From road map to impact: Three ways to advance landmark meningitis plan

January 12, 2021 by Mark Alderson, PhD

The international community has committed to defeat meningitis by 2030. But how do we get there, and what will it take?

The 2010 MenAfriVac® introduction in Burkina Faso was the beginning of the end for meningitis A in Africa. Photo: PATH/Gabe Bienczycki.

The 2010 MenAfriVac® introduction in Burkina Faso was the beginning of the end for meningitis A in Africa. Photo: PATH/Gabe Bienczycki.

Meningitis sets in rapidly and can kill within hours. There are an estimated 5 million cases every year, with nearly 300,000 deaths—almost half of which are children under five years of age.

Meningitis is a serious infection of the thin lining surrounding the brain and spinal cord. It can be caused by a viral, bacterial, or fungal infection, but bacterial cases are the most dangerous. Survivors frequently suffer deafness, cognitive impairment, and limb amputation due to sepsis. The World Health Organization (WHO) estimates that in 2015, meningitis and associated neonatal sepsis killed more children than malaria, measles, and tuberculosis combined.

And yet, progress against meningitis lags behind that of other preventable diseases.

Global action for a global disease

The global public health community has yet to see big, international campaigns raise significant awareness, funds, and political interest in meningitis response. Because there are many different causes, we can’t eradicate meningitis in the same way we eradicated smallpox.

But despite the complexities, vaccines against meningitis are highly effective. In some instances, they have virtually eliminated disease caused by a specific pathogen. We must celebrate, and build upon, such successes. Meningitis is a global threat. It deserves a coordinated, global response. And now, for the first time, we have one.

In November 2020, the World Health Assembly endorsed the first-ever resolution on meningitis prevention and control and approved Defeating Meningitis by 2030: A Global Road Map. Led by WHO and developed with input from PATH and other global health leaders, the road map outlines goals and provides a strategic framework to achieve them. Major goals include eliminating bacterial meningitis epidemics and reducing cases and deaths from vaccine-preventable meningitis disease.

But endorsement of the road map is just the beginning of the journey. How do we translate the road map into action? If we want to achieve its ambitious goals, there are three things to remember:

1. Success will depend, first and foremost, on local leadership.

The road map was developed by a group of experts and it yielded a strong global framework, but it must be adapted to local contexts. Disease strain prevalence can differ depending on location, so a vaccine formulated for one market may not be fully protective in a different setting.

And this goes beyond vaccine formulation. Local context should inform everything from education and advocacy to health system support, including training for health care workers, determining the target population for vaccination, planning for vaccine distribution, and more.

Meningitis A, once the most prevalent form of the disease in Africa, has virtually disappeared.

The 2010 introduction of MenAfriVac®—an affordable conjugate vaccine against meningococcal serogroup A designed specifically for use in the African meningitis belt—has proven what is possible when solutions are tailored to meet specific needs. MenAfriVac® was a historic achievement that changed the face of meningitis epidemics in Africa. Now, more than 340 million people have been immunized across 24 countries, and meningitis A, once the most prevalent form of the disease in Africa, has virtually disappeared.

2. Success will require coordination and alignment across sectors.

The road map strategy spans five priority areas: prevention and epidemic control, diagnosis and treatment, disease surveillance, support and care for people affected by meningitis, and advocacy and engagement.

Few organizations have the expertise, or capacity, in all areas. We must work together to ensure we have the tools, resources, and systems to tackle meningitis from all angles. Critical to MenAfriVac’s success, for example, was the Meningitis Vaccine Project, a collaboration between PATH, WHO, and the Serum Institute of India that created a new model of vaccine development based on collaboration across continents and sectors.

3. Success demands that meningitis is high on the political agenda.

Meningitis has never before been elevated to such a level of global action. We must take advantage of this moment to advocate for the vision outlined in the road map, to raise awareness of meningitis as a public health threat, and to encourage partnership and action to prevent disease and save lives.

It won’t be easy. Existing meningitis treatment and prevention approaches were developed without a coordinated, global strategy. Even in countries where vaccines are accessible, there is no standard approach to meningitis prevention: some high-income countries routinely vaccinate children and adolescents against all meningococcal serogroups that cause disease; others recommend vaccinating only those at high risk of infection. Moreover, meningitis can be rare in many parts of the world, lessening the perception of threat. However, when it does occur, meningitis is often severe, with high mortality rates and long-term complications for survivors.

Harnessing momentum and advancing progress

There is a range of promising research already underway. PATH is currently advancing vaccines against three of the four major causes of bacterial meningitis, all of which are primarily designed for use in low- and middle-income countries.

This includes a multivalent meningococcal meningitis vaccine candidate in late-stage clinical development that has the potential to eliminate meningococcal epidemics from Africa; a more affordable pneumococcal vaccine that received WHO prequalification in 2019 and is poised for roll out in low- and middle-income markets this year; and a group B Streptococcus vaccine development project that could yield a novel vaccine that prevents infant meningitis and sepsis through maternal immunization. PATH’s diagnostics team is also supporting landscape and market analysis work for the development of meningitis diagnostic technologies that can detect and monitor bacterial, viral, fungal, and parasitic pathogens.

There has been great progress, but meningitis is a formidable foe. The international community can do better, and the global road map to defeat meningitis by 2030 provides a strong impetus to scale. Now is the time to make big advancements in meningitis detection, surveillance, prevention, and management—and to advance health equity so all people and communities can thrive.

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