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HEALTH & EDUCATION

Nigeria is Pioneering a New Vaccine to Fight Meningitis – Why this Matters

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Nigeria recently became the first country to roll out a new vaccine (called Men5CV) recommended by the World Health Organization (WHO), which protects people against five strains of meningococcus bacteria. Idris Mohammed, a professor of infectious diseases and immunology and former board chair of Nigeria’s National Programme on Immunisation,  explains the new vaccine and its likely impact.

What is meningitis?

Meningitis is the inflammation of the tissues surrounding the brain and spinal cord, usually caused by infection. It can be fatal. Meningitis can be caused by several species of bacteria, viruses, fungi and parasites. The highest global burden is seen with bacterial meningitis. Around one in six people who get this type of meningitis die. One in five have severe complications

The main bacteria responsible for the disease are Neisseria meningitidisHaemophilus influenzae and Streptococcus pneumoniae. The main symptoms are sudden high fever, backache, stiff neck, headaches, nausea, vomiting and intense dislike for sunlight (photophobia). Patients with a severe infection can experience confusion, delirium and loss of consciousness. Meningitis can affect people of any age.

Meningitis bacteria are transmitted from person to person through droplets of respiratory or throat secretions from carriers. Kissing, sneezing or coughing on someone, or living in close quarters with an infected person, facilitates its spread. The average incubation period is four days but can range between two and 10 days.

Epidemics of meningitis are seen across the world, particularly in sub-Saharan Africa. The so-called “African meningitis belt” consists of 26 contiguous countries from Senegal and The Gambia in the west to Ethiopia in the east. Outbreaks have also been reported in countries outside Africa like Canada, Belgium, France, Brazil and Denmark.

Why does Nigeria have a high burden of meningitis?

Nigeria’s 19 northern states are within the African meningitis belt. A few southern states such as Osun, Ogun and Anambra are also affected. The major factors that determine meningitis infection include a hot and dry environment and dusty atmospheric conditions.

Between 1 October 2022 and 16 April 2023, Nigeria reported 1,686 suspected cases of meningitis, including 124 deaths, for a case fatality ratio of 7%. The highest proportion of reported cases is among children aged 1 to 15 years. Factors that contribute to meningitis are all present in northern Nigeria. Low or no vaccination; presence of carriers; under-nutrition; overcrowding; scarce rainfall; low humidity; high temperatures. It’s often over 35°C, sometimes as high as 45°C.

The general population can’t afford nutritious foods that can boost the immune system. Add to these factors the level of education, poor hygienic conditions and overcrowding, and perfect conditions for an epidemic outbreak are complete. Although the burden of epidemic meningitis is highest in the north of Nigeria, there is sporadic infection countrywide.

What’s specific about the meningitis strains in Nigeria?

There are five strains of meningitis in Africa: serotypes A, C, W, X and Y. Infectivity and clinical features (symptoms and signs) are the same with the strains. These features were established by serotype A, which was the first and dominant strain in the country. The severity of the infection may be higher with the new variants, such as group C meningococcal, as seen in some cases in north-western Nigeria. Serotypes W, X and Y may have similarly higher severity because the organisms are new to the country. Immunity to them is therefore not strong enough.

What makes this new 5-in-1 vaccine so special?

For more than a century, epidemics of meningococcal meningitis have ravaged the African meningitis belt. Some of the earliest prevention attempts involved the use of sulphur drugs and penicillin based antibiotics.

But these were not successful in preventing outbreaks. Mass use of sulphur-based drugs for prevention had to be abandoned because by the 1970s Neisseria meningitides had become resistant to these drugs.

The next obvious line was to consider vaccination with available polysaccharide vaccines. These use specific pieces of the disease-causing germ, like its protein, sugar, or the casing around it. They give a very strong immune response that targets key parts of the germ.

There was only one such vaccine available at the time. This was the A+C vaccine (Institut Meriuex), which had never been used routinely or on a large scale until an epidemic in Bauchi in 1978. The vaccine terminated that epidemic within a few weeks.

