleen Donnelly, senior publications associate, PATH

December 3 , 2010—When I tell friends I’m going to Burkina Faso on Friday, the first thing they ask is “Where’s that?” (In West Africa, north of Ghana and Ivory Coast, south of Mali and southwest of Niger.) Next, they ask how to spell Burkina (with a “k,” not a “t”). Usually, a short pause follows. If we’re on the phone, I can hear fingers scrabbling across a keyboard, and I know they’re Googling. Next, almost invariably, my friend says, “Wow. I bet you had to get a lot of shots.”

As a matter of fact, I did.

First, I had to get a couple I’d already had long ago, as part of basic childhood immunization in 1960s California: MMR, to protect against measles, mumps, and rubella; and polio, which I remember being popped into my mouth on a vaccine-soaked sugar cube, a sweet surprise for a toddler expecting a needle.

This time, I also got shots for hepatitis A, hepatitis B, and yellow fever. To guard against typhoid, I took a vaccine that came in four capsules, popping one every other day for a week. And I was vaccinated against meningococcal disease, a serious bacterial infection that includes meningitis.

Now I’m ready to help document the launch of MenAfriVac, which will provide the kind of protection I easily obtained in my Seattle travel health clinic to people in the low-income countries of the meningitis belt. I’ll be reporting from Burkina Faso next week as the first mass immunization campaigns take place. These campaigns are the beginning of the end of epidemic meningitis in sub-Saharan Africa—an important milestone for Africa and for the entire global health community.

Isn’t there already a vaccine?

November 22, 2010—A visitor to our website recently emailed to let us know it wasn’t easy to find answers to her questions. Here’s some of what she told us, “I was very confused because I knew meningitis vaccines are available in the US, and it took me a LOT of time to figure out that there were several versions of meningitis.”

Support out work; donate now.

We appreciate your comments! Here’s some further explanation, along with links to places you can find more information.

As our visitor discovered, different types of bacteria can cause bacterial meningitis, and the disease can show up in all countries, including the United States. Until the 1990s, when children began to be routinely vaccinated against it, Haemophilus influenzae type b was the leading cause of bacterial meningitis. Now, Streptococcus pneumoniae and Neisseria meningitidis are the leading causes. Meningitis caused by Neisseria meningitidis is especially important because it has the potential to explode in large epidemics.

The meningitis belt of sub-Saharan Africa, which stretches from Senegal in the west to Ethiopia in the east, has the highest rates of meningitis caused by Neisseria meningitidis in the world. Why? Sub-Saharan Africa has conditions that allow the bacteria to thrive. During the dry season, wind-borne dust, cold nights, and upper respiratory tract infections combine to damage mucus in the back of the throat, increasing people’s risk for bacterial meningitis. Crowded housing and large numbers of people traveling on pilgrimages or to traditional markets contribute to the risk that epidemics will break out during the dry season.

Meningitis vaccines are available in the United States and other countries. But the vaccine used most often has limited impact in the meningitis belt:

  • It provides protection for only two or three years.
  • It doesn’t protect infants from the disease.
  • It doesn’t block transmission of Neisseria meningitidis to people who have not been vaccinated.

The new vaccine developed through the Meningitis Vaccine Project addresses these problems—and more. It targets the specific type of disease that causes epidemics in sub-Saharan Africa. And it does so at a price that poor countries may be able to afford: less than US$0.50 a dose.

The making of MenAfriVac

November 17, 2010—How long did it take to make a new meningitis vaccine? In this video, about 90 seconds. We’ve sped up time to show you the MenAfriVac vaccine being manufactured by Serum Institute of India Ltd. at their headquarters in Pune, India. Watch as the Serum workers wave goodbye to the first packages of vaccine, bound for Burkina Faso, Mali, and Niger!

Video: PATH.

The story of Jean-François

November 15, 2010—When times are tough, MVP director Dr. Marc LaForce remembers the promising young Jean-François.

Video: PATH.

Rains of hope

November 11, 2010—“When the first rains come, the epidemics cease,” describes MVP director Dr. Marc LaForce. Mothers in sub-Saharan Africa refer to these first rains as “the rains of hope.”

Video: PATH.

MenAfriVac + VVM = a powerful partnership

November 2, 2010—When health care workers uncap doses of MenAfriVac in Burkina Faso, Mali, and Niger for the first countrywide vaccination campaigns, a small purple sticker will provide them with key information about the condition of the vaccine. The little round dot is a vaccine vial monitor (VVM), developed by PATH to tell if vaccine has been exposed to excessive heat. The sticker changes color as its exposure to heat increases over time, letting health workers know at a glance if the vaccine may no longer be effective.

Hands holding three vials with vaccine vial monitors affixed to them.

Vials of MenAfriVac carry stickers that change color with exposure to vaccine-damaging heat. Photo: PATH/Yancy Seamans.

VVMs are considered a critical component of vaccines prequalified by the World Health Organization (WHO). Under a policy jointly established by WHO and the United Nations Children’s Fund (UNICEF), VVMs are now required on all vaccines purchased by UNICEF on behalf of the GAVI Alliance, a global health partnership that increases access to immunization in the world’s poorest countries.

In sub-Saharan Africa and developing countries around the world, keeping vaccines at safe storage temperatures (2°C to 8°C) is an ongoing challenge. Hot weather, intermittent electricity, and poor roads all pose threats to a vaccine’s potency. The VVM helps health workers have confidence that the vaccine they are administering has not been damaged by exposure to heat. If there is evidence of heat damage within a vaccine shipment, health workers can rely on the VVM to avoid wasting vials that have not been damaged. It’s one more smart way to make sure MenAfriVac and other crucial vaccines are doing their job: protecting lives.

