Niger: after vaccination, the hope of a substantial reduction in meningitis A epidemics

Dosso, Niger

It is almost midday. The air is dry and rasping. By the side of the road, sheltering under some branches, five women patiently await the arrival of the last people to vaccinate. We are in Tourobon, a village in the Dosso district, and it is the last day of the vaccination campaign against meningitis and meningococcus A. The two vaccinators, the preparer and the pointer (the person who records the number, age and gender of those vaccinated) explain to the Médecins Sans Frontières (MSF) team that they have only vaccinated 39 people since this morning.

"It's the end! We are sure to have vaccinated all the children and women aged 30 and over in the village and its surroundings. Some men aged 15 to 29 are still out in the bush, as they finish millet-gathering, and they have to be vaccinated at the end of the day. Some have already gone off to find work elsewhere after the harvest, but in total, we will have been able to vaccinate almost everybody" explains one of the vaccinators, draped in a long multicoloured dress.

Initial results from the vaccination campaign in the Niger districts of Dosso and Boboye, in which MSF took part, are indeed satisfactory: more than 90% of the 627,000 people aged between 1 and 29 were immunised between 7 and 17 December. "It is encouraging, because this is a new vaccine which gives protection for 10 years, and if the coverage rate is really so high, this could prevent the outbreak of meningitis A epidemics, the most common form of this disease in Africa" confirms Seco Gerard, field coordinator for Médecins Sans Frontières in Dosso. This major vaccination campaign – also carried out in neighbouring Mali and Burkina Faso – will continue until the end of 2011 and will end up covering the entire territory of Niger.

In the Dosso and Boboye districts, MSF has provided support to the Ministry for Public Health and its 300 vaccination teams. Thanks to its experience in implementing major vaccination campaigns[1], the humanitarian organisation enrolled 22 international volunteers to take part in supervising the vaccination teams, to support vaccine conservation by providing part of the "cold chain" and to support waste neutralisation and destruction.

Supervision and cold chain
"Supervision occurred in conjunction with specialists from the Ministry for Health. Specifically this involved checking whether the teams had enough material required for vaccination, ensuring satisfactory hygiene and injection techniques, using more ice packs when the vaccine conservation temperature was too high" explains Seco Gerard.

The cold chain is actually an essential part of any vaccination campaign. Over 600,000 doses of the vaccine destined for the inhabitants of Dosso and Boboye had to be permanently stored between 2°C and 8°C, from their production in India to their administration in the farthest-flung villages. In order to do this, MSF set up 6 refrigerators and 33 freezers in Dosso, designed to produce ice in the form of ice packs, which are small plastic containers slipped into iceboxes used to keep vaccines cold during transport and use on vaccination sites.

Dragon Incinerator
A vaccination campaign of this size generates a lot of waste, and along with the authorities in Dosso and Boboye, MSF defined how this waste would be recovered and destroyed. Waste is classified into three categories. The first includes plastics, packaging, cotton and gloves. These are burned on-site at health centres, and because the residual waste created is not a health risk, they are buried on-site at the main vaccination centres. The second includes glass vaccine bottles and the thinners used. These are collected and crushed in 200-litre metallic barrels, which are then neutralised with concrete and buried in trenches one metre deep.

Finally, the third category is the largest: it includes syringes and needles used, packed into plastic-coated board security boxes – around thirty cubic metres in total. "In order to destroy these, we called in a "Dragon" incinerator especially for this vaccination" explains Yann Tauleigne, MSF waste management manager. "For increased security, any residual waste will also be encapsulated into concrete barrels and buried."

"MSF seldom gets involved in prevention campaigns such as this one. Normally we vaccinate in an emergency when faced with an epidemic, in an attempt to stop it in its tracks by cutting off the germ transmission chain. But in this specific case, it was important for us to get involved right from the introduction of this new vaccine, since MSF followed its development closely, especially the fact that it could be made available at an affordable price." If it is used widely, then there is a real hope of seeing a sharp drop in bacterial transmission, and thus in meningitis A epidemics" explains Tanja Ducomble, who works with MSF vaccination support, present in Dosso.

[1] In 2009, MSF vaccinated 7 million people against meningitis A in the "meningitis belt", an area stretching from Senegal to Ethiopia. The vaccine used that year in response to a major epidemic only offered protection of three years.