Miriam Alía, who leads vaccination and epidemic response efforts for Médecins Sans Frontières, provides an analysis of the meningitis C and measles outbreaks that have impacted Niger.
Understanding the persistence of measles and meningitis C in Niger
Despite the availability of vaccines, Niger continues to face periodic outbreaks of measles and meningitis C—two highly infectious and potentially fatal diseases. The challenges in controlling these epidemics differ significantly for each condition.
Regarding meningitis, the global medical community lacks a single, affordable vaccine that covers every serogroup. Furthermore, pharmaceutical production remains limited due to low commercial interest in these specific markets. This scarcity often forces medical teams to adopt a reactive approach, launching vaccination drives only after an epidemic is officially confirmed, which creates critical delays in saving lives.
In contrast, measles has been part of standard immunization programs for decades. However, the percentage of the population currently vaccinated remains too low to effectively halt the transmission of the virus.
Current trends in the African meningitis belt
While the region known as the African meningitis belt has seen a relatively stable period recently, vaccine supply shortages continue to pose a threat. The International Coordinating Group on Vaccine Provision, which manages limited stocks to ensure equitable distribution, aimed for a minimum reserve of five million doses for meningitis C. Unfortunately, this target was not met. Consequently, health workers are often restricted to vaccinating only when epidemic thresholds are surpassed, rather than implementing the preferred preventive strategies at the first sign of an alert.
The search for a universal meningitis vaccine
Meningitis is categorized into several serogroups, including A, B, C, W135, and X. Currently, no single vaccine protects against all of them. The most effective option today is the quadrivalent conjugate vaccine, but its high price limits widespread use. While the Serum Institute of India is developing a more affordable pentavalent vaccine (covering A, C, Y, W-135, and X), it is not yet ready for the market. This gap in production persists because laboratories are hesitant to invest in new vaccines that might not yield high financial returns.
Responding to meningitis C in Niger
In partnership with the Ministry of Health, over 30,000 individuals in the Tahoua region received vaccinations against meningitis C. During this response, medical teams identified a concerning number of cases involving serogroup X. Because no vaccine currently exists for this specific strain, it represents a significant public health challenge for the future of Niger.
Innovative prevention methods
Health experts are exploring new ways to curb meningitis C, including the use of the antibiotic ciprofloxacine. A study conducted in Niger and published in PLOS Medicine in 2018 demonstrated that administering a single dose of this antibiotic to entire rural communities can significantly lower disease transmission. This method could become a vital tool for managing smaller outbreaks in the future.
95% Coverage
To effectively stop measles from spreading, at least 95% of the population must be immune. Maintaining such high coverage is exceptionally difficult in regions with mobile or displaced populations.
Barriers to effective measles immunization
The current vaccination framework in Niger is hampered by rigid age requirements. While national protocols suggest vaccinating children up to 23 months old, international funding from GAVI often only covers infants under one year. This leaves older children without access to boosters or initial doses when they visit health centers.
Additionally, many people in Niger lead nomadic lives (transhumance) or reside in conflict zones, making it hard for them to reach stationary health facilities. These factors combine to keep vaccination rates below the necessary 95% threshold.
Strategies for broader health protection
Improving immunity requires a more adaptable schedule that includes children up to age five. Every medical consultation should serve as an opportunity to check and update a child’s immunization status.
Implementing multi-antigen campaigns is another effective strategy. For example, during a measles response in Arlit (Agadez), teams also administered pentavalent and pneumococcal vaccines to provide comprehensive protection. Furthermore, when supplies allow, health workers provide tetanus vaccinations to pregnant women and those of childbearing age, ensuring both mother and newborn are protected. Maximizing every contact with the community is essential to fighting these deadly diseases.
Since the start of 2018, MSF and the Ministry of Health have immunized more than 179,460 people across Niger. This includes 145,843 children in Tahoua and Agadez vaccinated against measles, and 33,620 individuals in Tahoua protected against meningitis C. Ongoing efforts in Arlit aim to reach an additional 50,000 children with a combination of measles, pentavalent, and pneumococcal vaccines.
