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In a historic move, Nigeria has become the first country in the world to roll out a new Men5CV vaccine recommended by the World Health Organization (WHO), which protects people against five strains of the meningococcus bacteria. 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.
Nigeria is one of the 26 meningitis hyper-endemic countries of Africa, situated in the area known as the African Meningitis Belt. Last year, there was a 50% jump in annual meningitis cases reported across Africa.
In Nigeria, an outbreak of Neisseria meningitidis (meningococcus) serogroup C outbreak led to 1742 suspected meningitis cases, including 101 confirmed cases and 153 deaths in seven of 36 Nigerian states (Adamawa, Bauchi, Gombe, Jigawa, Katsina, Yobe, Zamfara) between 1 October 2023 and 11 March 2024. To quell the deadly outbreak, a vaccination campaign has been undertaken on 25--28 March 2024 to initially reach more than one million people aged 1-29 years.
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 seriously disable or kill within 24 hours those that contract it.
“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,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Nigeria’s rollout brings us one step closer to our goal to eliminate meningitis by 2030.”
The revolutionary new vaccine offers a powerful 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 much of Africa, which is only effective against the A strain.
The new vaccine has the potential to significantly reduce meningitis cases and advance progress in defeating meningitis. This is especially important for countries like Nigeria where multiple serogroups are prevalent. The new vaccine uses the same technology as the meningitis A conjugate vaccine (MenAfriVac), which wiped out meningococcal A epidemics in Nigeria.
“Northern Nigeria, particularly the states of Jigawa, Bauchi and Yobe were badly hit by the deadly outbreak of meningitis, and this vaccine provides health workers with a new tool to both stop this outbreak but also put the country on a path to elimination,” said Prof. Muhammad Ali Pate of the Nigerian Ministry of Health and Social Welfare. “We’ve done a lot of work preparing health workers and the health system for the rollout of this new vaccine. We got an invaluable support from our populations despite this fasting period and from our 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 13 years in the making and was based on a partnership between PATH and the Serum Institute of India. Financing from the UK government’s Foreign, Commonwealth and Development Office was critical to its development.
In July 2023, WHO prequalified the new Men5CV vaccine (which has brand name MenFive) and in October 2023 issued an official recommendation to countries to introduce the new vaccine. Gavi allocated resources for the Men5CV rollout in December 2023, which is currently available for outbreak response through the emergency stockpile managed by the International Coordinating Group (ICG) on Vaccine Provision, while roll-out through mass preventive campaigns is expected to start in 2025 across countries of the Meningitis Belt.
“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. “This is exactly the kind of scientific innovation, supported by the UK, which I hope is 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. This includes disease surveillance, active case finding, sample testing, and case management. WHO and partners have also played a vital role in supporting Nigeria to prepare for the rollout of the new vaccine and training health workers.
In 2019, WHO and partners launched the global roadmap to defeating meningitis by 2030. The roadmap sets a comprehensive vision towards a world free of meningitis, and has three goals:
- elimination of bacterial meningitis epidemics;
- reduction of cases of vaccine-preventable bacterial meningitis by 50% and deaths by 70%; and
- reduction of disability and improvement of quality of life after meningitis due to any cause.
“With outbreaks of infectious diseases on the rise worldwide, new innovations such as MenFive® 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 the start of Gavi support for a multivalent meningococcal conjugate vaccine (MMCV) program, which, with the required donor funding for our next five years of work, will see pentavalent meningococcal conjugate vaccines rolled out in high-risk countries. Thanks to vaccines, 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."
Following Nigeria’s meningitis vaccine campaign, a major milestone on the road to defeat meningitis is the international summit on meningitis taking place in Paris in April 2024 where leaders will come together to celebrate progress, identify challenges and assess next steps. It is also an opportunity for country leaders and key partners to commit politically and financially to accelerate progress towards eliminating meningitis as a public health problem by 2030.