In just a matter of days

October 14, 2010—As September came to a close in the meningitis belt and brought the region even closer to the pending dry season, more than 1 million people received a shot against group A meningococcal meningitis. Burkina Faso, Niger, and Mali have now completed their district-level introduction of MenAfriVac in a pilot campaign to check for any hiccups in the system. These countries are preparing for December’s mass vaccination campaign.

In just 17 days, 1,038,457 people were vaccinated against an illness that has plagued the region for a century. In barely two months, millions more will get the same vaccine—protection from meningitis and the huge peace of mind that comes with that protection.

Phased introduction!

September 14, 2010—Yesterday, people in Mali became the very first to receive MenAfriVac in an early introduction in preparation for December’s launch. In December, Mali, Burkina Faso, and Niger will begin country-wide vaccination campaigns, reaching more than 20 million people. Now the countries are introducing the vaccines in select districts to test logistics and allow time to iron out any kinks in the process.

Woman receiving a vaccination in her upper arm.

This woman in Mali is among the very first to be vaccinated in yesterday's pre-introduction of the MenAfriVac vaccine. Photo: WHO/Mali.

There’s a lot to think about when introducing a new vaccine into a public health system. Health officials are looking at staffing and transportation issues, any challenges with waste disposal, whether clinics have the proper equipment, and how they can improve post-vaccination surveillance to track the success of the vaccine. Phased introduction also allows them to detect and investigate any potential, and very rare, reactions that were not identified in early and rigorous evaluation of the vaccine among smaller populations.

Plus, this pre-introduction—which is bringing the vaccine to about 400,000 people in each of the three countries—allows the vaccine’s manufacturer, the Serum Institute of India Ltd., a bit more time to prepare the number of doses needed to meet the demand in December.

Shipment leaves India, bound for Mali

September 13, 2010—The Serum Institute of India Ltd. took some recent pictures of MenAfriVac being packaged and prepared for shipment to Mali. Each box contains 1,200 vials of vaccine. In a few months, health workers across Mali, Burkina Faso, and neighboring Niger will fill their syringes with the vaccine, prick the arms of their patients, and inject doses of lifesaving protection against meningitis.

Four men surrounded by stacked boxes of meningitis vaccine.

Staff at the Serum Institute of India prepare shipments of the MenAfriVac vaccine against meningitis. Photo: SIIL/S. Vinayak.

The Serum Institute plays a fascinating, and pivotal, role in the eight-year endeavor to make this vaccine a reality. When members of the Meningitis Vaccine Project (MVP) first began talking with African public health officials about the possibility of the vaccine in 2001 and 2002, the health officials issued a caveat: the cost of the vaccine couldn’t exceed US$0.50 per dose. Developing a vaccine they couldn’t afford would be worse than having no vaccine at all, they said.

The MVP team shopped the vaccine to the big multinational manufacturers, but no one would take it on to fit the price limits. Then MVP found Serum Institute, a developing-world business with an exemplary social conscience that said it could manufacture the vaccine in volume and keep the cost below 50 cents. Scientists at Serum have been toiling away on the vaccine ever since, carefully studying and testing it to bring it to fruition.

When the vaccine debuts later this year, it will indeed cost less than 50 cents—a feat many said couldn’t happen.

Vaccine arrives in Burkina Faso

August 12, 2010—The campaign to vaccinate nearly all 1- to 29-year-olds in Burkina Faso against meningitis won’t begin until December, but shipments of the vaccine MenAfriVac are already arriving in the West African country. The first 1.35 million doses reached Burkina Faso safely on the evening of August 12, shrink-wrapped in giant cubes and ready for distribution to the locations where the first shots will be given.

Man touching two large, shrink-wrapped pallets of vaccine.

The first shipment of the MenAfriVac vaccine arrives in Burkina Faso. Photo: WHO/Rodrigue Barry.

The World Health Organization (WHO) prequalified the vaccine on June 23, clearing the way for its introduction later this year. Once the vaccine passed that final regulatory hurdle, the vaccine’s manufacturer, Serum Institute of India Ltd. (www.seruminstitute.com), sprang into action to produce and send MenAfriVac a continent away. Shipments to Burkina Faso’s neighbors, Mali and Niger, took place later in August to prepare the countries for pilot campaigns—in advance of the official launch—this fall. Our WHO colleagues, who are PATH’s partners in the Meningitis Vaccine Project (MVP, www.meningvax.org), are busy working on the ground to get ready for the launch.

Health workers receiving the vaccine shipments are no doubt already feeling the buzz of excitement. Life in the “meningitis belt” changes drastically each winter when the dry and dusty Harmattan winds blow south from the Sahara, blanketing West Africa in a haze. With the winds come the spread of meningococcal meningitis, which is carried quickly via sneezing and coughing. The disease attacks the lining of the brain and spinal cord, causing hearing loss, mental retardation, epilepsy, and death. Africa’s worst epidemic, in 1996, killed 25,000 people.

Those vaccinated with MenAfriVac will have immunity for 10 to 15 years, says Dr. Marc LaForce, director of the MVP. With a goal of vaccinating 80 percent of the susceptible population in Burkina Faso—10 to 11 million people—in the upcoming mass campaign, LaForce anticipates the number of cases in the country will drop to zero in a couple of years, just around the time all newborns will begin receiving the vaccine. The whole dynamic of the country will change—from fear as the winds begin to blow, to calm knowing the disease is on its way out.

MenAfriVac is a registered trademark of Serum Institute of India Ltd.