From Simona Zipursky in Ferney-Voltaire, France.
Several weeks ago, a quiet revolution began in Banikoara, in northern Benin, during a new campaign to stop the deadliest cause of much-feared meningitis epidemics in the region. On that day, vaccinators hopped on motorbikes, trucks and bicycles—bearing thousands of life-saving doses of vaccine out to rural villages in the West African nation. But not one of the vaccine carriers contained an icepack—peanut butter to the jelly of vaccine delivery in Africa.
Breaking with 30 years of strict adherence to the rules of the cold chain, which require vaccines to be kept between 2 and 8 degrees Centigrade, this year’s meningitis campaign in Benin was the first in the world to allow vials of life-saving liquid to be exposed to outdoor temperatures–in this case as high as 39 degrees Centigrade (104 degrees Fahrenheit), and for as long as four days.
After regulators in Canada and India had reviewed data on the vaccine’s ability to remain stable at high temperatures, MenAfriVac became the first vaccine ever authorized for use outside the cold chain by the World Health Organization.
Across the meningitis belt, this dramatic change in policy is expected to transform the way the MenAfriVac is delivered. But it would be a shame to stop there.
The task of keeping vaccines cold is all-consuming in settings where electricity is intermittent and the freezing of ice packs a challenge. These obstacles often decide who will be immunized and when.
As new lifesaving vaccines are introduced in developing countries, we face ever-greater challenges in immunizing those most in need. Today, many countries protect children from as many as 12 diseases, and vaccines against another three to 10 diseases are expected over the next decade. Immunisation programmes initially targeted children, but are now expanding to include women and adolescents, placing growing pressure on health workers and systems.
Aware of the implications of this breakthrough for overcoming a major obstacle in delivering vaccines in some of the world’s poorest nations, health authorities, manufacturers and global partners worldwide are carefully monitoring the experience of MenAfriVac.
For decades, we’ve known that vaccines are more stable than their current labels indicate. But the relabeling of MenAfriVac, a vaccine developed by WHO and PATH in collaboration with Serum Institute of India, marks the first time a vaccine intended for use in Africa has been tested and submitted to regulatory review and approved for this type of use. Earlier this month in Ottawa, regulators and vaccine manufacturers from around the world gathered at the invitation of WHO and Health Canada, one of the regulatory agencies that reviewed MenAfriVac for use outside the cold chain. They are charged with mapping out how to take advantage of this flexibility for delivery of other lifesaving vaccines.
In describing the challenges they usually face in keeping vaccines cold, health centre managers in Benin cite lack of storage space in the cold chain for the vaccine, and obstacles to freezing enough ice packs to meet demand. To reach remote populations, vaccination teams must return every night to health centres for fresh ice packs and new vaccines. The trip can exceed two hours on a motorcycle, crossing flooded bridges and traveling rutted roads. In the morning, they start out again, often starting from the same place they left the night before, impeding their reach.
As they worked on the campaign to deliver MenAfriVac, the managers told a different story. The new guidelines for MenAfriVac freed teams in Benin to travel to rural villages for three days or more. During the recent November campaign, they were able to move on to more remote populations, rather than consuming hours every day, returning to the centre for more supplies.
The health care workers I spoke to in Benin can’t quantify how many more people they will be able to immunize under the new guidelines for MenAfriVac, but they don’t need a scientist to tell them what the impact will be. They say that if other vaccines were available with the sort of guidelines provided to them with MenAfriVac, they would be able to reach more people, more efficiently, and with confidence, and they would spend less time worrying about the cold chain and more time providing other desperately-needed medical services to the populations they serve.
We urge manufacturers and regulators to heed the requests of the health care workers on the frontlines, and take action that will move this revolution forward. They have in hand the means to provide new tools for tasks done against unimaginable odds—helping to expand access to life-saving technologies to those most at risk.
Simona Zipursky works for project Optimize, a collaboration between PATH and the World Health Organization that is funded by the Bill & Melinda Gates Foundation. She leads the Controlled Temperature Chain work.