Posted on: Thu 18-04-2024

In a historic move, Nigeria has become the first country in the world to roll out a new vaccine called Men5CV, recommended by the World Health Organisation (WHO), which protects people against strains of the meningococcus bacteria.

The revolutionary new vaccine offers a shield against the five major strains of the meningococcal bacteria (A, C, W, Y and X) in a single shot. All five strains cause meningitis and blood poisoning. This provides broader protection than the current vaccine used in Africa, which is only effective against the A strain.

The vaccine and emergency vaccination activities are funded by Gavi, the Vaccine Alliance, which funds the global meningitis vaccine stockpile and supports lower-income countries with routine vaccination against meningitis.

Meningitis is a serious infection that leads to the inflammation of the membranes (meninges) that surround and protect the brain and spinal cord. There are multiple causes of meningitis, including viral, bacterial, fungal and parasitic pathogens. Symptoms often include headache, fever and stiff neck. Bacterial meningitis is the most serious, can also result in septicaemia (blood poisoning), and can disable or kill within 24 hours of contacting it.

For several decades, epidemic meningitis has been a major public health problem in Africa’s meningitis belt, especially Sub-Saharan Africa, where 26 states in Nigeria account for over 50 per cent of the global burden of meningitis.

Following another large-scale outbreak of meningitis between 2016/2017, which recorded over 14,000 cases, and about 1,166 deaths, the Nigeria Centre for Disease Control (NCDC) collaborated with states within the meningitis belt to drastically reduce the number of suspected cases to less than a thousand, and fatality rate to 5 per cent.

In 2022/2023, Nigeria recorded 2,765 suspected and 303 confirmed cases with 190 deaths across 140 local councils in 30 States, including the Federal Capital Territory. Consequently, cases of Meningitis in the past few years have been on a downward trend. In October 2022, NCDC also launched a roadmap aimed at eliminating meningitis by 2030, which envisioned a world free of meningitis.

A recent outbreak of Neisseria meningitides (meningococcus) serogroup C outbreak led to 1,742 suspected meningitis cases, including 101 confirmed cases and 153 deaths in seven of 36 Nigerian states, especially in Adamawa, Bauchi, Gombe, Jigawa, Katsina, Yobe, Zamfara between October 1, 2023, and March 11, 2024, according to the World Health Organization (WHO). To quell the deadly outbreak, a vaccination campaign was rolled out last month to initially reach more than one million people aged 1-29 years.

Though meningitis affects all ages, the most at-risk persons are young children, especially those under or not immunised, individuals living in overcrowded households, individuals who smoke, individuals exposed due to poor ventilation and indoor air pollution such as from cooking with wood, or charcoal, those with poor hygienic practices and health care workers who provide direct patient care, clean, and disinfect contaminated materials or handle biological specimens without using personal protective equipment and/or adhering to infection prevention control protocols.

With just six years left to kick out meningitis globally, experts are of the view that the MenFive vaccine, which has just been introduced in Nigeria, will be a game changer in the nation’s efforts to ensure the elimination of the scourge by 2030. Speaking with The Guardian, a Professor of Virology and the former Vice Chancellor of Redeemers University, Ede, Prof Oyewale Tomori noted that Meningitis is a debilitating disease estimated to cause 236,000 deaths and 2.51 million cases globally.

He stated that one in five survivors of the disease can develop long-lasting neurological disorders and disabilities, including loss of hearing, deafness, and also loss of limbs adding that Meningitis is the second-highest cause of neurological disorders in Africa.

Tomori, who observed that Nigeria contributes substantially to this devastation, said, ‘We all remember the 1996 Kano meningitis outbreak which brought the Pfizer company to Nigeria to conduct an unethical clinical trial with an unapproved drug, known as Trovan’..

He explained that the newly approved MenSCV or MenFive vaccine contains the five antigens representing the five bacteria meningococcal stains (A, C, W, Y, and X) associated with meningitis outbreaks in Nigeria and the other 25 countries in Africa’s meningitis belt.

