New vaccine for meningitis promises health and economic benefits

During the annual dry season in sub-Saharan Africa, between December and June, meningococcal meningitis rates skyrocket. People cough and sneeze—dry air and dusty winds damage their mucous membranes, allowing bacteria to invade—and the deadly infection travels rapidly from one person to the next. About 450 million people in 21 countries live at risk. Children, adolescents, and young adults are especially threatened.

PATH and the World Health Organization are out to eliminate the threat of meningitis epidemics through a partnership called the Meningitis Vaccine Project (MVP). The partnership is supporting the development, testing, licensure, and widespread introduction of a vaccine that will not just halt outbreaks, but prevent them.

About meningitis

Meningococcal meningitis is a bacterial infection of the fluid surrounding the brain and spinal cord. The disease develops quickly, is highly contagious, and kills about one in ten people who get it. Even with the right treatment, up to a quarter of survivors suffer permanent damage—most commonly hearing loss, mental retardation, or epilepsy.

Antibiotics that can cure meningococcal meningitis are often unavailable in the poor countries that are most affected by the disease. Vaccines against the disease exist—they are “polysaccharide” vaccines—but they have limitations. They don’t work in children under two and thus leave the most vulnerable unprotected. And even for older children and adults, immunity lasts only two or three years. For these reasons, countries in sub-Saharan Africa only administer meningitis vaccine reactively, after an outbreak is underway.

That is too late for so many. Between 1995 and 2004, outbreaks resulted in 700,000 cases of illness and 60,000 deaths.

The disease impacts many more by wreaking havoc with health systems. Because polysaccharide vaccines do not provide long-lasting immunity, the reactive mass vaccination campaigns must be repeated outbreak by outbreak, interrupting routine health services and consuming scarce public health resources year after year.

A new vaccine

The vicious cycle of meningitis outbreaks and reactive vaccination is about to be broken. Next year, MVP will launch a new meningitis vaccine to eliminate epidemic meningitis in Burkina Faso, one of the hardest-hit countries in Africa. Introduction of this groundbreaking vaccine will set the stage for the ultimate elimination of meningococcal meningitis in sub-Saharan Africa.

The new vaccine is a “conjugate” vaccine and targets group A meningococcal meningitis, which causes most epidemics in Africa. Conjugate vaccines have been shown to be much more immunogenic than polysaccharide vaccines, and they can be given to infants. In addition, they have been shown to induce herd immunity, which means that, once a critical percentage of the population has been vaccinated, the entire population is protected. The new meningitis vaccine will be given preventively to 1- to 29-year-olds and should provide protection for at least ten years.

MVP’s unique partnership model has made it possible. To develop the vaccine, several players have come together from three corners of the world. The technology comes from the US Food and Drug Administration’s Center for Biologics Evaluation and Research, one of the main vaccine components comes from SynCo BioPartners BV in the Netherlands, and another main vaccine component plus manufacturing comes from the Serum Institute of India Limited. MVP is the linchpin, coordinating the efforts of the rest of the partners and working with governments to prepare for introduction of the new vaccine.

Available and affordable

Making a successful vaccine available is a huge accomplishment, but it is just as important that a vaccine meant for countries with few resources be affordable. To ensure that the new meningitis vaccine would have positive public health impact, MVP sought advice from African public health leaders early on, and they emphasized the need for a low-cost vaccine—less than 50 cents per dose—for use in mass vaccination campaigns. Through collaboration with Serum Institute of India Limited, MVP has helped limit the initial price of the vaccine to just 40 cents per dose.

MVP is creating a model for international partnerships that succeed in meeting public health goals—finding innovative solutions that are as affordable as they are effective. The partnership has advanced low-cost vaccine that will address a specific health need in Africa: protection against meningitis epidemics and against the fear that comes every year to those who live in the meningitis belt.