Since then, several researchers like John Robbins have advocated intensified mass vaccinations with the polysaccharide vaccines. But the WHO was reluctant, with fairly good reason.

Polysaccharide vaccines are poorly immunogenic, meaning not able to elicit protective immunity to the disease – particularly in young children, because they do not have immune memory. So the vaccines are not cost-effective or sufficiently protective.

The 1996 outbreak in northern Nigeria affecting over 120,000 people and causing 12,000 deaths – and described by the WHO as the largest in recorded history – changed the narrative. A joint WHO/PATH “Meningitis Vaccine Project” facilitated by the Bill and Melinda Gates Foundation produced the highly effective conjugate meningitis A vaccine (known as MenAfriVac). Over 260 million people in the African meningitis belt were vaccinated with it. This led to the virtual elimination of meningococcal A serotype.

But serotypes C, W, X and Y then emerged. Hence the critical importance of the 5-in-1 (also known as MenFive, or Men5CV). Proper and sustained vaccination with the 5-in-1 vaccine should put paid to epidemics of meningococcal meningitis in Africa.

What impact will the new vaccine have on meningitis control in Nigeria?

By containing the five most important serotypes causing meningitis in Nigeria, this vaccine is bound to have a far reaching positive impact on control of the disease. Among all the 26 African countries within the African meningitis belt, Nigeria is by far the most populous. Thus an epidemic of the disease affects many people.

Before the year 2000 hardly a case of serotype C, W, X, or Y had been reported in Nigeria. The success of group A conjugate MenAfriVac introduced in 2010 in Burkina Faso has changed the pattern and periodicity of epidemic meningitis, and the real challenge and menace of replacement serotypes underscores the critical importance of the 5-in-1 conjugate meningitis vaccine. Its impact will be huge.

Idris Mohammed is a Professor Emeritus, Gombe State University

Courtesy: The Conversation


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HEALTH & EDUCATION

Islamic Development Bank Opens Two New Hospitals in Indonesia

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By Our Special Correspondent

On August 31, 2024, Indonesia reached a significant milestone in its healthcare sector with the inauguration of two state-of-the-art hospitals by President Joko Widodo and Dr. Muhammad Al Jasser, President of the Islamic Development Bank (IsDB). This event was part of a broader initiative to introduce six new hospitals across the nation, collectively adding over 1,000 beds to address the growing healthcare demands of Indonesia’s burgeoning population. This ambitious project not only aims to expand access to healthcare but also to bridge the gap in medical service availability, particularly in underserved areas—a challenge faced by many developing nations.

Two Hospitals Indonesia: Specialized Care Advancements

These new facilities are equipped with cutting-edge medical technologies and infrastructure, emphasizing specialized care, particularly in maternal and child health. Maternal and child health is a critical focus area globally, as it impacts the core of family and community well-being. High rates of maternal and infant mortality have been persistent challenges in Indonesia, as well as in many other developing countries. The targeted approach of these new hospitals aims to address these issues head-on by providing high-quality, specialized care.

Dr. Al Jasser emphasized the transformative potential of these hospitals on Indonesia’s healthcare landscape. The specialized care units for children and mothers are expected to provide life-saving treatments that could significantly reduce mortality rates and promote healthier futures for the country’s next generation. The use of advanced medical technologies in these hospitals also sets a new standard for healthcare delivery in Indonesia, providing models that other regions may replicate.

Sustainable Development and Strategic Partnerships

The development of these hospitals aligns closely with Indonesia’s broader sustainable development goals. Enhanced healthcare infrastructure not only meets immediate health needs but also supports long-term societal growth and stability. By prioritizing health, Indonesia is investing in its human capital, which is essential for sustained economic development and societal well-being. This investment is in line with the United Nations Sustainable Development Goals (SDGs), particularly SDG 3, which focuses on ensuring healthy lives and promoting well-being for all at all ages.

