Bill & Melinda Gates Foundation

Meningitis A Vaccine Breaks the Cold Chain Barrier

January 02, 2013

It’s 7:30 a.m. on Thursday November 15, the first day of the MenAfriVac campaign in Banikoara, in northern Benin. People are excited, the “disease that makes your neck stiff,” or as we know it, meningitis, is unfortunately well known here, and the chance to be vaccinated against it is one people are lining up to seize.

Usually on campaign days, the staff at Kokey health center would already be on their motorbikes, travelling down a dusty, pothole-filled dirt road to the district capital in order to pick up vaccines and icepacks. Kokey has no functional cold chain at the health center. As vaccines are generally  required to be kept in a cold chain, between 2°–8°C, each immunization campaign day requires a run to the district capital and back again. On a good day, in dry season, it takes an hour.

But with this campaign, things are different.

Banikoara is home to the world’s first controlled temperature chain (CTC ) campaign. MenAfriVac, a vaccine produced by Serum Institute of India through the Bill & Melinda Gates-funded Meningitis Vaccine Project, a partnership between WHO and PATH, is the first vaccine to be prequalified by WHO for use at ambient temperatures of up to 40°C for up to four days. During the MenAfriVac campaign held November 15–25, 2012, over 147,000 people were vaccinated using the CTC approach.

For the Kokey health center, the CTC approach means daily trips to pick up ice are no longer needed, and trips to get vaccines only need to be done once every four days. Instead of ice packs, a small paper card, a peak threshold indicator, is placed inside the vaccine carrier to ensure that the vaccine is not exposed to temperatures above 40°C. Together with the vaccine vial monitor, a little sticker on the vaccine vial which monitors cumulative exposure to heat over the life of the vaccine, vaccinators can confidently administer MenAfriVac without needing to worry about ice packs or the inadvertent risk of freezing (MenAfriVac’s diluent contains an aluminum adjuvant which, if exposed to freezing temperatures, can be damaged, reducing the efficacy of the vaccine).

At another health center in Benin, the flexibility offered from the new CTC approach is being used in a different way. The Founongou health center is responsible for a large population, with many villages over a two-hour motorbike ride away. Usually vaccinators have to return each night to Fonoungo to get new vaccines and frozen ice packs, and then in the morning, start out again for the villages. This means that in some instances, not all remote communities were reached during a campaign. On November 15, 2012 Founongou sent out a team of vaccinators to Kanderou, a village almost two hours away by motorbike. To get there involves crossing three almost sunken bridges and a back of steel to survive the bumps in the road. Rather than having to make that trek each day, vaccinators will base themselves out of Kanderou, and for four days, conduct their outreach activities from there, allowing them to reach more remote villages, and ensure all those at risk from meningitis A are protected.

The CTC campaign in Benin was a pilot, run jointly by the Government of Benin, WHO regional office for Africa, Agence de Médecine Préventive, the Meningitis Vaccine Project, and Optimize (another collaboration between WHO and PATH aimed at developing immunization systems and technologies for the future). This was first time the guidelines and training materials developed by WHO’s Immunization Practices Advisory Committee on how to safely use vaccines in a CTC during meningitis A campaigns were tried, the first time we used peak threshold indicators for MenAfriVac, and the first time we got input from health care workers on how this can and should work in the future.

Although the final campaign results and evaluations have yet to be tabulated, so far things look promising. Not just for the results of the pilot, but for all the African countries still planning to introduce MenAfriVac over the next few years—Burundi, Central African Republic, Democratic Republic of Congo, Erithrea, Ethiopia, Gambia, Guinea, Guinea Bissau, Ivory Coast, Kenya, Mauritania, Nigeria, Rwanda, South Soudan, Tanzania, Togo, Uganda —which now have the opportunity to run their campaigns more efficiently and effectively, without being constrained by ice. It may seem like a small thing, but for countries, it’s a small thing that will make things a lot easier.

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