Putting an end to meningitis season

In the region of Africa stretching west to Senegal and east to Ethiopia, the scorching dry season is known by another name: meningitis season. For more than a century, large-scale outbreaks of meningitis primarily caused by the bacteria Neisseria meningitidis have led to significant suffering.  As a result, meningococcal disease is a particularly feared disease in the countries of the meningitis belt. Patients experience a sudden onset of symptoms such as headache, fever, and a stiff neck and can die within 48 hours or sustain permanent cognitive and hearing impairment. Hundreds of thousands of cases and thousands of deaths occurred during the largest epidemic recorded, in 1996.

Meningococcal vaccines were first developed in the 1970s and have been used extensively to control epidemics in Africa. Unfortunately, these polysaccharide vaccines have a limited impact on preventing future outbreaks since they do not protect very young children and provide protection to older children and adults for only a few years.

When I first began collaborating with the Centre pour le Développement des VaccinsMali (CVD-Mali) in Bamako and the African Meningococcal Carriage Consortium (MenAfriCar) as a graduate student in 2009, a new opportunity to prevent meningitis outbreaks was on the horizon.

The Meningitis Vaccine Project (MVP) was formed through a partnership between the World Health Organization and the nonprofit health organisation PATH with funding from the Bill and Melinda Gates Foundation. MVP’s goal was to develop an affordable vaccine designed specifically for use in the meningitis belt, where Neisseria meningitidis serogroup A was the most common cause of meningitis at that time, using new conjugate technology to join the polysaccharides in the older vaccines to a protein, eliciting a stronger immune response.

Evidence from the UK, US, and other resource-rich nations where conjugate meningococcal vaccines were already in use indicated that these types of vaccines could protect very young children, induce a long-lasting immune response, and result in widespread protection in the population. Even though the technology already existed to produce this vaccine and similar vaccines were being used elsewhere with great success, the vaccines had not yet reached the resource-poor countries of the meningitis belt, the region of the world that needed them most. Not surprisingly, one of the largest barriers was cost. Conjugate meningococcal vaccines are available in the US for approximately $100-150 a dose.

The challenge for MVP was to create a new model for vaccine development that would overcome this barrier in countries like Mali where the per capita income in 2010 was less than $700 a year. After significant effort to secure a producer, conduct clinical trials, and acquire the necessary approvals, MVP marked an historic moment in December 2010 when the newly developed vaccine MenAfriVacTM was introduced in Burkina Faso, Mali, and Niger in the first-ever preventative campaign against meningococcal disease in Africa. Through a coordinated effort between partners across several countries and continents, nearly 20 million individuals aged 1 to 29 years were vaccinated during a four-week period. And the price of the vaccine? Forty cents a dose.

That no cases of meningococcal disease caused by serogroup A bacteria have been identified among the millions of vaccine recipients since then is an incredible step forward for public health. This is an encouraging sign, but only time will tell if this vaccine will completely eliminate serogroup A meningococcal disease from the meningitis belt. MVP continues to work to roll out the vaccine in other high-risk countries.

Photo: Nicole Basta (standing second from left) with CVD-Mali director Dr. Samba Sow (standing far left), members of the CVD-Mali field research team, and representatives from the MenAfriCar Consortium. Bamako, Mali, May 2010.

As an infectious disease epidemiologist, I am interested in understanding the transmission dynamics of infectious diseases, assessing the direct and indirect effects of vaccines and vaccination programmes, and determining optimal strategies for disease prevention and control. This December, I will launch a field study to address the number one question following the introduction of the MenAfriVac vaccine: how long will protection last? Through the “MenAfriVac Antibody Persistence” (MAP) study, we will enrol thousands of residents of Bamako, Mali, over the next five years to investigate the magnitude and duration of the immune response to this vaccine, identify risk factors that may lead to poor vaccine response, and determine whether protective immunity is maintained in the entire population over time or if booster doses or catch-up campaigns are needed. This research is supported by the US National Institutes of Health Director’s Early Independence Award and will allow me to continue to collaborate with colleagues at the CVD-Mali to address a significant and timely public health problem.

The history of the field of public health is full of stories of significant triumphs over diseases such as smallpox and health hazards that once dominated everyday life but are now nearly forgotten. While the introduction of MenAfriVac and its early success is incredibly promising, researchers and public health officials now have the challenging task of monitoring the impact of the vaccine and evaluating its effects on the population. My hope is that the NIH-funded MAP Study will contribute to our knowledge about the immune response following vaccination, and help determine the best strategy for utilising this groundbreaking vaccine to protect those at highest risk in the future.

*Nicole Basta (Gates-Cambridge 2003-2004 – MPhil Epidemiology) is an Associate Research Scholar at Princeton University in the Department of Ecology and Evolutionary Biology. She is the Principal Investigator for the upcoming NIH-MAP study. Additional details of her research can be found at: http://www.princeton.edu/~nbasta


Celebrating sport and remarkable people

I admire sport.  I was one of the 150 million viewers that tuned in to the Olympics this past August, cheering wildly as my country defended its medal count, and as some of its most beloved athletes crushed old records.

I will also be watching the Paralympics, an event occurring alongside the Olympics.  While networks like NBC have promised to show streaming coverage and commentation akin to what was done for the Olympics, I have my doubts that the Paralympics will draw the same 150 million to the television, and further, that we’ll hear the names of successful Paralympians in the newspapers as we did those of Phelps and Douglas.  I’m sure that records will be broken, and yet I fear that the public won’t know.

But, as sad as I am about this potential, I know that we’ve come a long way.

