Participants at a WHO meeting (Ouagadougou, Burkina Faso, Sept 23-24, 2002) called on vaccine manufacturers to reduce the price of a tetravalent meningitis vaccine to less than US$1 per dose to help Burkina Faso and other African countries fight a potential W135 meningitis epidemic.
"Unfortunately, the latest offer from GlaxoSmithKline (GSK), which manufactures the vaccine that immunises against A, C, Y and W135 strains, is $2.75 per dose. This is simply too high for Africa", Bernard Pecoul of Médecins Sans Frontières (MSF) told The Lancet.
To build up emergency vaccine stocks to manage meningitis outbreaks in Africa, the International Coordination Group on Vaccine Provision for Epidemic Meningitis Control - which includes WHO, MSF, UNICEF, and the International Federation of the Red Cross and Red Crescent - will make a $10 million appeal in the next few weeks.
Over the next 5 years, Africa needs an estimated 20-50 million doses of the vaccine to fight meningitis. However, "vaccine manufacturers have indicated they can supply Africa with only 2 million doses next year because they don't have the production capacity to cover all of Africa", according to Pecoul.
In the past, most large meningitis epidemics in Africa had been caused by group A meningococci. But between February and May this year, a W135 strain outbreak in Burkina Faso infected 13,000 people and resulted in 1,500 deaths, mostly in children. Many of those who survived developed disabilities.
Josef Decosas (Regional Health Advisor for Plan International, West Africa Region, Accra, Ghana) warns that: "Our lack of preparedness for 2003 is scandalous. The industry may not have received clear signals as to what is needed. It is time to give those signals now. This is an issue that can be solved next year if we all stop playing strategic games with the lives of African children".
Each year, Aventis Pasteur and GSK supply 12 million doses of the quadrivalent vaccine to rich countries at a price ranging from $4 per dose in the Middle East to $50 per dose in the USA. Burkina Faso and other African countries are simply too poor to buy these. A mid-term solution put forward at the meeting is to introduce a monovalent W135 vaccine at less than $0.50 per dose. However, Aventis Pasteur believes it would take 4-5 years to produce the vaccine.
Decosas disagrees, saying the real constraint on increased production is industry's own strategy for profit. Although at a price below $1 the industry can still make an acceptable profit, "expanding vaccine production to the level where it could make a difference in Africa could potentially undermine its very lucrative profit margins in rich countries", he noted.
In 1974, Merieux (now merged into Aventis Pasteur) made 90 million doses of a monovalent vaccine in only 6 months to help Brazil manage a group-A meningitis epidemic. "If such a fast-tracking manoeuvre was possible with the know-how and technology that was available more than 25 years ago, it must be feasible today", MSF argued.
Over the next five years, Africa needs an estimated 20-50 million doses of the vaccine to fight meningitis. However, "vaccine manufacturers have indicated they can supply Africa with only 2 million doses next year because they don't have the production capacity to cover all of Africa", according to Bernard Pecoul, Director of the MSF Access to Essential Medicines Campaign.