Indonesia’s prominent role as the third-largest shareholder in IsDB has enabled strategic use of funds and influence, resulting in substantial developmental gains. Over the last four years, IsDB has provided US$1.4 billion in financing for Indonesian health projects, making the country’s Health Ministry its biggest institutional partner. This substantial investment underscores a strong commitment not just to building hospitals but also to enhancing overall health systems and capacities. Such partnerships are crucial for sustainable development, as they bring together expertise, resources, and a shared vision for the future.

Economic and Employment Benefits

The construction and operation of these hospitals have far-reaching economic implications. The healthcare sector is a significant contributor to employment, and these new facilities are expected to generate numerous job opportunities, from medical professionals to support staff. This boost in local employment not only contributes to economic growth but also helps to alleviate poverty, as more families gain stable income sources. Moreover, better health outcomes lead to a more productive workforce, reducing the economic burden of healthcare costs on families and the government. Healthier populations are also better able to participate in the workforce, contributing to overall economic stability and growth.

The economic benefits of healthcare investments extend beyond direct employment. Improved healthcare infrastructure can attract foreign investment and partnerships, further stimulating economic growth. In addition, the increased capacity for medical tourism, which has become a significant industry in many countries, could be a potential avenue for Indonesia to explore, especially as the quality of healthcare continues to improve.

Regional Impact and Global Relevance

Indonesia’s advancements in healthcare infrastructure have implications beyond its national borders. Southeast Asia is witnessing a surge in healthcare investments, with countries recognizing the importance of robust health infrastructure to economic resilience and growth. Indonesia’s proactive efforts serve as a model for its neighbors, demonstrating the benefits of strategic investments and partnerships in healthcare. The lessons learned from Indonesia’s experience can be applied to other developing nations facing similar challenges, particularly in terms of integrating new technologies and expanding access to underserved populations.

Furthermore, Indonesia’s approach highlights the importance of aligning national health strategies with global health and development frameworks. The collaboration between Indonesia and IsDB is an example of how international partnerships can drive progress toward achieving global health goals. As countries across the globe strive to meet the SDGs, Indonesia’s experience offers valuable insights into the role of strategic partnerships, sustainable investments, and innovative solutions in overcoming healthcare challenges.

Challenges and Opportunities

Despite these significant advancements, integrating new technologies and facilities into the existing healthcare system presents challenges. Ensuring that these hospitals are not just well-equipped but also effectively integrated with Indonesia’s broader health network is crucial. This requires comprehensive planning and coordination at multiple levels, including training for specialized care, maintenance of high-tech equipment, and ensuring sustainable operations. The success of these hospitals depends not only on their initial construction but also on their ability to function effectively and sustainably over the long term.

Moreover, addressing the healthcare needs of a diverse and geographically dispersed population like Indonesia requires ongoing efforts to expand access to quality care. This includes not only building new facilities but also improving transportation infrastructure, increasing healthcare education and training, and addressing social determinants of health. By taking a holistic approach to healthcare development, Indonesia can ensure that its investments yield lasting benefits for its population.

A Global Perspective on Health

The inauguration of these hospitals in Indonesia is more than just the opening of new facilities; it represents a forward-thinking approach to healthcare that prioritizes quality, accessibility, and sustainability. The collaborative efforts of the Indonesian government and IsDB are commendable, showcasing a commitment not only to enhancing healthcare but also to investing in the nation’s long-term development and prosperity. This initiative sets a precedent for healthcare excellence and strategic development, promising a healthier, more resilient Indonesia.

As these facilities begin their operations, they offer a hopeful glimpse into the future of healthcare in Indonesia and highlight the potential for similar advancements across the region. The success of Indonesia’s healthcare strategy could inspire other nations to pursue similar approaches, emphasizing the importance of global cooperation and the sharing of best practices in health and development.

Indonesia’s recent healthcare advancements underscore the critical role of strategic investments and international partnerships in achieving global health and development goals. By focusing on sustainability, community impact, and innovation, Indonesia is setting a new standard for healthcare in Southeast Asia and beyond. The lessons learned from this initiative can inform global health strategies, demonstrating that with the right resources, partnerships, and vision, even the most significant healthcare challenges can be overcome.

