Chantal Compaore, wife of the president of Burkina Faso, holds a boy being vaccinated Monday in Ouagadougou, the capital. A new, low-cost meningitis vaccine is being introduced in the West African nation.

More than 10 years ago, experts in Seattle were faced with the question of how to stop an epidemic of bacterial meningitis that has ravaged across Africa for generations and killed thousands of people at a time.

Even if an effective vaccine existed, people in the poorest countries in the world could never afford it.

Unless someone reinvented the process for making a vaccine.

On Monday, the first vaccine developed specifically for Africa began rolling out in Burkina Faso, the result of a decade of work by Seattle global-health nonprofit PATH and the World Health Organization (WHO), with funding from the Bill & Melinda Gates Foundation.

The new model they used cut the cost from the $500 million usually required to bring a new vaccine to market, to $50 million. The vaccine, called MenAfriVac, is being given to 12 million people this month at a cost of less than 50 cents per dose. It protects younger children and lasts longer than vaccines costing $4 to $50 a dose.

"This is taking what we knew from science and intentionally designing a product targeted for affordability," said PATH Chief Executive Christopher Elias. "It's a model we'll see applied more frequently to vaccine development, particularly given the financial crisis and the limitations of government financing."

But the same financial constraints now limit how much money is available to immunize 300 million people in 25 countries known as the meningitis belt and prevent epidemics. Another $475 million is needed, Elias said.

Last year, more than 88,000 cases of meningitis in sub-Saharan Africa caused 5,352 deaths, according to WHO, the largest number since the 1996 epidemic that spurred global-health leaders into action. The new vaccine targets Type A meningitis, which causes more than 80 percent of outbreaks in Africa.

Bacterial meningitis is a highly contagious infection of the brain membrane. It kills about 10 percent of patients within two days, and about 20 percent suffer long-term injury, such as loss of limbs, deafness or brain damage.

The disease strikes quickly and overwhelms health systems, said Dr. Rana Hajjeh, division director of bacterial diseases at the Centers for Disease Control and Prevention.

"Usually the whole country almost comes to a stop," she said. In 1996, "I remember seeing patients lying on the street."

Most new vaccines take decades to reach developing countries because they're not designed or priced for them. In this case, PATH set out to find a manufacturer that could produce the vaccine for Africa at the target price of 50 cents per dose.

The Serum Institute of India agreed to do that, but PATH had to help build its manufacturing capability and transfer technology from the U.S. Food and Drug Administration and a company in the Netherlands.

It helped that the vaccine didn't have to be discovered from scratch, Elias said.

"In this case we were confident the science would work," he said.

What's new is that a manufacturer from a developing country played a key role along the way. Companies in India, China and Brazil will likely be partners in future vaccine development.

"Because they're developing products for their own large domestic markets, where the kind of pricing of the U.S. and Europe isn't going to work, they're more inclined to think about affordability in the design," Elias said.

One vaccine expert suggest that the model may be limited.

Dr. Janet Englund, a Seattle Children's hospital doctor and professor of pediatric infectious diseases, said the vaccine uses an antigen "already proven to be exceedingly effective" and one that is neither expensive nor patented.

"I do see the potential for other vaccines to perhaps have similar routes to production [such as influenza vaccines], but I also see problems if this model is applied to other vaccines without understanding the many differences" with other potential vaccines, she said, such as patent issues and different target populations.

Vaccination across Africa depends on whether global donors and African countries can muster the remaining funding.

"Would we prefer that we knew now someone was going to give us the $475 million to immunize all of people in the meningitis belt? Sure," said Elias. "Has that ever really happened? No."

Elias said the Meningitis Vaccine Project partners are hoping the results of the vaccine in the six countries where meningitis hits hardest will prove how effective the investment can be.

"If we can show in those countries we actually prevented epidemic transmission in cases where the vaccine was delivered," he said, "that's a powerful health impact."

Source: The Seattle Times