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 meningitidis, Haemophilus 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

On November 30th, 2023, the International Summit on Financing Primary Healthcare Infrastructure in Nigeria took center stage in Abuja, bringing together global leaders, financial experts, and healthcare professionals to deliberate on a critical theme: “Islamic Finance: Exploring New Sources of Financing for Primary Healthcare Transformation in Nigeria.” This landmark event, which was organized by DUKE Consult Limited in strategic collaboration with the Africa Islamic Economic Foundation, Ghana and Glocal Healthcare Systems Ltd, India, marked a significant step towards addressing the healthcare infrastructure challenges in Nigeria through innovative and sustainable financing mechanisms.

The Urgency of Healthcare Infrastructure Transformation

Nigeria, like many other developing nations, faces substantial challenges in its healthcare infrastructure. The need for adequate facilities, skilled healthcare professionals, and sustainable funding mechanisms has become increasingly urgent, especially in the wake of global health crises. The summit recognized that achieving robust primary healthcare infrastructure is pivotal to ensuring the well-being of the population and addressing health disparities.

Islamic Finance as a Catalyst for Change

The choice of Islamic finance as the central theme reflects a strategic move towards diversifying sources of funding for healthcare infrastructure. Islamic finance principles, rooted in ethical and equitable financial practices, provide an alternative framework for generating funds. By exploring these principles, Nigeria aims to tap into new avenues that align with its cultural values while fostering inclusive economic development.

Key Discussions and Agreements

The summit facilitated in-depth discussions on the potential of Islamic finance to transform Nigeria’s primary healthcare infrastructure. Attendees deliberated on the principles of Islamic finance, such as risk-sharing, profit and loss sharing, and ethical investment, as tools for shaping a more sustainable healthcare future.

One of the primary outcomes was the establishment of collaborative initiatives between the public and private sectors, leveraging Islamic finance instruments to fund healthcare projects. The summit also saw the formation of partnerships with international organizations and financial institutions, showcasing a commitment to shared responsibility in addressing Nigeria’s healthcare challenges.

Emphasizing Inclusivity and Cultural Sensitivity

An essential aspect of the summit was the emphasis on inclusivity and cultural sensitivity in healthcare financing. Recognizing that Islamic finance aligns with Nigeria’s cultural and religious values, the summit underscored the importance of tailoring financial mechanisms to the specific needs and beliefs of the population. This approach ensures that healthcare development is not only economically sustainable but also culturally resonant, promoting widespread acceptance and participation.

Looking Forward          

The International Summit on Financing Primary Healthcare Infrastructure in Nigeria has set a precedent for innovative and inclusive approaches to addressing healthcare challenges. As Nigeria strives to achieve its healthcare transformation goals, the incorporation of Islamic finance principles serves as a beacon for other nations facing similar challenges.

In conclusion, the summit marked a pivotal moment in Nigeria’s journey towards sustainable healthcare development. By exploring new sources of financing rooted in ethical principles, the country is forging a path towards a healthier, more resilient future. As the initiatives launched at the summit unfold, they have the potential not only to transform healthcare infrastructure but also to serve as a model for other nations seeking innovative financing solutions in the pursuit of universal health coverage.

By our special correspondent

A one-day international Summit on Financing Primary Healthcare Infrastructure in Nigeria under the theme: Islamic Finance: Exploring New Sources Of Financing For Primary Healthcare Transformation in Nigeria was held in Abuja, the Capital of the Federal Republic of Nigeria on the 30^th of November, 2023, at the NICON Luxury Hotel, under the distinguished Chairmanship of His Excellency, Senator Ibrahim Shekarau, former Executive Governor of Kano State.

