CHORI Initiative Leads to $70 Million Award from the Gates Foundation to PATH and WHO for Prevention of Meningitis Epidemics in Africa (June 2001)

The World Health Organization (WHO) and the Program for Appropriate Technology in Health (PATH) recently announced that they received an award of $70 million from the Bill & Melinda Gates Foundation for a ten-year program to eliminate deadly meningitis epidemics in Sub-Saharan Africa (see PATH press release). The grant was a result of efforts begun two years ago by Dan M. Granoff, MD, an investigator at CHORI, working with Luis Jódar, MD, at WHO.

Meningococcal meningitis, a bacterial infection of the membranes covering the brain, is one of the most feared diseases in the African Sub-Saharan "meningitis belt". Epidemics can infect over 200,000 people per year. Despite antibiotic therapy, 10 to 15 percent of people with the disease die, and a similar proportion are left with disabilities such as epilepsy, deafness, or amputations of limb.

A plain polysaccharide meningococcal vaccine has been available for many years. However, this vaccine is not very suitable for routine use for prevention of epidemics. The reason is the vaccine is not effective in infants and young children, the age groups at highest risk of disease. Also, protection lasts only a few years, and immunized individuals may still carry the bacteria in their nose and throat and transmit infection to others.

For more than a decade the technology has been available to develop an improved meningococcal vaccine that induces long-term protection, and which is effective in all age groups ("conjugate vaccine"). A conjugate vaccine for prevention of meningococcal disease caused by serogroup C strains was introduced in the United Kingdom in 1999. Fifteen million persons under the age of eighteen were immunized in the first eighteen months and serogroup C disease has virtually been eliminated in this age group (Ramsay et al., Lancet 2001). Unfortunately, the vaccine developed for the UK does not prevent meningococcal disease caused by the serogroup A strain, which is the main cause of meningococcal disease in Sub-Saharan Africa.

In the 1990s, several manufacturers, in response to requests by WHO and the international community, began development of a conjugate vaccine against the strains causing disease in Africa. By 1999, all of these manufacturers had suspended or discontinued their projects. The reasons were simple: vaccine development is expensive, and the profit expected from a vaccine intended for Africa was too limited to justify the large investment of capital and human resources required for such a project.

In November 1999, recognizing that the prospects were dim for a low-cost vaccine for prevention of epidemic meningitis in Africa, Granoff made a proposal to WHO to explore the feasibility of developing a not-for-profit company to manufacturer a meningitis vaccine for Africa. As a result, WHO funded CHORI to conduct a feasibility study.

Working with consultants with expertise in manufacturing and vaccine development, Granoff determined the time required and cost to develop, license, and produce a vaccine, including building a manufacturing facility. Granoff and Jódar also met with each of the major vaccine manufacturers to determine their interest in reviving development of a meningococcal vaccine for Africa, should external funding become available. The results of these analyses were presented to representatives from Africa and scientists and health care experts from the international community at a meeting held at WHO in Geneva in April 2000. It was recommended that the project move forward and apply for funding from international donors.

Subsequently, representatives from the U.S. Centers for Disease Control and PATH joined the effort, which lead to the $70 million grant from the Gates Foundation to fund a private-public partnership to develop, manufacture, and support a pilot introduction of a meningococcal vaccine for Africa. The project is due to start this summer.