Progress on vaccinating against meningitis is too slow, says WHO

Amid a deadly meningitis outbreak in the Democratic Republic of Congo, the World Health Organization has launched its first global road map to defeat the disease by 2030.

While vaccines are available that target the major organisms causing meningitis, progress on its reduction has been slower than that for other vaccine-preventable diseases, according to WHO.

“We already have many of the tools we need. The challenge is to make them available, accessible, and affordable while fostering innovation to complete this arsenal of tools,” said Tedros Adhanom Ghebreyesus, director-general at WHO, during a launch event for the road map Tuesday.

The road map was several years in the making. It was approved by the World Health Assembly in November, and experts have worked to finalize it since then. Following Tuesday’s launch, countries are expected to start implementation.

Because of its multiple causes, the disease can’t be eliminated entirely. Some of the roadblocks to reducing cases globally include limited resources for diagnosis and treatment, low awareness among policymakers, weak surveillance systems, insufficient access to care for those disabled by the disease, and low vaccination rates.

The road map calls for the elimination of epidemics of bacterial meningitis, reducing cases of vaccine-preventable bacterial meningitis by half and deaths by 70%, and lessening disability for those who contract meningitis. WHO estimates this strategy could save more than 200,000 lives per year and significantly reduce disability.

Meningitis, an inflammation of the membranes around the brain and spinal cord, can result in a sudden onset of symptoms, with death potentially following in only a matter of hours.

“The disease can actually turn from a mild fever to a severe disease and death very quickly,” said Ziad Memish, director of the research and innovation center at the Health Ministry in Saudi Arabia.

Survivors can face lifelong disability, including limb amputations and cognitive impacts. Children are most at risk.

Disease outbreaks are often fueled by environments with close contact between people, such as refugee camps.

“They are bedfellows with conflict, crowding, displacement, poverty, and now climate stress as well,” said Mike Ryan, executive director at WHO’s Health Emergencies Programme. “Meningitis is an outcome, very often, of that. We are lucky to have an intervention that can change the game.”

2017 saw an estimated 5 million new cases and 290,000 deaths. The burden is highest in the “meningitis belt” in sub-Saharan Africa, which runs through 26 countries. Large epidemics of meningitis occur in this region because of the climate, population displacement, and crowded living conditions.

In DRC, an outbreak declared earlier this month has resulted in 940 suspected cases and 174 deaths. At the outset, many people died from the disease; the mortality rate reached 80% at some points. There were also long delays between the detection of infections in early July and the declaration of an outbreak. The fatality rate has since shrunk to about 19%.

Immunization will play a key role in reaching targets on reducing roadblocks. Currently, vaccines exist to protect against disease caused by four organisms that accounted for over half of the deaths from acute bacterial meningitis in 2017. But these vaccines are not widely available.

“As we’ve seen with COVID, ensuring equitable access to vaccines is paramount to ending the scourge of an epidemic disease,” said Chris Elias, the president of global development at the Bill & Melinda Gates Foundation.

And vaccines don’t yet exist to prevent all causes of meningitis. Group B Streptococcus vaccines are in development but are not currently available. The type of meningitis caused by these bacteria has a particularly high incidence among newborn babies.

Treatment for meningitis relies on the heavy use of antibiotics, so an increase in vaccinations will help mitigate the negative impacts of antimicrobial resistance as well.

The road map also calls for the improvement of surveillance, prevention, and response strategies. It states that its successful implementation depends “on regional and country engagement and political willingness.”

“This is a road map, and we must make absolutely sure we don’t lose our way on this road,” WHO’s Ryan said.