This World Immunization Week, CoMO is talking about how vaccines bring us closer and the need to maintain high levels of vaccine uptake to prevent the preventable and defeat meningitis.
Since the start of the Covid-19 pandemic in December 2019, everyone worldwide has experienced – some for the first time – what it means to live with a dangerous disease in their midst. This new reality has spurred scientific ingenuity and new partnerships, all seeking to race towards a future where people can resume the lives they had pre-Covid. The sheer demand for a vaccine to protect against Covid saw huge gains being made in vaccine development. Delivering these vaccines to everyone in a safe and equitable manner is a huge logistical challenge but there are gains there as well, with the COVAX program having effectively delivered over 38 million vaccines.
While there are still many challenges ahead, these encouraging strides mean many countries are looking to relax physical distancing restrictions. After a tough year, it is reasonable to want to rush to live life to the fullest as quickly as possible. However, given disrupted immunisation services, there is a risk that we see a resurgence of vaccine preventable diseases (VPDs) like meningitis once people start to gather again. Public health measures like physical distancing and masks, aimed at curbing the spread of Covid-19, have also been effective at stopping the spread of other infectious diseases like meningitis. Spain, for instance, has reported a 90% fall in meningitis cases over the past year which is excellent but we cannot be complacent because meningitis has not vanished. Maintaining routine immunisation rates is still incredibly important if we are to emerge from this public health crisis without falling into a new one and there may be problems ahead. In the US, a report warned that routine vaccinations declined as much as 26% in comparison to 2019. France has reported 57% of routine immunisations affecting children have been postponed or cancelled. These figures are a cause for concern because even small declines in vaccine coverage threaten the true power of vaccines - how they protect others, not just the person who is immunised.
This form of indirect protection from infectious diseases is called herd immunity, herd protection or community immunity. Most vaccines, such as Hib and the MenACWY vaccines, offer this kind of protection so when enough people in a group are immunised, it disrupts the spread of the bacteria. This protects those who cannot be immunised including: babies who are too young to be vaccinated, people with chronic illnesses and people who are taking medication that affects their immune systems. Stopping the spread of disease protects these at-risk individuals and it is vital for diseases like bacterial meningitis because an estimated 1 in 10 people carry the meningococcus bacteria in their throats. Most carriers never develop meningitis but they may unknowingly transmit the bacteria to others. While only a small portion of those who come into contact with the bacteria develop meningitis, the disease can be devastating and unfortunately we do not fully understand why only some people get ill from germs that are harmless to most of us.
That’s why vaccines are such a powerful tool in our arsenal to defeat meningitis and there is lots of evidence for this. In 1996-1997, the epidemic-prone region known as the Meningitis Belt in Africa (stretching from Senegal in the West to Ethiopia in the East) experienced a MenA epidemic, resulting in over 250,000 cases and 25,000 deaths. A low cost vaccine to immunise against MenA, known as MenAfriVac, was introduced and Burkina Faso was the first country to start the vaccine roll-out, immunising an amazing 11 million people in the first 10 days. The results? In the years that followed, there have been no reports of the disease among the 153 million people who received the vaccine as part of the program. An estimated 142,000 lives were saved and 284,000 permanent disabilities were averted. The benefits are even felt in non-epidemic prone regions; when the UK introduced the MenB vaccine to prevent meningococcal meningitis type B, cases decreased by 75%.
It’s easy to ignore the benefits of vaccines when we do not necessarily see the impact they’ve had on people’s lives. We can only truly understand the impact of vaccines when we see how quickly a disease like meningitis can turn someone’s life upside down.
Jamie, of The Jamie Group, is a gold-medal winning cyclist and a powerful advocate to prevent the preventable. Here she shares her meningitis story, acknowledging that there are many others who sadly do not survive to tell theirs.
The way in which vaccines can prevent epidemics and stop people from experiencing a serious disease with life-long impacts is why one facet of the Global Roadmap to Defeat Meningitis by 2030 is "Prevention and Epidemic Control". With this plan, there’s newfound hope and a validation of people’s experiences of the disease, one that has, historically, not received the attention it’s due. Despite the positive steps taken to introduce the MenA vaccine on the meningitis belt and the MenB vaccine in the UK, there is a lot of work left to do. Meningitis and neonatal sepsis combined is the second leading infectious cause of death in children under the age of five, making it deadlier than malaria. Progress in reducing the number of cases and deaths from meningitis is still lagging behind other vaccine preventable diseases. Between 1990 and 2019 the number of deaths caused by measles and tetanus fell 90% and 91% respectively. For meningitis? That number is just 61%.
What you can do to help #DefeatMeningitis
Our members and supporters know all too well the devastation meningitis can cause. Its rapid onset can take a life in under 24 hours or lead to serious, life-long after effects. Meningitis is always a medical emergency and so prevention – and specifically immunisation - is the best way to combat the disease.
Safe and effective vaccines against meningococcal disease have been available for more than 40 years and we recommend keeping up with your routine immunisations and speaking to your local healthcare provider to finding out what is available for you. Keep in mind that multiple vaccines are needed to be protected against the most prevalent strains of meningitis and it is possible that not all of the available vaccines are being recommended by doctors in your area. The Meningitis B Action Project conducted a study amongst healthcare providers in the U.S. and found that 49% of pediatricians and 69% of family physicians did not discuss the MenB vaccine during routine visits for 16-18 year-olds, despite this group being at higher risk of meningitis. Meningitis awareness is still too low, even amongst doctors, with nearly 50% of providers not being aware of ACIP's (Advisory Committee on Immunization Practices) recommendations for the MenB vaccine. That's why we encourage everyone to be proactive and to ask doctors about all of the available vaccines for meningitis.
If you are unable to access vaccines to protect against meningitis we recommend learning the signs and symptoms and seeking treatment as soon as possible if you suspect meningitis. You can also adopt other protective behaviours like not smoking, keeping surfaces clean, washing your hands regularly and avoid sharing anything that’s already been in contact with someone else’s mouth (e.g. drink, cigarette etc.). Please keep in mind that, even if you are fully vaccinated, knowing the signs and symptoms is still important because not all types of meningitis are vaccine preventable.
In the context of Covid-19, preventing diseases we already know how to prevent safely and effectively is something we must all work on. Doing so means we protect our loved ones and our healthcare systems that have to focus their resources on getting through a pandemic.
References  https://www.gavi.org/covax-vaccine-roll-out  https://www.euroweeklynews.com/2021/04/24/cases-of-meningitis-in-spain-drop-by-90-per-cent-in-last-year/  https://eu.lansingstatejournal.com/story/news/2021/04/12/michigan-routine-vaccine-rates-decline-coronavirus-covid-pandemic/7187021002/  https://www.euractiv.com/section/health-consumers/news/health-expert-routine-immunisation-should-not-be-put-on-back-burner-due-to-covid/  https://www.meningitis.org/meningitis/vaccine-information/hib-(haemophilus-influenzae-type-b)-vaccine  https://www.meningitis.org/meningitis/vaccine-information/meningococcal-groups-acwy-vaccine-in-the-uk  http://millionssaved.cgdev.org/case-studies/eliminating-meningitis-across-africas-meningitis-belt  https://www.nejm.org/doi/full/10.1056/NEJMoa1901229 https://www.who.int/immunization/sage/meetings/2019/april/1_DEFEATING_MENINGITIS_BY_2030_A_ROADMAP_Draft_goals_and_milestones.pdf?ua=1  https://meningitisbactionproject.org/provider-survey  https://www.comomeningitis.org/prevention