As the world continues to grapple with complex health issues, Indonesia’s example serves as a reminder of the importance of investing in health as a cornerstone of development. By prioritizing healthcare, nations can build stronger, more resilient societies that are better equipped to face the challenges of the future. The story of Indonesia’s healthcare transformation is a testament to the power of strategic planning, collaboration, and a shared commitment to improving live


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HEALTH & EDUCATION

Mpox: African Countries have Beaten Disease Outbreaks Before – Here’s What it Takes

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By Oyewale Tomori

Outbreaks of diseases like mpox aren’t new to African countries. The continent has successfully contained health threats like this in the past. But mpox, with new variants and modes of transmission, is making global headlines. It’s spreading to new countries within and outside Africa and the World Health Organization (WHO) has deemed it a global health emergency. Virologist Oyewale Tomori blames this on the failure of African governments to properly invest in their health systems and experienced health workers.

What’s the advice of WHO on managing mpox?

The WHO strategic framework for enhancing prevention and control of mpox 2024-2027 highlights the need for countries to take immediate action to ensure that surveillance, testing, treatment and vaccination responses are established and integrated with other health programmes.

This includes disease surveillance, sexual health services, risk communication and community engagement, primary healthcare, immunisation and other clinical services. The control and containment of the 2022-2023 multi-country outbreak within a year in non-endemic countries outside Africa was achieved through a combination of:

  • surveillance (detection and laboratory confirmation of cases, contact tracing)
  • isolation of cases
  • infection protection and control
  • targeted vaccination of high-risk individuals.

African health workers have over 50 years of experience dealing with different and various outbreaks of yellow fever, Ebola, mpox and COVID-19. They have acquired the relevant expertise and skills to prevent the spread of epidemics.

There are at least four instances in African countries where outbreaks were contained before they escalated to emergencies of concern. These successes were achieved through enhanced surveillance, rapid laboratory confirmation of cases, contact tracing, isolation of cases, as well as awareness campaigns on avoiding contacts with cases. Infection protection and control measures were taken.

In mid-2014, west Africa was in the grip of the largest epidemic of Ebola the world had ever seen. On 20 July 2014, a man infected with Ebola landed in Lagos, Nigeria, a city of 21 million. Infections began to spread immediately. By the end of the month, the first patient had died, an infected individual had flown to another city and one thousand contacts had been exposed to the virus. And yet, in Nigeria, the outbreak was over in less than three months. Nigeria stopped Ebola from spreading nationally, and potentially regionally, with effective communication, coordinated response activities and dedicated leadership.

In 2018, Ebola crossed into Uganda through its busy border with the Democratic Republic of Congo. Uganda rapidly mobilised its response teams and activated its health emergency response system, which stopped Ebola from spreading into the country.

Again in 2018, in a rural area of Kenya, a deadly anthrax outbreak was identified and brought under control thanks to a community-based surveillance system and a trained volunteer who acted quickly.

Health officials in Akwa Ibom, Nigeria quickly contained, within a month, an outbreak of mpox in 2021. They did this through strong collaboration with national rapid response teams, identifying and correcting weaknesses in the response and providing education and recommendations to improve future responses.

In all these instances, no vaccine was used to contain these outbreaks. Successful containment resulted from the rapid institution of disease surveillance to detect, diagnose, isolate and treat cases, and contact tracing among engaged, involved and aware communities.

Why aren’t these lessons being applied?

There are two main reasons that African governments have not taken advantage of their skilful human resources with relevant disease control experience.

Firstly, they have not provided adequate and sustained funding for an efficient disease surveillance system. Such a system needs to be backed by reliable diagnostic laboratory service for timely detection and confirmation of yellow fever, Ebola, Lassa fever, cholera and other diseases. These diseases often start as sporadic cases, later spreading and becoming large outbreaks.

