November 9, 2015 | ,

PATH works to end the cycle of an insidious disease

We’ve nearly eliminated the cause of a deadly kind of meningitis in Africa. Two PATH leaders tell us why we can’t stop the fight.
Children standing in line to get vaccinated.
Our best solutions are often in response to answering a call for help. Following a devastating meningitis A epidemic that resulted in over 250,000 cases of meningitis and 25,000 deaths, we responded to African leaders who called for a vaccine that would eliminate these epidemics. Photo: PATH/Amy MacIver.

Five years ago, PATH and its partners introduced a new vaccine across a sub-Saharan region in Africa known as the “meningitis belt.” MenAfriVac® is the first vaccine developed specifically for Africa. It protects against meningitis epidemics of a particularly insidious kind (group A meningococcal meningitis), which can cause severe brain damage or long-term disabilities such as deafness. It is fatal in 10 percent of cases, most of which are children under five years old.

Mass immunization campaigns in 16 of the meningitis belt’s 26 countries have successfully vaccinated more than 220 million people—and counting. Where the vaccine has been introduced, group A meningitis outbreaks have disappeared. Its health impact, already dramatic, is expected to protect more than 400 million people by 2020.

Three health care workers sit behind a table and two boxes of vaccines.
There was a need to make a meningitis vaccine temperature stable to allow it to travel long distances outside the cold chain across sub-Saharan Africa. All these challenges were met in record time. Photo: PATH/Amy MacIver.

Innovation and success hinges on collaborative partnerships

This success would not have been possible without MenAfriVac®. But more importantly, MenAfriVac® would not have existed without the creation of a new model of vaccine development, one based on a collaborative process spanning multiple continents, partners, and sectors.

Through an innovative partnership between PATH and the World Health Organization (WHO), and funding from the Bill & Melinda Gates Foundation, we were able to launch the Meningitis Vaccine Project in 2001. We forged a unique partnership with the Serum Institute of India, Ltd., who was willing to create a quality, temperature-stable vaccine for less than US$0.50 per dose, a price that health ministers across the African meningitis belt said they could afford.

We’ve made great progress against the most widely feared form of meningitis in Africa by developing and licensing a new vaccine in record time and at one-tenth of the cost usually needed.

So why must more work be done?

Three people with lab coats and hair coverings standing at the open door of a vaccine cold room.
Our work at PATH typically requires working with a diverse set of partnerships and funders. Photo: PATH/Satvir Malhotra.

Sustaining success by expanding our impact

Now that we have an effective vaccine, we need to ensure sustainability, otherwise we risk a resurgence of devastating meningitis A epidemics. The approach is two-phased: complete the mass campaigns to ensure the meningitis belt is covered, and then include MenAfriVac® into the routine immunization schedules in these countries so the youngest and most vulnerable remain protected. As always, we must continue to monitor the effectiveness of the vaccine over time.

These Expanded Program on Immunization (EPI) programs are scheduled to begin with support from the WHO in 2016. The vaccine is competing with other health priorities across Africa, so maintaining momentum is incredibly important for fully breaking the epidemic cycle.

A baby is held in an adults arms.
We must ensure that MenAfriVac® is included in routine immunization schedules across the meningitis belt countries so that infants and young children are protected. Photo: PATH/Monique Berlier.

We’re not done until epidemic meningococcal meningitis, in all its forms, is gone

MenAfriVac® is making group A meningitis in Africa a thing of the past, but epidemic meningitis has other causes too (such as C, W, X, and Y) that require new vaccines. Meningococcal meningitis epidemics could be eliminated from Africa if a vaccine were developed to cover all its disease-causing varieties.

With this vision in mind, PATH is once again partnering with the Serum Institute (this time, through funding from the UK Department for International Development) to develop exactly such a meningococcal vaccine, one that has broader coverage. This candidate is expected to enter early-stage clinical evaluation in early 2016.

MenAfriVac® has demonstrated that eliminating epidemic meningitis in Africa is possible. We know how; we just need to stay on task. Our in-depth knowledge of MenAfriVac® makes PATH well-placed to study its long-term benefits so that it can achieve its full potential. We’re also uniquely suited to applying MenAfriVac®’s lessons to the next generation of meningitis vaccines in development.

By agreeing that any meningitis epidemic is unacceptable in Africa, PATH is committed to eliminating all such epidemics across the continent. Let’s get the job done.

Watch a short video on the history of making MenAfriVac®.

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  • Cheryl Keech is the director of clinical and regulatory affairs in the Vaccine Access and Delivery Program at PATH.
  • Mark Alderson is the director of the pneumococcal vaccine and the polyvalent meningococcal vaccine projects in the Center for Vaccine Innovation and Access at PATH.