When MenAfriVac® was introduced in Burkina Faso in 2010, we predicted the end of meningococcal meningitis wouldn’t be far behind. It was a bold assertion; for more than a century, the disease had reigned freely in the 26 countries that make up Africa’s meningitis belt, causing debilitating annual epidemics that, at their largest, would claim tens of thousands of lives in a single season. But just three years after introducing MenAfriVac®—which targeted serogroup A meningococcal meningitis, then the most prevalent serogroup (think, “strain”)—disease incidence had dropped by 94 percent in vaccinated areas and today, meningitis A has effectively been eliminated from the meningitis belt.
It was a landmark achievement that proved meningococcal meningitis control was possible—and it was only the beginning of the story. If we could defeat one serogroup, why not all epidemic-causing serogroups?
Today we’re on the precipice of seeing that original prediction come true; MenFive®, the first vaccine to protect against the five predominant causes of meningococcal meningitis in Africa, has been prequalified by the World Health Organization (WHO). MenFive® has the potential to stop meningococcal meningitis epidemics in Africa, once and for all.
Status quo means lives lost
Meningitis—a serious infection of the thin lining surrounding the brain and spinal cord—has many causes, usually viruses or bacteria. Viral cases typically resolve on their own without treatment; bacterial cases can be devastating.
Meningococcal meningitis is a bacterial form of meningitis that has the most potential to cause large epidemics. While it can occur anywhere in the world, it’s most prevalent in Africa’s meningitis belt, which stretches from The Gambia and Senegal in the west, to Ethiopia in the east and has an at-risk population of about 450 million.
Meningococcal meningitis sets in rapidly and can kill within hours. Even with timely antibiotics treatment, one in ten infected people die within two days of the onset of symptoms. Without antibiotics, 50 percent of those infected may die. Those who do survive the infection often suffer from brain damage, hearing loss, or limb amputation due to sepsis.
Historically, reactive, emergency mass vaccination campaigns using polysaccharide meningococcal vaccines have been the only recourse for African countries suffering meningococcal epidemics. But there are two major problems with this approach.
First, since these campaigns occur in response to epidemics, they’re often implemented after the epidemic has already progressed significantly—offering little to no health impact. Second, polysaccharide vaccines have substantial limitations. They only provide short-term protection, don’t promote herd immunity, are not effective in children under two years of age, and don’t protect against all meningococcal groups. This means communities need to be vaccinated each time an epidemic strikes—an expensive approach that puts a high burden on Africa’s already-stretched health system.
To truly address meningococcal meningitis, Africa needs better, more affordable vaccines that prevent epidemics before they can ever start.
A better vaccine
MenFive® is a multivalent meningococcal conjugate vaccine that protects against meningococcal serogroups A, C, W, Y, and X. It was developed through a 13-year partnership between Serum Institute of India Pvt. Ltd. (SIIPL) and PATH, with funding from the UK government’s Foreign, Commonwealth & Development Office.
Conjugate vaccines chemically link the polysaccharides in the older vaccines to a protein carrier, which activates a much broader part of the immune system to provide better, longer-lasting protection against disease. Multivalent vaccines target multiple strains. Importantly, they can be delivered to children younger than 2 years of age and they protect the unvaccinated via herd immunity.
Multivalent meningococcal vaccines have been available on the global market for decades, though. What makes MenFive® so special?
MenFive® builds on the legacy of MenAfriVac®—also developed by SIIPL, in collaboration with PATH and WHO—and was designed specifically to meet the needs of African meningitis belt countries. While other multivalent meningococcal vaccines are too expensive for meningitis belt countries to include in their prevention strategies, MenFive® will be much more affordable than the existing licensed meningococcal vaccines.
Like MenAfriVac®, MenFive® is also temperature stable. This means it can be delivered outside of the cold chain and can reach remote communities that would otherwise be left out of vaccination efforts. By increasing the number of people who are vaccinated against the disease, especially in areas that have limited access to health services, we can prevent meningococcal meningitis from finding any foothold that could lead to a future outbreak or epidemic.
Perhaps most notably, MenFive® is the only vaccine in the world that protects against serogroup X meningococcal meningitis, which is increasingly implicated in African meningitis outbreaks. If other currently licensed multivalent meningococcal vaccines were to be introduced in Africa, countries would still be vulnerable to serogroup X outbreaks and the epidemic cycle would simply continue. To truly eliminate African meningococcal epidemics, we must target all significant disease-causing serogroups in circulation.
“Meningococcal meningitis epidemic prevention is an urgent need,” says Dr. Ama Umesi, who served as a co-investigator for MRC Unit The Gambia’s Phase 3 study of MenFive® in Banjul, The Gambia.
“Licensure of MenFive® will provide an affordable and accessible vaccine that protects against the meningococcus strains prevalent in Africa. This vaccine promises to be a gamechanger in the fight against meningitis—one with the potential to break the barriers caused by lack of vaccine or vaccine shortages, and that can prevent morbidity and mortality from epidemic outbreaks.”
Dr. Samba Sow, director general and principal investigator for the Center for Vaccine Development in Mali’s Phase 3 study of MenFive® in Bamako, Mali, and former Ministries of Health and Hygiene in Mali, says meningitis is a devastating health problem for too many people in his home country of Mali.
“I have never met a family that hasn’t been touched personally either by the mortality or the severe morbidity that is directly associated with meningitis. This is all the more devastating given the disease itself is largely preventable through vaccination. MenFive® is a new and exciting vaccine that will provide more protection to vulnerable communities and really provides a huge opportunity to accelerate progress.”
“[MenFive] promises to be a gamechanger in the fight against meningitis.”— Dr. Ama Umesi, MRC Unit The Gambia
A world without meningococcal meningitis
MenFive® brings us one step closer to Defeating Meningitis by 2030.
Endorsed by the World Health Assembly and launched by WHO in September 2021, the global roadmap to defeat meningitis by 2030 cites a reduction in cases of vaccine-preventable bacterial meningitis as a visionary goal and development of new, affordable meningitis vaccines as a critical pillar in reaching that goal. The more than a decade-long investment in MenFive® demonstrates vision and alignment with global priorities and signals commitment to a healthier world with more equitable access to lifesaving tools.
MenFive® is approved by WHO for use in people between 1 and 85 years of age and will prevent not just death from meningitis, but disability in survivors who would otherwise suffer lifelong social and economic consequences. It will initially be available for use in reactive vaccine campaigns for outbreaks.
That’s a huge achievement but is only part of the solution; to fully realize MenFive’s® lifesaving potential, it needs to be provided in mass campaigns and/or introduced in routine immunization programs. Discussions are underway about the most effective ways to harness these strategies, but continued partnership, leadership, advocacy, and investment are crucial to finish the work we’ve begun.
We look forward to a future where the African meningitis belt is free from meningococcal meningitis and epidemics are a thing of the past—a future where even the term “meningitis belt” is no longer needed.
One thing is certain now, though: the meningitis landscape will never be the same.