The groundbreaking event, which was organized by DUKE Logistics & Consult (Nigeria) Limited, Abuja, in strategic collaboration with the Africa Islamic Economic Foundation, Ghana and Glocal Healthcare Services Limited, India, was held to explore innovative healthcare financing models that leverage Islamic finance instruments such as sukuk (Islamic bonds), waqf (endowments), and takaful (Islamic insurance), etc. in providing sustainable and long-term financing for primary healthcare transformation in Nigeria; and to foster collaboration between the various states of the federation to share best practices and experiences in leveraging Islamic finance for healthcare projects.

The summit featured keynote speeches and discussions on various topics related to Islamic finance, healthcare infrastructure development and digital health solutions: The role of Islamic Finance in healthcare Infrastructure Development in Nigeria, by Prof. Ahmad bello Dogarawa of the Ahmadu Bello University, Zaria; Digital Health Solutions Innovation: The Glocal Story, by Mr Shailesh Kumar, of the Glocal Healthcare Systems Limited, India; Digital Health Transformation: Opportunities & Challenges, by Hon Dr Abdel Majeed Haroun, former Minister of Agriculture, Republic of Ghana; Africa Healthcare Infrastructure Program (AHIDEP), by Hajiya Aishatu Usman Muhammad of the Gombe State University, Gombe, The foregoing presentations were supported with expert and insightful discussions by Dr Aisha Ahmed, an Islamic Finance expert and consultant, Abuja and Mr. Muhammad Lawal Shu’aibu, CEO, LCM Consult Limited Abuja.

One of the key discussions revolved around the role of Islamic Finance in healthcare infrastructure development in Nigeria. Participants delved into the potential of Islamic Finance to provide sustainable funding for the construction and maintenance of healthcare facilities. This topic explored innovative financing models that align with the principles of Islamic Finance, such as waqf (endowment) and sukuk (Islamic bonds).

Another captivating topic discussed at the summit was “Digital Health Solutions Innovation: The Glocal Story.” The term “Glocal” refers to the combination of global and local perspectives. The Summit focused on the Glocal Story, which highlighted its cutting-edge digital health solutions that bridge the gap between global advancements and local healthcare needs. Experts shared success stories, case studies, and best practices, showcasing how technology can revolutionize healthcare delivery in Nigeria by improving access, affordability, and quality of care.

Furthermore, the summit covered the topic of “Digital Health Transformation: Opportunities and Challenges.” This presentation highlighted the importance of adapting digital health solutions to the specific needs and contexts of Nigeria. It addressed how these innovations can improve healthcare accessibility, efficiency, and quality, particularly in underserved areas. Participants explored the potential benefits and challenges associated with digital health transformation in Nigeria. They examined how technological advancements, such as telemedicine, electronic health records, and artificial intelligence, can revolutionize healthcare delivery and management in the country.

The presentation of the Africa Healthcare Infrastructure Development Program, the flagship initiative of the Africa Islamic Economic Foundation, offered participants a glimpse of the functions of the Program. The presentation shows that AHIDEP is a great platform to connect with international organizations and investors who are interested in supporting healthcare initiatives in Nigeria. However, to showcase the importance and potential of a healthcare project to potential investors, potential beneficiaries would have to prepare a comprehensive proposal outlining their healthcare infrastructure development goals, strategies, and the potential impact.

The discussions also touched upon the importance of involving stakeholders and ensuring efficient management of healthcare infrastructure projects. Furthermore, the discussions elucidated in detail how Islamic finance can support the innovation and implementation of digital health solutions tailored to the Nigerian context. The conversation revolved around leveraging technologies like telemedicine, mobile health applications, and electronic health records to enhance access to healthcare services, especially in remote areas. The importance of collaborations between local and international stakeholders for effective digital health transformation was also emphasized.

Overall, this one-day event, the international summit on financing primary healthcare infrastructure in Nigeria provided a platform for experts, policymakers, and stakeholders to discuss strategies and explore new sources of financing for primary healthcare transformation in Nigeria. It showcased the potential of Islamic Finance as a viable option and emphasized the importance of digital health solutions in shaping the future of healthcare in the country.