Why have these meningitis C and measles outbreaks occurred?

Once again, Niger has faced multiple outbreaks of measles and meningitis C, both of which are highly contagious and potentially fatal. While immunization efforts should have theoretically prevented these crises, each disease presents unique challenges.

Regarding meningitis, there is currently no affordable vaccine that provides universal protection against all serogroups. Furthermore, limited global production—due to low commercial interest from pharmaceutical companies—means that vaccination is often used only as a reactive measure once an outbreak is already confirmed. These delays significantly hinder the effectiveness of immunization campaigns.

Additionally, although the measles vaccine has been part of routine immunization programs since 1974, the actual coverage remains too low to effectively stop the virus from spreading.

While we have seen major meningitis C outbreaks in the region in recent years, has the situation improved this year?

The year has been relatively quiet in the African “meningitis belt.” However, a significant vaccine production shortage persists. The International Coordinating Group, which manages the distribution of scarce vaccines based on equity and epidemiological data, aimed for a minimum stockpile of five million doses for serogroup C this year. Unfortunately, this goal was not met, and we are forced to continue vaccinating only after the epidemic threshold is crossed, rather than acting preventively or at the initial alert stage.

Why is there a shortage of meningitis vaccines?

There are several types of meningitis—including serogroups A, B, C, W135, and X—and no single vaccine covers them all. Currently, the best available option is the tetravalent conjugate vaccine, which is highly effective but extremely expensive. The Serum Institute of India is developing an affordable pentavalent conjugate vaccine (covering A, C, Y, W-135, and X), but it is not expected until 2020. Because of high development costs, other laboratories are hesitant to invest in new vaccines due to uncertain market returns.

What has been the response to the meningitis C outbreak in Niger?

Working alongside the Ministry of Health, we vaccinated over 30,000 people against meningitis C in the Tahoua region and supported patient care. We were surprised to identify a high number of serogroup X cases, for which no vaccine currently exists. This remains a major concern for the coming years.

Are there alternative prevention strategies for meningitis C?

New prevention methods are being tested, such as the use of the antibiotic ciprofloxacin. A study published in PLOS Medicine in June 2018 demonstrated that administering this antibiotic to all residents in a rural area significantly reduces disease transmission. Further studies are planned to assess this strategy in urban environments, potentially providing a vital tool for managing future small-scale outbreaks.

Why does the routine vaccination schedule fail to stop measles outbreaks?

The current schedule is very age-dependent. In Niger, national protocol targets children up to 23 months, but vaccines provided by GAVI only cover children under 12 months. Consequently, the 15-month booster shot is missing, and children older than one year who visit health centers often go unvaccinated.

Furthermore, many people in Niger live as transhumant pastoralists or reside in conflict-affected areas, limiting their access to health facilities. Maintaining the 95% coverage required to prevent measles outbreaks is extremely challenging in these conditions.

How can coverage rates be improved?

Immunization schedules should be more flexible, extending protection up to the age of five. Every interaction with the health system should be treated as an opportunity to update a child’s vaccination records.

Multi-antigen campaigns should also be prioritized. For instance, while responding to a measles outbreak in Arlit (Agadez), we are also administering pentavalent and pneumococcal vaccines to maximize protection.

Whenever possible, we also include tetanus vaccination for women of childbearing age. Since this requires five doses, we use every health center visit as a chance to provide protection to both the women and their future newborns. We must seize every opportunity to vaccinate against deadly diseases.