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Experts debate vaccinations in the “Meningitis Belt”
The emergency vaccination campaign against meningitis being carried out in Africa by the WHO has unearthed an old scientific disagreement. Some French scientists unconvinced by this strategy are arguing the advantages of preventive vaccination as opposed to targeted vaccination during epidemics…
Jean-Philippe Chippaux of France’s Institute for Development Research (IRD: Institut de Recherche pour le Développement) is one of these. Speaking to us from La Paz in Bolivia, he tells us that, together with his team, he has just shown that “preventive vaccination can stop up to 72% of cases when later waves of infection occur”.
The polysaccharidal vaccine most often used has two major disadvantages. On the one hand the immunity it gives lasts for only 3 to 5 years. Mass vaccination campaigns therefore have to be rerun on a regular basis. And, most importantly, it is ineffective in nursing infants! Its main advantage remains its cost – just half a euro. And the peoples who live in the countries of this “Meningitis Belt” , which stretches from Senegal to Ethiopia, are among the world’s most disadvantaged.
According to Dr Eric Bertherat of the WHO, “to be effective as a preventive measure, this partial and temporary immunity requires operational efforts that are incompatible with the means available in these countries. On the other hand, if used in a reactive and well-targeted mass campaign, this vaccine is capable of halting an epidemic”. However, this approach creates long delays due to hold-ups in shipment of the vaccines and the setting up of logistical support.
It has however “met with a consensus among health officials – the WHO, UNICEF, the Federation of Red Cross Societies, Médecins Sans Frontières and other NGOs – as well as among most research institutes working on meningococcal disease”.
The parties are in agreement on one point: they are all awaiting the arrival on the market of a new combined vaccine, expected in 2010. Eric Bertherat believes that “thanks to its special qualities, it will be able to be used preventatively in Africa”. And Jean-Philippe Chippaux points out that “the key thing will be to get a purchase price of less than one dollar per dose”.
So how to manage the situation up to 2010? It is of course essential to lessen the delays involved in setting up targeted vaccinations while still ensuring basic vaccine coverage. Dr André Prost, former director at the WHO and President of the Destination Santé Scientific Board, stresses that “for the moment the ideal thing is to combine the two strategies. That is to say, preventive vaccination in the countries where this is possible and the building up of stocks of vaccine in various places to enable rapid deployment of emergency vaccines”.
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