Success and Setback: Vaccination Campaigns in Africa

Francesca Tomasi received her B.A. from the University of Chicago and is now a microbiologist.

The term "meningitis belt" refers to 26 countries in sub-Saharan Africa that together have the highest global incidence of meningococcal disease, or meningitis. The causative bacterium of this life-threatening disease is Neisseria meningitidis, a gram-negative diplococcus (two conjoined spherical microbes). Meningococcal meningitis is characterized by sudden headache, fever, and neck stiffness that is often accompanied by nausea, vomiting, decreased tolerance to light, or altered mental status. Early diagnosis of the disease is critical for improved treatment outcomes; the infection is potentially fatal and, if suspected in an individual, is always treated as a medical emergency.
 
In 2010, a new meningococcal vaccine called MenAfriVac was developed in India for use in Africa’s meningitis belt. It protects infants under one year old to people up to 29 years old against Group A Neisseria meningitidis and costs under 50 cents per dose. The Meningitis Vaccine Project, a partnership between PATH (the Program for Appropriate Technology in Health) and the World Health Organization, worked with many international partners starting in 2010 to develop and administer the vaccine in all 26 “meningitis belt” nations. MenAfriVac is a freeze-dried vaccine and therefore does not need to be refrigerated, making it an easy vaccine to distribute in resource-poor settings.
 
Earlier this week, the World Health Organization published a press release outlining a colossal public health achievement: meningitis A has been nearly eliminated in Africa through vaccination, which has managed to reach over 235 million people. Five years after it was first used in the "meningitis belt," cases of the deadly infectious disease have gone from over 250,000 in 1996 to a mere 80 cases in 2015. These 80 cases occurred in countries that have not yet performed mass immunization campaigns among unvaccinated populations. MenAfriVac is now being integrated into routine national immunization programs.
 
In order to sustain the success of the Meningitis Vaccine Project, all at-risk countries need to ensure that the vaccine remains an integrated part of each nation's health programs, and many organizations are stepping up to help fund these essential efforts. Since the introduction of MenAfriVac in Burkina Faso in 2010, sixteen out of the 26 "mengitis belt" countries have conducted mass vaccination campaigns. The other 10 countries have yet to conduct full campaigns, though the vaccine has been administered in some places. Five out of these ten countries are set to begin their campaigns in 2016 either nation-wide or in high-risk areas. Burundi, Eritrea, Kenya, Rwanda, and Tanzania are expected to begin by 2017.
 
“Meningitis A was a scourge across Africa’s meningitis belt for generations but today we can be proud that a safe, effective meningitis vaccine is protecting hundreds of millions of people from death and disability,” said Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance. “But we must not be complacent. It is critical that at-risk countries begin introducing this vaccine into their routine schedules and ensuring every child is reached and protected.” (Source: WHO)
 
On the same day that MenAfriVac’s success story was published, a more somber article also appeared in the WHO’s press releases: "Despite gains in access, 1 in 5 African children go without lifesaving vaccines." Africa's routine immunization coverage of 80% is the lowest in the world. The good news is that routine immunization coverage, though still low, is on an upward trajectory: in 2000 the average coverage was 57% for the DTP3 vaccine compared to 80% today. DTP3 protects against diphtheria, tetanus, and pertussis. This vaccine is recommended for all infants worldwide and is therefore a standard metric for evaluating overall immunization coverage in different countries.
 
Measles deaths in Africa have declined by 86% between 2000 and 2014. However, incidence is still high. Measles is a highly contagious virus, so adequtae control requires 95% or more coverage using the two-dose vaccine. In 2014, the coverage of the first dose in Africa was 74%, and the coverage of both doses was only 19%. In fact, on February 22, Lagos, Nigeria, confirmed the death of 20 children from measles in the Otodo-Gbame community in Ikate. A mass emigration to Lagos from neighboring states is likely what sparked the measles outbreak, which began in January 2016, and poor sanitation contributed heavily to the spread of the disease.
 
In 2013, Africa housed almost half of global deaths due to measles, despite the illness being nearly eliminated in most regions of the world. Furthermore, 25% of African nations still have incidences of neonatal tetanus; only 23 countries worldwide have not eliminated tetanus. Finally, countries that already had fragile health infrastructures were obliterated with the sudden Ebola crisis. An increased resilience against major epidemics and local conflict is pivotal to withstanding future infectious disease-related shocks. The current ease with which massive vaccination efforts are reversed due to a delicate tipping point in many parts of Africa is hindering vital progress.