Secondly, they have not created an enabling environment to carry out disease surveillance activities, such as contact tracing and isolation of cases. Disease surveillance is needed to contain the sporadic cases.

For instance, in the 2014-2016 Ebola outbreak, which primarily affected Guinea, Liberia and Sierra Leone, it took months to identify the disease after a first cluster of cases in December 2013. It took almost three years to contain, and claimed thousands of lives. The epidemic exposed the dire consequences of weak health systems, poor disease surveillance, an initially lethargic response, and inadequate community engagement. It would be far cheaper and more cost effective to provide funds for such a system than to respond to an epidemic with fatal consequences. A neglected disease outbreak can become the catalyst for gross domestic poverty.

What is the role of vaccines in preventing diseases?

Vaccines work by stimulating the immune system to recognise and mount a response against specific pathogens, such as viruses or bacteria. They are designed to mimic the infection without causing the disease itself, allowing the body to develop immunity against the targeted pathogen. Vaccines play a critical role in controlling and preventing epidemic diseases by boosting immunity and reducing the spread of infectious agents.

Great as they are, vaccines cannot take the place of rapid institution of disease surveillance to detect, diagnose, isolate and treat cases. Prevention has always been better than cure.

Are different responses needed for the different variants of mpox?

Not really. However, the mode of transmission – animal-human or human-human (sexual or non-sexual) – will determine the process to prevent or halt transmission and spread of the disease. These are two clades with variants.

Clade Ia: This is endemic in the Democratic Republic of Congo. It primarily affects children, with a case fatality rate of 3.6% in 2024. Other African countries reporting Clade Ia outbreaks in 2024 include the Central African Republic and the Republic of Congo. Clade Ia has historically been characterised by more severe disease than that associated with Clade II.

Clade Ib: This emerged after September 2023. It is spread through human-to-human transmission. It has spread rapidly in the eastern part of the DRC. The outbreak has primarily affected adults. It is sustained, but not exclusively, through transmission linked to sexual contact and amplified in networks associated with commercial sex and sex workers.

Since July 2024, cases of Clade Ib, linked (in the way it emerged and spread) to the outbreak in the eastern provinces of DRC, have been detected in four countries neighbouring the DRC which had not reported cases of mpox before: Burundi, Kenya, Rwanda and Uganda.

Clade IIaReported cases in Cameroon, Côte d’Ivoire, Liberia, Nigeria and South Africa are linked to Clade IIa.

Clade IIb: This virus caused the multi-country outbreak from July 2022 to May 2023. In 2022, mpox entered a new phase when the first case of the disease not associated with travel from Africa was reported in the UK.

This triggered the multi-country outbreak which the WHO declared a global public health emergency of international concern in July 2022. By the time it was declared over in May 2023, 118 countries (7 mpox endemic and 111 mpox non-endemic) had reported a total of 87,377 cases (1,587 in endemic and 87,377 in non-endemic countries).

Oyewale Tomori is a Fellow, Nigerian Academy of Science. 

Courtesy The Conversation


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EVENTS & ANNOUNCEMENTS

Celebrating 25 Years of the Ibn Sina Institute: A Milestone in Global Health and Elder Care

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On August 16, 2024, the Ibn Sina Institute marks its 25th anniversary with an international conference in Ankara. Founded in 1999 and named after the influential Persian physician Ibn Sina, the Institute has become a leading authority in global health, aging, and elder care under the guidance of Dr. Kemal Aydin. This anniversary not only honors past achievements but also highlights the need for continued global partnerships to enhance health and care worldwide.

By Baba Yunus Muhammad

The Ibn Sina Institute, a beacon of excellence in global health and elder care, is celebrating its 25th anniversary with an international conference in Ankara on August 16, 2024. Established in 1999, the Institute is named after the renowned Persian physician and philosopher Ibn Sina, whose contributions to medicine and healthcare have had a lasting impact on the field. Located in Ankara, Turkey, the Institute has been at the forefront of advancing knowledge and practices in gerontology and elder care, making significant strides in promoting global health and advocating for the human rights of the elderly.

