Vaccination in Niger: tackling measles and meningitis outbreaks

Miriam Alía, who manages vaccination and epidemic response for Médecins Sans Frontières, provides an analysis of the meningitis C and measles outbreaks that have impacted Niger.

Understanding the persistence of measles and meningitis C

Niger continues to face recurring battles against meningitis C and measles, two highly infectious and potentially fatal diseases. Although immunization should theoretically prevent such crises, the drivers behind these specific outbreaks differ significantly.

Regarding meningitis, the global market lacks a vaccine that is both affordable and effective against every serogroup. Furthermore, limited global production—driven by a lack of commercial interest from pharmaceutical firms—means vaccines are often used only as a reactive tool once an epidemic is officially confirmed. These operational delays severely hinder the success of immunization efforts.

In contrast, the measles vaccine has been part of standard health programs since 1974. However, the current percentage of the population immunized remains too low to effectively halt the spread of the virus.

The challenge of vaccine shortages

While the situation in the African meningitis belt has been relatively stable recently, a critical lack of vaccine production remains a major hurdle. The International Coordinating Group on Vaccine Provision, which manages limited supplies to ensure equitable distribution, aimed for a minimum stock of five million doses for meningitis C. This target was not met. Consequently, medical teams are forced to wait until epidemic thresholds are reached rather than launching preventive campaigns when early warning signs appear.

Meningitis is categorized into several serogroups, including A, B, C, W135, and X, and no single vaccine protects against all of them. The most effective option currently is the quadrivalent conjugate vaccine, but its high price tag limits accessibility. A more cost-effective pentavalent vaccine (covering A, C, Y, W-135, and X) is being developed by the Serum Institute of India, though it is not expected until 2020. Because existing vaccines are expensive and new ones are in development, other laboratories are hesitant to invest in production for fear of financial loss.

The medical response in Niger

In partnership with the Ministry of Health, over 30,000 people in the Tahoua region received vaccinations against meningitis C, alongside support for patient care. A worrying discovery during this intervention was the high prevalence of serogroup X cases, for which there is currently no available vaccine—a major concern for future public health.

Alternative prevention methods are being explored, such as the use of the antibiotic ciprofloxacin. A study conducted in Niger and published in “PLOS Medicine” in 2018 demonstrated that distributing this antibiotic to entire rural communities can significantly lower disease transmission. This could become a vital tool for managing smaller-scale outbreaks in the future.

95%: To stop the spread of measles, at least 95% of the population must be protected, a target that is difficult to sustain in many areas.

Barriers to effective measles immunization

Strict age protocols often limit the impact of routine vaccination. In Niger, national guidelines target children up to 23 months, yet GAVI-supplied vaccines frequently only cover those under 12 months. This leaves out the 15-month booster shot and older children who visit health centers.

Access is further complicated by the fact that many people in Niger are nomadic or live in conflict-prone regions, making it difficult to reach stationary health facilities. Achieving the necessary 95% coverage rate remains a significant challenge under these conditions.

Strategies for better health coverage

To improve outcomes, vaccination schedules need to be more adaptable, ideally covering children up to age 5. Every medical consultation should be viewed as a chance to update a child’s immunization status.

Furthermore, “multi-antigen” campaigns are being utilized. In Arlit, within the Agadez region, medical teams responding to measles are also providing pentavalent and pneumococcal vaccines. Where possible, the tetanus vaccine is offered to pregnant women or those of childbearing age to ensure protection for both mothers and infants. Every opportunity to immunize against life-threatening diseases must be seized.

Since early 2018, Médecins Sans Frontières and the Ministry of Health have immunized more than 179,460 individuals across Niger. This includes 145,843 children vaccinated against measles in Tahoua and Agadez, and 33,620 people protected against meningitis C. Ongoing efforts in Arlit aim to reach an additional 50,000 children with a combination of essential vaccines.