According to him, ‘ MenFive is the first vaccine to protect against all five strains of the meningococcal bacteria that cause meningitis, hence the name Men5CV or MenFive vaccine.

He said: “Our country is the first country in Africa’s meningitis belt to roll out the new vaccine. It is a smart move that will protect, especially, our children, and significantly reduce the burden of meningitis disease in Nigeria. Initially, the new MensCV vaccine will be used to address outbreaks.

“It is hoped that starting in 2025 it will be used as a preventive health intervention to protect all children from the age of two years from the ravages and debilitation of meningitis. In this way, Nigeria can look forward to achieving the elimination of bacterial meningitis by the year 2030.

“The rollout of the new vaccine is one of the ingredients needed to achieve renewed hope for our country, and all those involved deserve our commendation. To achieve the goal of eliminating meningitis by 2030, we all (parents, community, government, media, and the private sector) must get involved by increasing awareness about the vaccine, and ensure that each Nigerian child receives the Men's vaccine, and no Nigerian child is left out”, he added.

The Virologist said that the vaccine is estimated to cost $3 per shot and is slightly more expensive than the older vaccine (MedAfriVac), However, with a broader and more widespread uptake, the price is likely to drop.

“Moreover, if we can give millions of naira out as severance pay for a population of retired presidents, governors, senators, and legislators, what excuse do we have for losing a child dying from or being maimed for life by meningitis, because we failed to give the child a $3.00 vaccine shot?”.

An infectious disease expert at the Department of Microbiology Adeleke University Ede, Osun State and Honorary Associate Professor, Department of Chemical Engineering, University of Birmingham, UK, Dr Oladipo Kolawole told The Guardian that the introduction of the Men5CV vaccine represents a significant advancement in the prevention of meningitis in Nigeria, adding that the vaccine offers broader protection against multiple strains of meningococcal bacteria compared to previous vaccines, potentially reducing the burden of meningitis in affected Nigerian populations.

Kolawole, however, noted that while the Men5CV vaccine is a valuable tool in the fight against meningitis, achieving the goal of eliminating meningitis by 2030 may be challenging due to its coverage and access.

He said ensuring high vaccine coverage rates, particularly in regions where meningitis is endemic, and crucial for achieving disease elimination. “Meningitis-causing bacteria can vary in prevalence by geographic region and over time. Continued surveillance and adaptation of vaccination strategies may be necessary to address emerging serogroups. Meningococcal bacteria can develop resistance to antibiotics, which may complicate treatment and control efforts.”

The MensSCV vaccine offers broader protection against multiple serogroups of meningococcal bacteria, potentially leading to a significant reduction in the incidence of meningitis and related complications. This can translate into fewer cases of morbidity and mortality, alleviating the burden on healthcare systems and improving overall public health.

“Vaccination against meningitis not only protects individuals from the disease but also contributes to community immunity, reducing the transmission of meningococcal bacteria and preventing outbreaks,” Kolawole said.

According to him, by preventing cases of meningitis and associated complications, the Men5CV vaccine can lead to significant cost savings for healthcare systems and society. The economic burden of treating meningitis cases, including hospitalisation and long-term care, can be reduced with high vaccine uptake.

Among several strategies he listed to ensure optimal uptake of the Men5CV vaccine is making the vaccine readily available and accessible to all eligible populations through routine immunization programmes, healthcare facilities, and outreach efforts.

He said: “This includes ensuring sufficient vaccine supply, distribution networks, and trained healthcare providers to administer the vaccine, conduct comprehensive public awareness campaigns to educate individuals, families, and communities about the importance of meningitis vaccination, the benefits of the Men5SCV vaccine, and the recommended vaccination schedule. This can help dispel myths, address vaccine hesitancy, and empower individuals to make informed decisions about vaccination.”

