In July 2023 Serum Institute of India (SIIPL) and PATH announced that the first conjugate vaccine against the five predominant causes of meningococcal meningitis in Africa, MenFive, has been prequalified by WHO. This vaccine, developed through a 13-year collaboration between the two organisations and largely funded by the UK Foreign, Commonwealth, and Development Office, protects against serogroups A, C, W, Y, and X. It is designed to eliminate annual meningitis outbreaks and epidemics in the so-called African meningitis belt. The prequalification from WHO allows MenFive to be procured by UN agencies and Gavi.
The burden of meningitis in Africa
The African meningitis belt is a string of 26 countries from Senegal and The Gambia to Ethiopia. WHO emphasises that this region is prone to “major epidemics”, which place significant strain on health services. Meningococcal meningitis is a bacterial infection with rapid and devastating consequences. Fatal in 50% of cases, it can cause severe brain damage or sepsis. Although anyone can contract meningococcal meningitis it is most dangerous for children under the age of five.
Although polysaccharide vaccines are traditionally used in response to African meningitis epidemics, they provide short-term protection and are less effective in children under the age of 2. Furthermore, they do not promote herd immunity. Conjugate vaccines provide “better, longer lasting protection”, suggests SIIPL.
Multivalent meningococcal conjugate vaccines have been available on the global market “for decades” but not at attainable prices for the meningitis belt countries to include them in their meningitis prevention strategies. This leaves 450 million people at risk of death or severe disability.
MenFive “builds on the legacy of MenAfriVac, which was also developed in partnership with PATH, and WHO. MenAfriVac successfully saw the elimination of serogroup A meningococcal meningitis outbreak from the African meningitis belt after its introduction in 2010. MenFive is “designed to prevent not just death” but also disability in survivors who would otherwise “suffer lifelong social and economic consequences”.
It is expected to provide an affordable new intervention with two highly impactful health outcomes:
- Broad, highly effective direct protection against invasive meningococcal disease
- Indirect “herd” protected by markedly reducing the meningococci bacteria in the nose and throat that is key to transmission
MenFive is approved by WHO for use in individuals between the ages of 1 and 85, for initial use in reactive vaccine campaigns for meningitis outbreaks. It is currently being examined in a Phase III study to examine its safety and immunogenicity when administered in conjunction with measles/rubella and yellow fever vaccines.
Adar Poonawalla, SIIPL CEO, described MenFive as a “game-changer vaccine”, the fruit of a “powerful” collaboration.
“MenFive offers hope for a future free from annual outbreaks and epidemics in the African meningitis belt. It is a big moment as we, together, pave the way towards a healthier Africa, saving countless lives.”
Dr Rajeev Dhere is Executive Director of SIIPL, and suggests that MenFive is a “much-required medical intervention” that will be “extremely affordable”.
“Making sure vaccines are available to those who need them most is a philosophy SIIPL has followed with all our products.”
UK International Development Minister Andrew Mitchell says this is a “landmark scientific achievement” with “huge implications” for public health. Dr Bill Hausdorff, director of PATH’s meningitis vaccine development projects, agrees that it is a “turning point” for the region and global efforts against meningitis.
“The introduction of new multivalent meningococcal conjugate vaccines is a key strategy for bacterial meningitis prevention and control. MenFive is a critical addition to the toolbox that will save thousands of lives every year.”
Dr Nanthalile Mugala, PATH Africa Region Chief, echoed that meningitis has “long been a torment” for the countries in the belt. Although the 2010 introduction of MenAfriVac was a “landmark achievement”, it was “only the beginning of the story”.
“With MenFive, we now have the potential to finally end all meningococcal meningitis epidemics in Africa, once and for all.”
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