January 8, 2015 |

Breaking the paradigm: how an essential vaccine was fast-tracked

What's it take to get a vaccine approved for infants in Africa?
Group of people standing in line. Launch of MenAfriVac.
The World Health Organization (WHO) has approved an innovative and affordable vaccine to protect infants from a major cause of deadly meningitis A. Photo: PATH/Gabe Bienczycki.

Editor’s note: Recently, the World Health Organization (WHO) opened the door to include the meningitis A vaccine MenAfriVac® in routine childhood immunization programs. MenAfriVac is the product of a new development model that put country needs first and accelerated delivery of a new vaccine to those who needed it most.

It’s an exciting day at PATH. We’re celebrating the World Health Organization’s (WHO) prequalification of an infant version of MenAfriVac®, a meningitis A vaccine that’s protected millions of children and adults from a devastating disease.

The prequalification serves as both a landmark achievement and an opportunity to reflect on our pioneering Meningitis Vaccine Project (MVP), made possible with funding from the Bill & Melinda Gates Foundation.

MVP was established 14 years ago, as a collaboration between WHO and PATH, in partnership with the Serum Institute of India Ltd. (SIIL) and public health officials across African countries.

Infant sleeping in a carrier on a woman's back.
Making an immunization essential for infants is the best option for long-term control, especially after it becomes part of a country’s routine health care. Photo: PATH/Gabe Bienczycki.

In 2001, MVP had one goal in mind: to eliminate epidemic meningitis in sub-Saharan Africa

For years, people living in the meningitis belt, a region that stretches from Senegal in the west to Ethiopia in the east, were regularly struck by meningitis A epidemics in which a sudden onset of disease could rapidly lead to death or permanent disability.

The epidemics would come in waves, affecting up to hundreds of thousands of people, with high mortality rates. The only existing meningitis A vaccine before MenAfriVac was ineffective in breaking these cycles, and expensive and difficult to deliver in hard-to-reach areas of sub-Saharan Africa.

Motorcycle with a box labeled BD
The MenAfriVac vaccine can survive hot, long-distance travel to remote towns and villages. Photo: PATH/Gabe Bienczycki.

MVP was unique and pioneering from the onset

Step one involved listening to the affected countries. Health ministers wanted a practical, affordable vaccine to alleviate the suffering of their people.

Step two focused on developing the tactics and strategy to achieve the goal. The latter wasn’t easy, and as one door closed, the MVP team made sure to open others, even when they were stuck, barred shut, or seemingly too small. If there was no door, then the team looked for a window.

The keys to success

It can take years, and often decades, for a vaccine to reach the public. This timeline is even longer in low-resource countries. Teamwork was critical to success.

MVP worked with an unprecedented number of global partners, including SIIL, the vaccine manufacturer, and Gavi, the Vaccine Alliance. Our partners were visionary and had the end in mind at the beginning. Despite political instability and outbreaks of other diseases in the region, the team forged ahead.

Close up of a child looking over a woman's shoulder as he is carried at the MenAfriVac launch.
Close up of a child at the MenAfriVac vaccination launch in Burkina Faso. Photo: PATH/Gabe Bienczycki.

Remarkably, the first large-scale vaccination campaigns began in 2010, the same year that MenAfriVac was licensed and WHO prequalified for people aged 1–29 years. To date, not a single case of meningitis A has been reported among the more than 215 million people who have been vaccinated.

With the wonderful news of the infant vaccine approval and availability, this protection can now be extended to all babies in the region with the other essential vaccines that are routinely delivered to keep them healthy.

Why this was all possible

Another key reason for our success is that our country partners were involved from the start. We worked directly with countries to focus on the end goal; ensuring a vaccine price, supply, and implementation plan that focused on sustainability.

This sets us up for the next challenge. MVP didn’t stop problem solving when outbreaks were over. They knew meningitis was still out there. Yet to succeed, the team kept moving ahead and working hard even when a meningitis outbreak wasn’t in the news.

Table with MenAfriVac vaccine in an insulated box and a disposal box for syringes.
A health worker prepares her table during the launch of MenAfriVac in Burkina Faso. Photo: PATH/Gabe Bienczycki.

I’m entirely confident that, although MVP is coming to a close, the success of this program will continue because of our emphasis to put country involvement and country ownership front and center from the very beginning.

PATH’s role in the future

The greatest sign of success for us is to have programs at PATH wrap up, and then watch them continue on after empowering countries and partners to own them.

While MVP has achieved its last milestone—prequalification of the infant MenAfriVac—PATH, WHO, Gavi, SIIL, and other partners will continue to work diligently to assist countries in ensuring that our successes live on.

While we wish that MVP didn’t have to close, it is in fact this ending that will seal its place in history. MVP’s legacy will be measured in lives saved and disability prevented.

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  • Portrait of Kathy Neuzil.
    Kathy Neuzil was formerly the Vaccine Access and Delivery Program leader at PATH.