He also stressed the need for the government and relevant agencies to implement robust monitoring and evaluation systems to track vaccine coverage rates, identify barriers to uptake, address gaps in vaccination coverage and continuously assess the impact of vaccination efforts on meningitis incidence and adjust strategies as needed to optimise vaccine uptake and effectiveness.

On whether there are safety concerns about the vaccine, Kolawole said: “The MenSCV vaccine has shown promise in preventing meningitis, generally, vaccines undergo rigorous testing and evaluation for safety before approval for public use. Continuous monitoring of vaccine safety is essential to detect and investigate any potential safety concerns. The vaccine has shown good efficacy when given in an age-based schedule, and it has been demonstrated to be safe in clinical trials.”

Also speaking, the Chief Executive Officer, Vaccine Network for Disease Control, Chika Offor, observed that vaccine is a preventive strategy that saves lives and money.

She noted that Nigeria has had many epidemics around meningitis, stressing that the new vaccine signals that meningitis is on its way out of Nigeria. Offor also noted that Meningitis is a killer disease, and Nigeria has the option of being able to eradicate meningitis.

She said: “We must ensure that all hands are on deck, government, civil society groups, and media have to come together to understand the vaccine and how it works, and expectations. It is important to get it right from the beginning and ensure that everything about the vaccine is well articulated,” she added.

WHO Director-General, Dr Tedros Ghebreyesus, said Nigeria’s rollout brings everyone one step closer to the goal to eliminate meningitis by 2030. He noted that Meningitis is an old and deadly foe, but this new vaccine holds the potential to change the trajectory of the disease, preventing future outbreaks and saving many lives.

Ghebreyesus stated that the new vaccine has the potential to significantly reduce meningitis cases and advance progress in defeating meningitis. “This is important for countries like Nigeria where multiple serogroups are prevalent. The new vaccine uses the same technology as the meningitis A conjugate vaccine, which wiped out meningococcal A epidemics in Nigeria,” he added.

The Coordinating Minister of Health and Social Welfare, Prof Muhammad Ali Pate, said that in Northern Nigeria, states such as Jigawa, Bauchi and Yobe were badly hit by the deadly outbreak of meningitis, and the MenFive vaccine provides health workers with a new tool to stop the outbreak and put the country on a path to elimination.

He said: “We’ve done a lot of work preparing health workers and the health system for the rollout of this new vaccine. We got invaluable support from community leaders, especially the Emir of Gumel in Jigawa State, who personally launched the vaccination campaign in the state. We’ll be monitoring progress closely and hopefully expanding the immunisation in the coming months and years to accelerate progress.”

This new multivalent conjugate vaccine was based on a partnership between PATH and the Serum Institute of India, as well as financing from the UK Government’s Foreign, Commonwealth and Development Office.

“The rollout of one million vaccines in northern Nigeria will help save lives, prevent long-term illness and boost our goal of defeating meningitis globally by 2030,” said Andrew Mitchell, UK Minister for Development and Africa, adding, This is the kind of scientific innovation, supported by the UK, which will be replicated in years to come to help us drive further breakthroughs, including wiping out other diseases.”

WHO has been supporting the Nigeria Centre for Disease Control and Prevention (NCDC) in responding to the meningitis outbreak in the country through disease surveillance, active case finding, sample testing, and management. WHO and its partners have also played a vital role in supporting Nigeria in preparing for the rollout of the new vaccine and training health workers.

“With outbreaks of infectious diseases on the rise worldwide, innovations are critical in helping us fight back,” said Aurélia Nguyen, Chief Programme Officer at Gavi, the Vaccine Alliance, which funds the global stockpile, as well as vaccine rollout in lower-income countries.

“This first shipment signals Gavi support for a Multivalent Meningococcal The Conjugate Vaccine (MMCV) programme, with the required donor funding for our next five years of work, will see pentavalent meningococcal conjugate vaccines rolled out in high risk countries. We have eliminated large and disruptive outbreaks of meningitis A in Africa. Now, we have a tool to respond to other serogroups that still cause large outbreaks resulting in long-term disability and deaths.”

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