Friday, March 16, 2007


Meningitis has infected nearly 16,000 people and killed 1,670 in sub-Saharan Africa in the last two months, the World Health Organization (WHO) said on Friday.

The United Nations agency said it was working with Medicins Sans Frontieres (Doctors Without Borders) to contain the outbreak with vaccinations in Burkina Faso, the Democratic Republic of Congo, Sudan and Uganda.

Doctors Without Borders reports there are just 25 million doses of A/C vaccine–the A strain being the most common cause of epidemics–available worldwide. Only 7 million doses have been reserved for epidemic responses. And the future prospects for replenishing the supply are bleak. In May, Sanofi-Pasteur, the sole provider of the A/C vaccine, announced that it was stopping production altogether while it transfers its production to another site.

One major reason for the shortage of vaccine production is that companies have become more interested in producing an expensive type of the vaccine which is used in developed countries than the less expansive one for use in underdeveloped countries.

Doctors Without Borders says it: working with the World Health Organization to find alternative sources of the current vaccine with companies in Brazil and Cuba. There are manufacturers in these countries that are WHO pre-qualified for vaccine production for yellow fever, for instance, but not meningitis. The earliest we can expect any dividends from this effort is for next season. We really need these short-term alternatives until the conjugate vaccine becomes available. Now you can see why no one is interested because there is a solution in five years time. So no one really wants to invest a lot of money in the immediate needs.

One manufacturer, Bio-Manguinhos in Brazil, was identified as the strongest and quickest alternative for scaling-up vaccine supply in the short and medium term. In partnership with the Finlay Institute in Cuba, Bio-Manguinos is working with WHO to ensure a supply of up to 10 million doses of bivalent AC meningitis vaccine by the next epidemic season.

Timely mass vaccinations are the most effective means of limiting the spread of epidemics. However, not surprisingly because of cost the threshold to begin mass vaccination programs is considerably lower in the developed countries than in Africa.

Meanwhile the poor just die!

The following news comes from IRIN.

AFRICA: Fighting meningitis a race against time

OUAGADOUGOU, 16 March (IRIN) - International health specialists worry that a major meningitis epidemic could hit Africa within the next three years, claiming tens of thousands of lives, just as supplies of vaccines for the illness are at an all-time low.

Health officials say the rising number of cases this year is a worrying sign. In Burkina Faso and Sudan alone 1,013 people have died among 14,279 who have been infected, according to the World Health Organisation (WHO) and Burkinabe officials.

Uganda and the Democratic Republic of Congo have also experienced meningitis epidemics this year. Other countries with outbreaks include Côte d'Ivoire, Niger, Mali, Benin, Ghana, Togo and Guinea.

"All the signs are pointing toward something stronger happening," William Perea, head of the meningitis programme for WHO in Geneva, told IRIN. "Whether this could be a major epidemic like the one we saw in 1997 we don't know. We are doing all that we can to face a crisis should a crisis arrive."

Epidemics across Africa's 'meningitis belt', which stretches from Senegal in the west to Ethiopia in the east, claimed 25,000 lives among at least 250,000 people who were infected between 1995 and 1997. Semi-arid Sahelian countries are hit each year by outbreaks of meningitis during the dry seasons between December and June when strong, dust-laden winds and cold nights make people more prone to respiratory infections. The meningitis bacteria is transmitted by sneezing or coughing.

Meningitis is an infection of the thin lining around the brain and spinal cord. Typically, five to 10 percent of meningitis patients die within 24 to 48 hours of the first symptoms, while 10 to 20 percent of survivors suffer brain damage, hearing loss, and learning disabilities.

Tipping point

As a result of the 1995-1997 wave of epidemics, WHO helped establish the International Coordination Group on Vaccine Provision for Epidemic Meningitis Control (ICG) to ensure rapid and equal access to low-cost meningitis vaccines and medicine.

The ICG has had a stockpile of about seven million vaccines to respond to meningitis epidemics in Africa this year. An additional four million vaccines are forthcoming. All of the vaccines are produced by Sanofi Pasteur in France, the only pharmaceutical company that continues to produce the bivalent polysaccharide AC vaccine, which is the one most widely used in Africa.

So far the current supply has been sufficient to battle this year's epidemic, but that could change if individual African countries decide to stockpile.

"There won't be any vaccine to respond to an emergency like the one that Burkina Faso and Sudan are facing now," Perea said.

Should a major epidemic occur in the next few years, the estimated vaccine gap could be as much as 52 million doses in a worst-case scenario, according to WHO's weekly epidemiological record released on 9 March.

"An epidemic wave will have an enormous impact on the countries' morbidity and mortality and will add to the already heavy burden placed on their health services," the report said.

Lower production

Sanofi Pasteur usually produces about 20-25 million polysaccharide AC vaccines. A portion is set aside for the ICG following consultations while the remainder is sold at the regular price. But the company's stockpile was depleted in 2006 and 2007 because of a temporary interruption in production.

Other pharmaceutical companies that used to produce the polysaccharide vaccine are instead producing the newer, longer-lasting but more expensive conjugate vaccines.

"Companies are more interested in conjugate vaccines for the developed world rather than polysaccharides for the developing world and that is why today we only have one company working on the polysaccharides," Perea said.

Currently, in Burkina Faso's capital, Ouagadougou, a dose of the conjugate vaccine sells for the equivalent of US$40, which is more than the monthly earnings of many people. By contrast, the polysaccharides can sell for $14 in the open market while governments get to purchase them at the equivalent of about 50 cents a dose and administer them for free during epidemics.

Although Sanofi Pasteur is currently producing less polysaccharide vaccines than it once did, the company's director general, Jacques Berger, says the company remains committed to Africa.

"We have been present in Africa since 1974. I can assure you that we are planning on staying in Africa with our vaccine as long as may be necessary," he said. "We have no plan to reduce our quantity. We have no plans to stop this vaccine."

Other alternatives

To help shore up meningitis vaccines for the coming years, ICG has been seeking potential new vaccine producers. It has spoken with health authorities in China, Cuba and Brazil where there are pharmaceutical companies that already produce the polysaccharide AC vaccines but not for export.

Perea said ICG is hoping to be able to get these companies to manufacture a vaccine that might be available on the international market by the end of this year.

In addition, development of a new vaccine is underway.

"So far it is showing good results and if things keep going like that by 2009 or 2010 we will have a vaccine on the market and this will be 40 cents a dose," Perea said.

Scientists say the new vaccine would be used preventatively instead of in emergency situations to halt epidemics, which is the current practice. It would also be able to cover more of the population for a longer period of time. The polysaccharide AC vaccine is administered to people over the age of two and only lasts for about three years.

Barring all else, if there are insufficient vaccines, health authorities are exploring the possibility of giving smaller doses to more people by dividing the current tetravalent polysaccharide A,C,Y and W135 doses into fifths.

"We looked into this to see if, in case of a crisis, we could use this [option] as a last resort in case everything goes wrong and we don't have enough vaccine," Perea said. "It is a very last resort."

In the meantime, WHO has called on the ministries of health in the countries that are at risk, their technical and operational partners, vaccine and drug producers and the donor community to take action in order to implement effective and timely interventions to help avert a wave of epidemics that could last for years.

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