GAVI partners mobilise to counter meningitis outbreaks

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GAVI commits US$ 55 million to fund vaccines and save lives

Geneva, 9 April 2009 - In an effort to save lives and contain the spread of meningitis, the GAVI Alliance has fast tracked a US$ 55 million contribution to establish a stockpile of meningococcal vaccines and pay for reactive campaigns in the highly endemic African "meningitis belt" countries.

400 million people live at risk of the deadly meningococcal disease and GAVI's contribution will fund 45 million doses of vaccines through 2013 to support emergency outbreak responses in the most vulnerable countries.

It is the responsibility of GAVI and its partners UNICEF and WHO, to ensure timely access to life-saving existing vaccines.

Nina Schwalbe, Director of Policy at the GAVI Alliance

Stockpile

The stockpile will be supplied with polysaccharide meningococcal vaccines, until a forthcoming conjugate vaccine becomes available. The funds are being channelled through UNICEF and the World Health Organization (WHO), two key members of the GAVI Alliance.

"Meningitis is a particularly dangerous threat in sub-Saharan Africa and the polysaccharide vaccine is our crucial weapon to prevent cases and epidemics," said Nina Schwalbe, Director of Policy at GAVI.

"It is the responsibility of GAVI and its partners UNICEF and WHO, to ensure timely access to life-saving existing vaccines. This contribution will also lay the groundwork for the introduction of an affordable new conjugate vaccine in the Expanded Programme of Immunization (EPI) schedule."

Meningitis belt

The highest burden of meningococcal disease occurs in a swathe of sub-Saharan Africa known as the "meningitis belt", which stretches from Senegal in the west to Ethiopia in the east and where epidemics occur every year.

During the dry season, between January and June, many factors, including social and climate habits, increase the risk of meningitis. Each year, the disease takes a heavy economic and human toll.

Attack rates

In major epidemics, attack rates range from 100 to 800 per 100,000 population, but individual communities have reported rates as high as 1000 per 100,000.

Between 1997 and 2007, 59,600 deaths due to meningitis were reported in the region.

Highly contagious

Meningococcal meningitis is a bacterial infection of the fluid surrounding the brain and spinal cord. The disease develops quickly, is highly contagious, and kills about one in 10 people who get it.

Between five and 10 percent of patients die within 24-48 hours after the first symptoms, even with quick diagnosis and therapy. Up to a quarter of survivors suffer permanent damage-most commonly hearing loss, mental retardation, or epilepsy.

Special mechanism

Because of a global shortage of meningococcal vaccine, a special mechanism was established in 1997 to ensure that the population most in need would receive the life-saving vaccine in a timely manner. This mechanism includes the careful review of country requests for vaccines for outbreak response by the International Coordination Group (ICG) for meningitis, members of which include the International Federation of Red Cross and Red Crescent Societies, Médecins Sans Frontières, UNICEF and WHO.

Now, with the US$ 55 million GAVI grant, the meningitis vaccine stockpile will provide a speedy response for epidemic control for the next five years. The GAVI grant will fund a stockpile of 45 million doses, which will be purchased and delivered according to countries' needs.

Mass campaigns

Mass vaccination campaigns are most effective when there is community awareness of the campaign and social mobilization is in place to ensure optimum coverage. The efforts of thousands of community-based volunteers, including those of the Red Cross and Red Crescent national societies and others in the meningitis belt countries, are critical to these efforts.

"The vaccine stockpile has been important in combating the current meningitis outbreaks in Niger and Nigeria. It is, however, important to ensure that there is rational, longer-term use of the available vaccines, taking into account the current production capacities, and that there is accessibility for areas with highest needs," said Dr William Perea, WHO coordinator for Epidemic Readiness and Interventions.

Polysaccharide

Polysaccharide vaccine: a vaccine made from polysaccharides or complex chains of simple sugar molecules that form the outer coat (capsule) of many bacteria. 

Conjugate vaccine: a vaccine formulated by chemically linking sugar chains derived from the pathogen to a protein backbone, created with improved ability to stimulate the immune system providing protection for a longer period of time and is aimed at giving better immune responses for those exposed to the bacteria or requires a repeat booster dose at a later stage. 

The polysaccharide vaccine is currently the only meningococcal vaccine available to combat the recurring epidemics in developing countries, 99 percent of which are caused by serotype A.

"Having funds available upfront to finance this vaccine is truly life-saving," said Shanelle Hall, Director of Supply at UNICEF. "This is a critical development because when a meningitis epidemic breaks out in the most vulnerable areas of the world, vaccines need to be deployed immediately to stop the spread and protect children and their families."

Routine immunisation is not possible with the currently available polysaccharide vaccine, as it provides protection for only two to three years and is not very effective in children under two years of age because they lack the ability to develop antibodies. A conjugate vaccine conferring long-term protection is expected to be available later this year in developing countries.

GAVI has already committed US$ 29.5 million to introduce this new conjugate vaccine as soon as it is available for preventive campaigns in the two years to come. In the interval before the conjugate vaccine is available, polysaccharide vaccines protect at-risk populations and ensure a speedy response to epidemics.

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