How a revolutionary vaccine “blew away” Meningitis A outbreaks in Burkina Faso
A cold wind blows across the patio of Dao Édita’s outdoor pottery studio in Tchériba, Burkina Faso. A shiver runs through her body as she dips her hand in a bowl of water and presses her fingers into a glistening mound of clay spinning on her potter’s wheel. She contours it into the shape of a ceramic pot, for which her town is renowned.
Pottery making in Tchériba is a folk art passed down from mother-to-daughter for generations. Édita, age 56, learned it from her mother, now she teaches her daughter, Rasmata Kournarek, age 28. It’s a delicate cycle whose disruption due to illness would be catastrophic for this family surviving at a subsistence level.
“We make our living from the earth,” Édita says. “It is hard work digging up clay from the ground for making into pottery. When I grow old, my daughter will take over and care for me in retirement.”
That’s why, when the seasonal “Harmattan” winds blow in January, Édita watches the sky with a remembered sense of foreboding. According to folk wisdom, every few years the windstorms bring death and suffering to the “Meningitis Belt” of Sub-Saharan Africa. The 26-country region spans from Senegal in the west to Ethiopia in the east and is home to 500 million people. Historically, extreme Harmattan wind seasons have coincided with surges in the number of people contracting Meningitis A, a bacterial disease that affects the lining of the brain and spinal cord. Sufferers experience a range of permanent symptoms, including paralysis and deafness, not to mention a 10 percent fatality rate.
The wind’s effect has changed during Édita’s lifetime. A historic partnership between Burkina Faso and Gavi, the Vaccine Alliance, has deployed life-saving vaccines that effectively nullified the threat of Meningitis A outbreaks during the Harmattan windy season.
As Édita molds her pot, she looks over at her daughter who has two small children of her own sitting beside her. They’ve received full schedules of routine immunizations, protecting them against Meningitis A, rotavirus, pneumonia, and many other vaccine-preventable diseases. Still, she can’t shake from her mind the memory of years when people died by the thousands.
The risk is gone, Édita tells herself.
In January 1996, a dust storm appeared on the northern horizon that carrying dirt from the Sahara Desert some 1,500 miles away. Within hours, the sky darkened, temperatures dropped, and the humidity level plummeted across the Meningitis Belt. When the dust settled, many weeks later, 25,000 people had died from an outbreak of Meningitis A across the region. A few years later, in 2000, another Harmattan dust storm coincided with a similar outbreak that killed 1,500 people. The cycle repeated every 8 to 15 years, dating back at least to an epidemic in Nigeria in 1905. (The world’s first recorded meningitis outbreak was in Geneva, Switzerland, in in 1805. French soldiers brought meningitis to Africa in 1840, though cases were few until Nigeria’s epidemic in 1905.)
“In the minds of the people, Harmattan winds spread Meningitis,” says Dr. Komi Ahawo, country manager of Gavi, the Vaccine Alliance. “Parents are afraid to let their children go outside. They coat their noses in shea butter and nobody shakes hands for months at a time because they are afraid of catching the disease.
Researchers have studied the correlation between the Harmattan wind season and Meningitis outbreaks, but the biological link is unclear. Bacterial meningitis can travel airborne, although in such small quantities it couldn’t possibly trigger mass outbreaks. More likely, dry and cold seasonal conditions aggravate mucus linings in people’s throats, increasing rates of infection. After all, 10 percent of the human population carries bacterial meningitis without experiencing symptoms. And the adverse weather conditions create living conditions conducive to the spread of all diseases: gathering indoors, infrequent bathing (too cold for outdoor bathing), increased coughing and spitting.
Yet, windstorms happen elsewhere in the world without causing disease outbreaks. Why was the Harmattan season any different? Part of the reason was because, for a long time, low-income nations like those in the “Meningitis Belt” couldn’t afford basic immunizations, such as an expensive Meningitis A vaccine sold by pharmaceutical companies for $100 per dose – too expensive for Burkina Faso to afford.
Gavi, the Vaccine Alliance, was founded in 2000 to address the inequity in access to life-saving vaccines around the world. The organization generates buying power by grouping the vaccine needs of low-income nations in order to negotiate lower pricing with pharmaceutical companies, while also helping improve vaccine programs on the ground.
In Burkina Faso (and many other countries inside the Meningitis Belt), the turnaround has been remarkable. Thanks to Gavi’s support, and the hard work of the Burkinabe ministry of health, WHO, UNICEF and other partners, immunization rates for basic childhood vaccines – such as diphtheria, tetanus, and pertusis (DPT) – have skyrocketed from 45 percent in 2000 to 91 percent in 2018.
“For more than 10 years, we’ve been above 90 percent of DTP3 coverage,” says Awaho.
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While Gavi was helping introduce routine immunizations, a partnership of groups including WHO, PATH, Serum, and others worked to develop a new, affordable vaccine for Meningitis A. In 2001, the partners started developing MenAfriVac, a vaccine that cost only $.60 a dose. It was approved in 2010, when Gavi helped launched the immunization campaigns, first in Burkina Faso, then across the Meningitis Belt. Since then, 305 million people have been immunized as part of the received Meningitis Vaccine Project. The effect has been near-immediate, with the last significant Meningitis A outbreak occurring in 2015 (80 confirmed cases).
A group of boys kicks off their sandals before walking into a dirt courtyard at the Association for Awakening Art and Culture in the city of Bobo-Dioulasso. Traditional dancers perform barefoot and the boys belong to a troupe called “The Mosquitos.” The boys, who range in age between 3 and 15, belong to the “vaccine generation” who has grown up with the benefit of robust routine immunizations. Many of them have known people afflicted by disease, so they understand how good health enables them to do things like dance and go to school.
“I think vaccinating children is a noble act,” says Issiaka Sanou, age 13. “It allows us to be healthy enough for the activities we want to do. Today, I was able to carry out my studies at school and do my dance rehearsals.”
The Meningitis A vaccine has been something of a Trojan Horse for improving coverage of other vaccines.
“In 2018 we had a measles outbreak in almost half the country,” says Dr. Annick Sidibe, an immunization specialist at Burkina Faso’s Ministry of Health. “The problem was that our coverage rate for second-year vaccines, which include the measles booster, was too low. But we knew parents are afraid of their children getting meningitis, so we moved the Men A vaccine to the second-year schedule and that’s motivated a lot more parents to come in.”
However, there are still some diseases troubling the people of Burkina Faso. In recent years, there have been outbreaks of a new strand of bacterial meningitis (serogroup W135), which MenAfriVac doesn’t protect against. The MenACWY conjugate vaccine costs $300 a dose, putting Burkina Faso again in the position of an economic disadvantage. Once again, PATH is working to develop another new, affordable vaccine that’s undergoing trials and could be available for distribution by Gavi in just a few years.
In late-February, traditional artists will travel from across West Africa to attend the 15th edition of the International Mask and Arts Festival in Dédougou, Burkina Faso. The biennial event was founded to celebrate and preserve the rich cultural heritage of folk artists in Sub-Saharan Africa. The Mosquitos dance troupe from Bobo-Diolasso will be there to perform, and the potters of Tchériba will attend to display their wares. But the main attraction for visitors traveling from around the world will be performances by the masquerade dancers whose ornate costumes and rhythmic dances take viewers on a visual journey into a fantastical and mythological time in Burkina Faso.
It will be the tail-end of the 2020 Harmattan season. If the winds happen to blow, the gusts will have the intended effect of animating the extravagant costumes worn by the dancers. Because, thanks to the work of Gavi, the Burkinabe government and partners, the ill effects of the Harmattan seasons have blown away with the wind.