Athletes with disabilities have competed in the Games since 1904 (George Eyser), and we recently saw Oscar Pistorius set the London Games on fire.  Individuals with disabilities first competed in their own venue in 1948, in what was called the International Wheelchair Games, meant to coincide with the 1948 Olympics.  These early competitions set the stage for the Paralympic Games, which occurred in Rome, in 1960.  They’ve been continuous since then, with their own committee (the International Paralympic Committee, which works alongside the International Olympic Committee), though their popularity has never matched the Olympic Games.

The Paralympics boast many favorite sports (think rowing, athletics, volleyball, etc), and divides each of these sports into different categories to ensure fair and equal competition.  I like to think of this as separating the men from the women’s competitions at the Olympics.  For example, in the first 10 sport classes of an event, athletes with physical impairments will compete, with the lower class numbers indicating a more severe activity limitation.  In classes 11 through 13, athletes with visual impairments will compete, and in class 14, athletes with intellectual impairments will compete.  You might even compare these further classifications to how the Olympics separate weight lifters by characteristics like weight.

“Disability”, as a word, has so many meanings, depending on whether you’re looking at the term from a medical model (a physiological condition), a social model (societal forces on impairment) or even a demographic category (like race or gender).  My biggest fear is that the Paralympic Games will be looked upon by some as a ‘consolation’ Olympics.  I have no idea if it will be, and I hope that my fear is unfounded.  If I’ve learned one thing from working for the past seven years at a recreational camp with individuals with disabilities, it’s that disability doesn’t define a person.  I hope that my fellow viewers feel the same.

I am extremely excited for the Paralympic Games, especially the rowing portion (me, being a die-hard coxswain and previous-teammate of a Paralympic team coxswain). 

Here’s to having another two-week celebration of two very important things: sport and remarkable people. 

*Brie Stark is a scholar-elect who has been a care-provider and recreational program leader at a camp for disabilities since 2005, an advocate for disability awareness, and a co-captain and coxswain of her undergraduate college’s rowing team.  She will pursue a PhD in Clinical Neuroscience at Caius College, and intends to cox for the Caius men’s rowing team this autumn. Picture credit: adysyady and Creative Commons.

Achieving personal best(s) through the Olympic movement

As the curtain falls on a happy and glorious Olympic Games in the city of London, one cannot help but marvel at the spirit of the Games and its ability to unite people across cultures, across geographies and across generations. Not only did London revel and embrace the Olympic spirit and the power of sport, the entire nation seemed to embrace the world.

London 2012 brought together 11,000 athletes from 204 national Olympic committees that competed in the greatest show on Earth. Behind the scenes, the London Organising Committee of the Olympic and Paralympic Games (LOCOG) assembled a legion of 70,000 GamesMaker volunteers to help staff and contractors to make it all happen. I was lucky enough to be one of those 70,000 dressed in khaki, purple and red for the majority of the last two weeks.

Four years ago, I was delighted to be accepted to the University of Cambridge for a Master’s course and subsequently a PhD degree. But little did I know, as timing would have it, pursuing a graduate programme has also allowed me to follow a life-time passion for sport and be a volunteer at three consecutive Olympiads starting with Beijing 2008, Vancouver 2010 and ending as a GameMaker for London 2012.

Beijing had the razzle-dazzle, Vancouver had my hometown bias (being a Canadian), but London had my personal best. I worked hard to complete my Cambridge degree a month early so that I could focus on London 2012 and give my whole-hearted commitment for the two weeks. I worked with a fantastic team of volunteers at my home venue – the Basketball Arena in Stratford. My fellow GamesMakers came from all walks of life, including maths teachers, probation officers and people who re-located for two weeks from India and Japan just to be present for the Games. Outside of my own workforce team, I was constantly amazed and appreciative of the thousands of fellow GamesMakers. As I entered the Olympic Park for every morning shift, or left late at night for every night shift, I was warmly greeted by other GamesMakers who wished me a fantastic day ahead or bid me a safe journey home. And as I watched as a common spectator for events that I attended with my family, the friendliness of the event services team always made me smile.

Over 16 days of magnificent sport, 44 new world records were set in London along with 117 new Olympic records. But how can we possibly count the number of friendly smiles being exchanged? Photos taken? Or conversations that were started by random strangers sharing the latest results and medal wins on buses, tubes and trains? For some athletes, they may have trained a lifetime for this moment. For some senior members of the London Organising Committee, the Games represent over a decade-worth of stewardship and hard work. But taken together, the number of man-hours applied by the 70,000 GamesMakers in a two-year long application process, including training sessions, venue sessions, test events and travel time, would stand on its own merit. Congratulations to the athletes who achieved personal bests at these London Games – you sure inspired a cadence of personal bests from your support team.

Volunteering for the Olympic movement has truly been one of my most memorable and awesome experiences. It is at times difficult being cheerful for eight-hour shifts or quickly learning new skills and adapting to different roles from everyday work. But whatever the challenge, it is easily amended by good preparation and a heap of enthusiasm. Every Olympic volunteer I have ever met and worked with has concluded that if the stars align and opportunity arises again, they would willingly get involved with the next Games. So bring it on Sochi and Rio – how many repeat GamesMakers will show up on your streets? And to the citizens of Russia and Brazil – apply when you can, because when you get involved, you will happily pinch yourself the day it starts and it all becomes real…

Thank you London 2012 – You have inspired generations.

*Julia Fan Li  [2008] is completing a PhD in technology management in the Department of Engineering. Her research interests focus on financing global health and she is a continuous supporter of the Olympic ideals of friendship, solidarity and fair play through sport.