Since its inception, the Ibn Sina Institute has been dedicated to addressing critical issues related to aging and elder care. Under the visionary leadership of Dr. Kemal Aydin, the Institute has become a leading authority on these matters, influencing policy and practice on an international scale. Dr. Aydin has been instrumental in raising awareness about global health, aging, and the rights of the elderly. His dedication has shaped the Institute into a key player in advancing these crucial areas of health.

Dr. Aydin’s efforts have been particularly noteworthy in the realm of global health. Through his advocacy, the Institute has significantly contributed to the discourse on aging and elder care, ensuring these issues receive the attention they deserve in global health agendas. His work has emphasized the importance of human rights for the elderly, advocating for policies and practices that protect and promote the dignity and well-being of older individuals.

Addressing Critical Health Challenges in Africa

As the Institute celebrates this milestone, there is a renewed call to address additional critical health challenges, particularly those affecting children and mothers in Africa. The continent continues to grapple with high rates of child diseases and maternal mortality, issues that demand urgent and focused attention.

According to the World Health Organization (WHO), Africa faces significant challenges in child health. The continent has one of the highest rates of child mortality globally. In 2022, the under-five mortality rate in Africa was approximately 77 deaths per 1,000 live births, compared to the global average of 37 per 1,000. Common causes of child mortality include malnutrition, infectious diseases, and inadequate access to healthcare services.

Maternal mortality is another pressing issue. The WHO reports that Africa has a maternal mortality rate of around 530 deaths per 100,000 live births, which is substantially higher than the global average of 211 deaths per 100,000 live births. Factors contributing to this high rate include limited access to quality prenatal care, skilled birth attendants, and emergency obstetric services.

Addressing these issues requires a multi-faceted approach, including improving healthcare infrastructure, increasing access to medical services, and enhancing education and resources for mothers and caregivers.

The Need for Expanded Collaboration

As the Ibn Sina Institute celebrates its 25th anniversary, it is clear that expanding its network and sphere of influence is crucial for addressing these pressing health issues. The importance of fostering collaborations with like-minded organizations worldwide cannot be overstated. By forming strategic partnerships with institutions that share its mission, the Ibn Sina Institute can enhance its impact and reach.

One such organization is the Africa Islamic Economic Forum (AFRIEF), which is actively engaged in health sector development through its Africa Healthcare Infrastructure Development Program (AHIDEP). The AHIDEP initiative focuses on improving healthcare infrastructure across Africa, making it a natural ally for the Ibn Sina Institute. Collaborating with AFRIEF could offer valuable synergies, advancing both organizations’ goals of improving health and care for the elderly, as well as addressing child diseases and maternal mortality.

The Future: Enhancing Impact through Collaboration

The future of the Ibn Sina Institute holds great promise, particularly with the potential for expanded international collaborations. By aligning with organizations like AFRIEF, the Institute can leverage new opportunities for growth and impact, bringing its expertise in elder care and global health to new regions and populations. This expanded network will not only strengthen the Institute’s efforts in addressing aging and elder care but also contribute significantly to reducing child mortality and improving maternal health in Africa.

As we celebrate the 25th anniversary of the Ibn Sina Institute, it is clear that the journey has been marked by significant achievements and contributions. The Institute’s ongoing commitment to advancing global health, addressing the challenges of aging, and advocating for the rights of the elderly continues to inspire and drive meaningful change. Looking ahead, the potential for greater collaboration and expanded influence offers an exciting horizon for the Institute and its mission.

In conclusion, the Ibn Sina Institute’s anniversary is not just a celebration of past successes but a call to action for the future. By strengthening partnerships and expanding its global network, the Institute is poised to continue its important work, making a lasting impact on the health and well-being of elderly populations, children, and mothers around the world.

Baba Yunus Muhammad is president of the Africa Islamic Economic Forum, Ghana


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