COVID Threatens Meningitis Fight in Africa
Dr Matshidiso Moeti, director of WHO’s regional office for Africa

The COVID-19 pandemic delayed plans to vaccinate more than 50 million African children with doses of MenAfriVac, a vaccine designed for the African meningitis belt. That could undo the progress in controlling a lethal form of meningitis in Africa, the World Health Organization warns.

Until 12 years ago, meningitis type A made up 90% of the meningitis cases and deaths in Africa. One particularly deadly outbreak in 1996 infected a quarter million people, and killed 25,000.

After African health ministers pleaded for a solution, the MenAfriVac was developed through a partnership between WHO, the Bill and Melinda Gates Foundation and PATH. Starting in 2010, more than 350 million people in 24 high-risk nations received the single-dose vaccine.

The stunning result? Not a single new case of meningitis type A has been reported in Africa in the past five years, WHO reported on Thursday, and the chance of survival is now 95%, up from 50% less than a decade ago.

“The defeat of meningitis A is one of Africa’s biggest health success stories with not a single case being reported on the continent in the past five years,” says Dr Matshidiso Moeti, director of WHO’s regional office for Africa.

Now, that progress is in jeopardy because “the COVID-19 pandemic has delayed [MenAfriVac] vaccination campaigns targeting more than 50 million children” under 12 years of age in Benin, Guinea, Guinea Bissau, Nigeria and Togo, she told reporters in an online briefing.

Meningitis A vaccination in Chad

“I think most importantly what we are learning about vaccines repeatedly – the lessons learned for the MenAfriVac vaccine, the lessons we’re learning very much for the COVID-19 vaccinations – is that it’s very important to create the demand for vaccines in the population,” said Moeti. “It’s very important that people know the value of vaccines.”

WHO officials say the pandemic severely disrupted meningitis prevention and control services by as much as 50% in 2020 compared to 2019, with disease surveillance, laboratory confirmation of cases and outbreak investigations all steeply declining. There was a slight improvement in 2021 but not enough to make much of a difference, according to Moeti.

“Meningitis is taking an enormous toll on our countries with COVID-19 threatening some of the extensive gains that have been made in the past,” she said. “Major outbreaks caused by meningitis group C have been reported in seven of the African sub-Saharan meningitis belt countries in the past nine years.”

Importance of ‘community acceptance’ in meningitis efforts

Twenty-six countries in sub-Saharan Africa are known as the ‘meningitis belt’ because of the frequency of outbreaks. The latest major outbreak in the Democratic Republic of Congo killed more than 200 people last year.

As a result, WHO says it is in a race against time to fight the heightened risk of outbreaks of meningitis type A caused by inflammation of the membranes that surround the brain and spinal cord. It can lead to death within 24 hours; children under the age of five are particularly at risk.

Four organisms are responsible for 50% of deaths: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and group B streptococcus.

Ahead of the start of the next meningitis season in January 2023, WHO is launching a US$1.5 billion global strategy to defeat bacterial meningitis in Africa by 2030.

One of the priorities is to roll out a next-generation vaccine that has been shown in clinical trials to be safe and effective against multiple forms, Moeti told reporters on Thursday.

“Community acceptance, which resulted in 95% coverage in affected countries for the MenAfriVac vaccine, is proof of what can be achieved,” said Moeti.

“Following this example, the new framework aims to roll out the new vaccine to all 26 meningitis belt countries between 2023 and 2030 – aiming to achieve 90% coverage,” she said. “WHO is expected to prequalify the vaccine by the first quarter of next year.”

The UN health agency wants to help countries shore up diagnosis, surveillance, care, advocacy and vaccination to eliminate outbreaks, curb deaths by 70% and halve infections, which it estimates would save more than 140,000 lives a year and significantly reduce disability.

Dr. F. Marc LaForce, the Serum Institute of India’s technical services director

Dr. F. Marc LaForce, the Serum Institute of India’s technical services director, emphasized the importance of the MenAfriVac vaccine in the fight against meningitis type A.

“The disease has disappeared in every country where campaigns have been done,” said LaForce, a former director of the Meningitis Vaccine Project, a PATH/WHO/Serum Institute of India partnership funded by the Gates Foundation.

“It is worth remembering that to this date, between 600,000 to a million cases of bacterial meningitis due to group A have been prevented. This is an enormous success and one I think we should all take great pride in,” he told the press briefing from his home in the United States.

“A new vaccine again specifically designed for the African meningitis belt will hopefully be prequalified [by WHO] later this year or early next year,” said LaForce. “But this vaccines holds the promise of finishing what MenAfriVac began, such that Africa may be the first continent to be free of meningitis epidemics.”

Image Credits: Gavi.

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