Miriam Alía, who oversees vaccination and epidemic management for Médecins Sans Frontières, provides an overview of the measles and meningitis C outbreaks that have impacted Niger since the start of 2018.
Understanding the persistence of measles and meningitis C outbreaks
Niger has once again battled several outbreaks of measles and meningitis C, both of which are highly infectious and potentially fatal. While these diseases are vaccine-preventable, the reasons they continue to spread vary significantly between the two.
Regarding meningitis, the world lacks a vaccine that is both affordable and effective against every serogroup. Furthermore, global production levels remain low because pharmaceutical companies show limited interest in these markets. This often restricts vaccine use to reactive measures once an epidemic is officially declared, creating delays that hinder the effectiveness of immunization campaigns.
In contrast, the measles vaccine has been part of routine health programs since 1974. However, the percentage of the population actually reached remains too low to successfully halt the transmission of the virus.
The current state of meningitis C in the region
While the area often referred to as Africa’s “meningitis belt” has been relatively quiet this year, a major shortage in vaccine production persists. The International Coordinating Group, which manages limited vaccine supplies to ensure equitable distribution based on epidemiological data, aimed for a minimum stockpile of five million doses for serogroup C. This target was not met. Consequently, vaccination still only occurs after epidemic thresholds are reached, rather than as a preventive measure when initial alerts are triggered.
The challenges behind vaccine shortages
Meningitis comes in various forms, specifically serogroups 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 common strains but is extremely expensive. The Serum Institute of India is developing a more affordable pentavalent vaccine (covering A, C, Y, W-135, and X) expected by 2020. Because of the high costs involved, other laboratories are hesitant to invest in new versions for fear they will not be commercially viable.
The humanitarian response in Niger
Working alongside the Ministry of Health, we successfully immunized over 30,000 individuals against meningitis C in the Tahoua region while providing medical care for those infected. A worrying discovery was the high percentage of serogroup X cases, for which there is currently no vaccine—a major concern for future health security.
Innovative prevention methods
Alternative strategies are being explored, such as using a single dose of the antibiotic ciprofloxacin. A study conducted in Niger and published in June 2018 in the journal “PLOS Medicine” demonstrated that administering this antibiotic to all residents in a rural area significantly lowers disease transmission. Further research will determine if this approach is effective in urban settings, potentially providing a new tool for managing smaller outbreaks.
95%: To stop measles from spreading, at least 95% of the population must be immune, a target that is difficult to maintain in certain regions.
Why routine measles vaccination is falling short
The current vaccination schedule is extremely rigid regarding age. In Niger, national protocols suggest vaccinating children up to 23 months, yet vaccines provided by GAVI (the Vaccine Alliance) typically only cover those under 12 months. This excludes the 15-month booster dose and leaves children older than one year without protection when they visit health centers.
Additionally, many people in Niger lead nomadic lifestyles or live in conflict zones, making it difficult to access traditional health centers. Achieving the 95% coverage required to stop the virus is a significant challenge under these conditions.
Strategies for increasing immunization rates
A more flexible childhood vaccination schedule that extends to age five is necessary. Every interaction between a child and the healthcare system should be viewed as a chance to update their immunizations.
Multi-antigen campaigns are another vital tool. For instance, during a measles response in Arlit (Agadez), we are also providing pentavalent and pneumococcal vaccines. Every opportunity to protect against deadly diseases must be utilized.
When supplies allow, we also offer tetanus vaccinations to pregnant women and those of childbearing age. In Niger, many women do not complete the full five-dose course, so these campaigns are essential for protecting both mothers and their future infants.
Since early 2018, MSF and the Ministry of Health have immunized over 179,460 individuals 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. A current campaign in Arlit aims to reach 50,000 more children under five with measles, pentavalent, and pneumococcal vaccines.