Patricia Grogg*

HAVANA, Oct 25 2010 (IPS) – The risk of meningitis outbreaks rises during the dry season December to June in some 20 countries of sub-Saharan Africa. Meningitis in the region is too often deadly, though the disease can be prevented with vaccination.

A technician in a Finlay Institute lab producing meningitis vaccines for Africa. Credit: Jorge Luis Baños/IPS

Nana Diallo, 45, has her children vaccinated whenever possible. It s one of the diseases that frightens me the most, because the person can be left blind or mute, the spice vendor told IPS at the Bozola market in Bamako, capital of Mali.

Diallo s children may have been immunised with some of the 1.94 million doses of the vaccine that arrived in this West African country in 2007, produced specially in laboratories in Cuba and Brazil. But they provide immunity for just two or three years.

Meningococcal meningitis is a bacterial infection of the membrane surrounding the brain and the spinal cord. It can cause severe brain damage and in 50 percent of the cases where it is not treated with antibiotics it results in death.

Climate conditions in the dry season favour an epidemic and they also favour poverty, overcrowding and constant human transit, contributing to a precarious immunological state, World Health Organisation (WHO) specialist Alejandro Costa told IPS by phone from Geneva.

When outbreaks occur, vaccines are needed immediately for treatment. But because the meningococcal meningitis epidemic is concentrated in a very impoverished part of the world, the big pharmaceutical laboratories have little incentive to cover demand.
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In mid-2006, the WHO was forced to send out an S.O.S. for production of the polysaccharide vaccine against types A and C in what is known as Africa s meningitis belt, a band that stretches across 23 countries, from Senegal in the west to Ethiopia in the east, home to 430 million people.

The Sanofi Pasteur company, at the time the only manufacturer of the vaccine, planned to discontinue production, although in the end it only cut back, explained Costa, the WHO scientist in charge of vaccine readiness for epidemics.

In response to the WHO call, two public entities, the Finlay Institute of Cuba and Brazil s Bio-Manguinhos immunobiological institute, joined forces to produce the Men AC vaccine.

The collaboration was successful because of the political will of both countries and because the operational infrastructure already existed between the Cuban biotech institute and the Brazilian government s Fiocruz, to which Bio-Manguinhos belongs, according to Ramón Barberá, Finlay vice-president for production.

It was a victory of unity. I m sure the Brazilians are very proud of this work and of having achieved it with Cuba, Barberá told IPS.

The Finlay Institute produces the active ingredients of the vaccine and sends them to Brazil for processing, which includes filling, lyophilisation (freeze-drying), packaging, labelling, and quality control.

To reach this point, Finlay remodelled and set up a new production plant for vaccines based on current standards. It began operating this new, self-funded lab in late 2008.

This Cuba-Brazil partnership, based on the two institutions commitment to public health, allowed them to supply the region in record time and at realistic prices, Bio-Manguinhos production advisor Elaine Maria Teles told IPS.

A dose of the Men AC polysaccharide produced by Cuba and Brazil costs about 95 cents on the dollar, while the polysaccharide for A, C, W135 and Y, manufactured by the transnational pharma labs, costs between 15 and 20 dollars per dose.

More than 11.5 million Men AC vaccines have been delivered so far, and the goal is to reach 15 million by the end of the year. From 2007 to 2009, the largest shipments went to Mali, Ethiopia, Burkina Faso, Nigeria, Niger and Chad, according to Bio-Manguinhos records.

The vaccines generally are acquired by the WHO itself, the United Nations Children s Fund (UNICEF), Médecins Sans Frontières and the International Red Cross. In addition, each country purchases some vaccines, depending on their budget resources available.

The epidemic is recurrent in the meningitis belt, said Costa. Every three or four years there are major outbreaks, with 50,000 to 80,000 cases, followed by years of smaller outbreaks.

In 2009, 14 countries that implemented a tighter monitoring system reported a total of 78,416 cases and 4,053 deaths.

So far in 2010 fewer cases have been reported than in 2009, but the death rate is higher. From Jul. 5 to Aug. 1, the WHO recorded 275 cases and 21 deaths in 14 countries.

We are truly grateful for the efforts of Brazil and Cuba, who responded in an extraordinary way. This South-South cooperation has few such successful precedents, said Costa.

In a short time they were able to produce a vaccine at the lowest cost, which contributed to reducing the cases of meningitis, the WHO expert remarked.

But measuring the impact of the vaccine is not easy, said Costa, because it is often applied in reactive campaigns in the midst of an epidemic, and does not cover the entire population.

Furthermore, the polysaccharide vaccines provide protection for just two or three years, and cannot be given to children under age two.

The staff at Finlay is working now to include type W135 meningitis in a vaccine it hopes to have ready by April. They are aiming for a price that would allow the WHO to begin replacing the current bivalent (AC) vaccine for the trivalent ACW135 to protect against the three types of meningitis most prevalent in the region.

We are not in a completely desperate situation, but if there is an epidemic and if most of the cases are caused by type W135, we won t have enough vaccines, warned Costa. The GlaxoSmithKline corporation stopped producing the trivalent vaccine, he noted. Ideally, the ACW135 (trivalent) vaccine would be ready a bit sooner, in February, because the epidemics begin in January, he added.

Costa believes the greater challenge for the Cuban-Brazilian partnership is to find a conjugate vaccine, which combines a polysaccharide antigen with a carrier protein to achieve longer-term immunity to meningitis. Applied to an entire population through a routine health programme, it could put an end to the epidemic, he said.

The commercial vice-president of the Finlay Institute, Francisco Domínguez, confirmed to IPS that they are working on conjugate vaccines for the different disease types.

The global market does have a conjugate tetravalent vaccine (A, C, W135 and Y) available, produced by Sanofi Pasteur, but it is authorised only for people between the ages of 11 and 25. There is also a recently trademarked vaccine by the pharma giant Novartis, but the three doses needed to protect one person cost around 300 dollars, said Costa.

Meanwhile, in September, pilot campaigns began in Mali, Niger and Burkina Faso for a conjugate A vaccine, the MenAfriVac, developed by a laboratory in India.

* With reporting from Fabiana Frayssinet in Rio de Janeiro and Soumaila T. Diarra in Bamako.