What triggered these outbreaks of meningitis C and measles?

This year, Niger has once again battled several epidemics of measles and meningitis C—two highly transmissible and potentially fatal diseases. While effective immunization should theoretically prevent these crises, the challenges surrounding each disease are distinct.

Regarding meningitis, there is a lack of affordable and comprehensive vaccines covering all serogroups. Furthermore, global production remains low because pharmaceutical companies often view these markets as unprofitable. This forces healthcare providers into a reactive stance, only administering vaccines after an epidemic is officially confirmed. These operational delays significantly hinder the success of immunization drives.

On the other hand, the measles vaccine has been part of standard health programs since 1974. However, the actual percentage of the population reached remains too low to effectively halt the spread of the virus.

In recent years, the region has seen major meningitis C outbreaks. Has there been progress this year?

The situation has been relatively stable across Africa’s “meningitis belt” this year. Nevertheless, a severe shortage in vaccine manufacturing persists. The International Coordinating Group on Vaccine Provision, which manages limited supplies for equitable distribution based on epidemiological data, aimed for a minimum reserve of five million meningitis C doses. Unfortunately, this target was not met. Consequently, we are still restricted to vaccinating only when epidemic thresholds are crossed, rather than acting preventively when initial alerts are triggered.

What is causing the meningitis vaccine deficit?

Meningitis is classified into several serogroups, including A, B, C, W135, and X, and no single vaccine protects against all of them. Currently, the most effective option is the quadrivalent conjugate vaccine, which covers the four most prevalent strains, but it is extremely expensive. While the Serum Institute of India is developing a more affordable and safe pentavalent conjugate vaccine (A, C, Y, W-135, X), it won’t be ready until 2020. Because a comprehensive vaccine is on the horizon, other laboratories are reluctant to invest in existing versions for fear of financial loss.

How did you respond to the meningitis C outbreak in Niger?

Working alongside the Ministry of Health, we immunized over 30,000 individuals in the Tahoua region and provided medical care for those infected. A worrying discovery was the high prevalence of serogroup X cases, for which no vaccine currently exists. This remains a significant concern for future public health efforts.

Are there alternative ways to prevent meningitis C?

Innovative prevention methods are being explored, such as using a single dose of the antibiotic ciprofloxacin. Research conducted in Niger in 2017 and published in the journal “PLOS Medicine” in June 2018 demonstrated that administering this antibiotic to all residents in rural areas significantly lowers disease transmission. Further trials are planned for urban settings. This could become a crucial tool in managing future outbreaks, particularly smaller ones.

Why hasn’t the routine measles vaccination schedule been enough to stop epidemics?

The current schedule is very restrictive regarding age. In Niger, national guidelines suggest vaccinating children up to 23 months, yet vaccines provided by GAVI (the Vaccine Alliance) often only cover those under 12 months. This means the 15-month booster dose is frequently omitted, and children over one year old who visit health centers are not being immunized.

Furthermore, many people in Niger are nomadic or live in regions plagued by conflict, making it hard for them to access stationary health centers. Achieving the 95% immunity threshold required to stop measles is incredibly challenging under these conditions.

What can be done to improve these coverage rates?

The childhood immunization timeline needs to be more adaptable, extending up to age five. Every interaction between a child and the healthcare system should be viewed as a chance to update their vaccinations.

Multi-antigen campaigns should also be prioritized to defend against multiple diseases simultaneously. For instance, while responding to a measles outbreak in Arlit (Agadez), we are also providing pentavalent and pneumococcal vaccines to maximize the impact of the campaign.

Whenever possible, we also provide tetanus shots for pregnant women or those of child-bearing age. This requires five doses, which many women in Niger do not complete. Using these opportunities to protect mothers and their infants is vital. Every chance to immunize against life-threatening diseases must be taken.

Since the start of 2018, MSF has collaborated with the Ministry of Health to vaccinate over 179,460 people in Niger. This includes 145,843 children aged 6 months to 15 years against measles in the Tahoua and Agadez regions, and 33,620 people aged 2 to 29 against meningitis C in Tahoua. Currently, a new initiative in Arlit, Agadez, aims to immunize 50,000 more children under five against measles, with younger infants also receiving pentavalent and pneumococcal protection.