As Nigeria takes stock of the heavy toll of the current meningitis outbreak on its citizens, concerns persist over the continuing failure of the authorities to take obvious measures to check the recurrent disease.

The current outbreak this year became an epidemic, despite the country’s past experiences with the disease and early warnings by local and international health agencies of its imminence.

The outbreak, which was first recorded in November last year in Zamfara, killed about 813 persons in 23 states across the country within 16 weeks.

Long before the first case was recorded in Zamfara State, however, the World Health Organisation, WHO, and the National Primary Health Care Development Agency, NPHCDA, the agency in charge of primary health care in Nigeria,  had issued stern warnings of likely Meningitis C outbreak in Nigeria due to previous occurrences and the epidemiological cycle of the disease.

In July 2015, the WHO predicted an outbreak of Meningitis C in Nigeria and some other African countries in 2016 and called for step-up in the production of vaccines to contain the disease before the 2016 meningitis season would start in January.

According to the WHO, in a statement published on its website, Africa was at large risk of Meningitis outbreak and an acute shortage of Meningitis C-containing vaccine threatened to severely limit the world’s ability to minimize the number of people that would be affected.

In a background to the grim prediction, William Perea, Coordinator for Control of Epidemic Diseases Unit at WHO, said meningitis tends to hit Africa in cycles. He pointed out that cases of Meningitis C had been rising since 2013, first in Nigeria in 2013 and 2014, and then in 2015.

“We have to be ready for a much larger number of cases during the 2016 meningitis season”, he warned.

Somehow, the warning went unheeded.

Instead, the Federal Ministry of Health did not start procurement of the vaccines until after deaths from the disease were reported in Zamfara and Sokoto. The two northern states were hardest hit by the outbreak, with close to 400 deaths recorded in Zamfara state alone.

According to the WHO, this year’s was the fourth Meningitis C outbreak in Nigeria in the last five years.

The difference this year, however, was that it is of epidemic nature, as 9,645 cases were suspected and 813 deaths recorded in 43 local government areas in 23 states in the country.

Zamfara, Sokoto, Katsina, Niger, Kebbi were the states most affected. Zamfara was the first to record the outbreak in November 2016. But the state did not report it to the appropriate health agency for intervention until February, about four months after the first incident.

According to Health Minister, Isaac Adewole, the Nigerian government could not immediately start the administration of vaccine to the affected states because it did not have vaccines for the type C meningitis in stock. It was after the outbreak that the authorities started soliciting the assistance of the WHO and other international partners to procure vaccinations and drugs to contain the spread of the deadly disease.

Mr. Adewole, a professor of Medicine, said containing the spread of the disease had at that point become an emergency for international health agencies, the federal government, state government, local government and concerned individuals across the globe.

Explaining why the country did not act on the early warnings ahead of the outbreak, the Minister of State for Health, Osagie Ehanire, said the drugs and vaccines are “extremely expensive” and have a short shelf life.

“The vaccines are expensive to make and if acquired and stored without use, they could expire and there is just a limited stock of the type C vaccine as it is not much in demand. This outbreak has led to a greater demand,” he said.

Though there is now a decrease in the rate of causalities, the government has now succeeded in providing vaccination only in two states, Zamfara and Sokoto.

Other states were yet to be catered for at the end of April, as the government had not been able to procure enough vaccines due to shortage of supply across the globe.

Statements from the Nigerian Ministry of Health showed that the government within the first month of soliciting international support got an estimated 1,300,000 doses of the vaccine. These consist of 500,000 vaccines from WHO and 800,000 from the British government. It said it was still expecting more vaccines from other international health donors.

Vaccine shortage

In 2015, the International Federation of Red Cross and Red Crescent Societies, IFRC, Médecins Sans Frontières, MSF, United Nations Children’s Fund, UNICEF, and WHO; (the four organizations organisations, which together constitute the International Coordinating Group for Vaccine Provision for Epidemic Meningitis Control – ICG) had called on vaccine manufacturers to step up meningitis C-containing vaccine production by five million doses ahead of the 2016 meningitis season in January.

“We have had preliminary discussions with vaccine manufacturers and impressed upon them (manufacturers) the need to produce a stockpile of five million doses of vaccine so as to be ready for flare-ups of the disease next year in Africa, but so far they haven’t yet revised their production plans to meet demand”, said Imran Mirza, Health Specialist, Program Division, UNICEF.

According to the WHO, substantial progress had been made in recent years in protecting Africa from other main sub-types of meningitis with, for example, the introduction of the MenAfrVac vaccine against meningitis A in 2010, which was also administered in Nigeria same year.

Much work, however, needs to be done to protect the African meningitis belt from meningitis C outbreaks.

Within six months in 2015, there were 12,000 cases of Meningitis C in Niger and Nigeria, and 800 deaths recorded from both countries.
Though there are few vaccine manufacturers globally, Nigeria unfortunately is one of the countries where infectious vaccine preventable diseases become endemic due to lack of vaccines to prevent occurrences.

Health experts have lamented the inability of Nigeria to produce vaccines locally.

The Nigerian Medical Association, in a press statement during the meningitis outbreak, lamented the government’s response to the epidemic and condemned the late immunisation of Nigerians against the disease.

Mike Ogirima, president of the association, said the government’s reactive measures were ineffective based on the epidemiology of the disease and demanded immediate resuscitation of local vaccine production (LVP) at Yaba, Lagos State and the expansion of the scope of LVP at the National Veterinary Research Institute, Vom, Plateau State. The facility in Yaba has been moribund since 1991.

“Our pharmaceutical industries should be challenged and supported to produce our consumables. This should be the new order instead of budgeting huge sums of money for importation of vaccines and other consumables”, Mr. Ogirima said.

The minister, Mr. Adewole, had said the country will need $1 billion to vaccinate 21 million people against the strain C meningitis.

In an interview with the Nigerian Guardian newspaper, Toyosi Raheem, National President, Association of Medical Laboratory Scientists of Nigeria, AMLSN, said the government needs to encourage local production of vaccines in the country and the resuscitation of the laboratory in Lagos.

He recalled that the Lagos laboratory was producing bacterial vaccines for local use and for export to neighbouring countries in the 60s and 70s, before it went moribund.

He, however, blamed gross mismanagement and corruption across all sectors, inappropriate leadership, lack of teamwork among health professionals and lack of commitment to the Nigerian project for Nigeria’s inability to produce its own vaccines.