Pioneering meningitis vaccine faces funding threat

[LONDON] A meningitis vaccine that costs just US50 cents a dose, and which advocates believe could eliminate epidemics of the disease in Africa, will be launched in Burkina Faso next week (6 December).

But hopes for the vaccine, which targets meningitis A, have been dampened by the lack of funding available to extend vaccination beyond Burkina Faso, Mali and Niger.

Meningitis A sweeps across Africa from west to east each year, afflicting mainly children and young adults, and killed more than 4,000 people last year. The current polysaccharide vaccines are ineffective in children under two years old, and only protect for 2–3 years.

The cheap alternative, MenAfriVac, was produced by the Meningitis Vaccine Project (MVP), which began in 2001, using a pioneering route to production that bypassed the usual drug company route.

But the project’s ultimate aim of eliminating meningitis on the continent may be jeopardised by lack of funds, a pre-launch press conference in the United Kingdom heard last month (22 November).

Jean-Marie Okwo-Bele, director of the Department of Immunization, Vaccines and Biologicals at the WHO, and Marc LaForce, director of the MVP, said that reaching 25 countries by 2015 would require up to US$550 million — US$370 million of which they hope will come from the Global Alliance for Vaccines and Immunisation (GAVI).

GAVI directs donor funding towards vaccination. So far it has committed US$30 million to introduce the vaccine into the three initial countries and a further US$55 million to support response to outbreaks in other countries by immunisation with the older polysaccharide vaccine.

"We’re not sure if GAVI will give [us] all that money — but they know that it’s wanted and needed," Okwo-Bele told the conference. "The know-how is there. [For example] many vaccine campaigns have taken place in West Africa. People are ready and waiting for it."

GAVI told SciDev.Net it was committed to providing the full US$370.4 million before the end of 2015.

But a spokesperson added that GAVI needs US$6.8 billion to meet its entire 2010−2015 programme, of which only US$3.1 billion has been assured.
Even if GAVI had the money, he said, it had decided not to spend the meningitis vaccine allocation all at once.

"The timings of the vaccine’s readiness were unclear at the time [the decisions were made]. The world was in the middle of a financial crisis, and with uncertainty around finance, GAVI also had several other important priorities. So the board approved a smaller tranche of money, together with US$55.2 million for a stockpile of medicines in case of epidemic outbreak.

Production constraints mean that production cannot be ramped up quickly, he said.

"Second, introducing a new vaccine in a sustainable way — so that it is used in routine immunisation — is quite complicated from both a practical and financial point of view. Countries have to have a system in place to deliver the vaccinations."

GAVI has also spent a substantial amount on strengthening immunisation systems in the meningitis belt so they can dispense the vaccine efficiently, he said.

MenAfriVac is the fruit of a partnership, funded by the Bill & Melinda Gates Foundation, between the WHO and PATH, a non-profit organisation that finds ways of adapting existing technologies for poor countries. The Serum Institute, in India, manufactured the vaccine. The process has been cited as a model for production of cheap drugs for developing countries and is already being pursued in the quest for a new polio vaccine.