A vaccine program started after an epidemic in the 1990s is on the verge of wiping out a deadly strain of bacterial meningitis.
Perhaps the greatest success of Western medicine comes in those rare announcements that a disease can be eradicated through vaccination.
And according to an international collaboration, we’re getting close to being able to make an announcement about a type of bacterial meningitis, meningitis group A.
Bacterial meningitis, an infection of the lining of the brain, is deadlier than the viral form. Even with proper treatment, 1 in 10 patients dies, and a fifth of all survivors are left with some form of brain damage.
In sub-Saharan Africa, bacterial meningitis regularly occurs in epidemic waves during the winter dry season, with meningitis A as the dominant strain. In 1996-97, the largest wave ever recorded swept across Africa, leading to more than 25,000 deaths.
That tragedy gave birth to an unusual partnership that has developed a vaccine that appears to be effective, inexpensive, and rugged enough to survive conditions on the ground in rural areas.
The unique vaccine, dubbed MenAfriVac, is working so well that the global health community may soon be able to announce the end of meningitis A in Africa.
According to the most recent numbers from the World Health Organization (WHO), a total of 8,184 diagnosed cases and 690 deaths have been reported in historically at-risk countries this year.
The new vaccine was developed through a product development partnership between the WHO and PATH, a Seattle-based nonprofit. The work was funded by another major player in global health based in Seattle: the Bill & Melinda Gates Foundation.
Together, the players call themselves the Meningitis Vaccination Project, or MVP.
Clinical trials of the vaccine began in 2005 in a handful of African countries and in India. Public health use began in 2010. By 2014, roughly 220 million people had received the vaccine.
“As the vaccine moved through clinical trials, more and more data became available about the vaccine’s positive performance that gave reason for optimism about the vaccine’s potential impact,” Mark Alderson, Ph.D., director of the pneumococcal and polyvalent meningococcal vaccine projects at PATH, told Healthline.
The vaccine will keep for as long as four days without being refrigerated. And it will cost just 50 cents per dose, a price low enough to promote widespread use throughout the affected region.
When MVP first began talking to African leaders in 2001, a Nigerian official said, “Please don’t give us a vaccine that we can’t afford. That’s worse than no vaccine.”
Cost and refrigeration have historically left Africa without enough vaccines to block the diseases that are endemic there. MenAfriVac is actually the first vaccine ever developed for Africa and launched there first.
It took unlikely teamwork, perseverance, and luck to make it happen.
PATH was able to keep the price low partly because the Food and Drug Administration (FDA) supplied a key part of the manufacturing technology. (The vaccine is a conjugate vaccine, with an antigen attached to a carrier protein.) Publically developed technology isn’t locked behind patents that protect pharmaceutical profits.
Once the raw materials suppliers were in place, the team needed access to the conjugation technology — intellectual property that is valuable and highly protected.
“This was not easy to resolve early on,” said MVP director, Dr. Marc LaForce.
But MVP acquired the FDA technology and with help from the National Institutes of Health (NIH) quickly got it to the Indian manufacturer that would make MenAfriVac.
No U.S. or European pharmaceutical laboratory could produce the vaccine at a price low enough for use in African public health efforts.
The manufacturer in India also devised a way to create a vaccine that wouldn’t have to be refrigerated. The biologic material is freeze-dried and reconstituted with liquid just before use.
“MenAfriVac was designed specifically for use in countries in Africa where the cold chain is a constraining factor for many immunization campaigns due to limited storage capacity and/or limited ice pack freezing capacity,” Alderson said.
Could such a process work for other outbreaks, like Ebola, that continue to plague African countries?
PATH is first eyeing other types of meningitis, which are better-understood pathogens than the Ebola virus.
“Epidemics caused by nongroup A meningitis are a sobering reminder that the toolkit for preventing meningitis in Africa is not yet complete,” Alderson said.
A vaccine that would target not just group A meningitis, which causes five out of six infections in Africa, but also groups C, W, X, and Y, will begin clinical trials later this year.