Meningitis: A Shot of Hope | Journeyman Pictures

Transcript

Meningitis: A Shot of Hope, Transcript

01:00:00:00

Opening music: Light Darkness

Composers/Performers:

Igor Dvorkin, Duncan Pittock & Ellie Kidd, Audio Networks

01:00:04:16

2007 and little Samba Coulibaly is on his way to make medical history. He’s one of the first children to take part in a trial for a new vaccine against deadly meningitis.

01:00:20:16

Assetou Coulibaly,

Samba’s mother,

Translation

We have had at least 3 cases of meningitis in our family When I heard there was a new vaccine, I was happy to take part so I can protect my children.

01 :00 :35 :05

Dr Marie-Pierre Preziosi,

Director Meningitis Vaccine Project

Many countries in Sub-Saharan Africa have called for this vaccine because of this dreadful and devastating disease, which is called epidemic meningitis, which was devastating their population for over a century now.

01:00:51:12

Over one million cases of meningitis have been reported in Africa since 1988 and thousands of people have died.

When an epidemic strikes people are desperate to be immunised.

01:01:08:06

Female translation

Mother with child in crowd waiting for vaccine

It’s a dangerous disease. It can kill me and my baby.

01:01:12:00

Scenes of people being injected with vaccine

But the emergency injections do not work on infants and give only temporary protection to adults.

What is urgently needed is a vaccine that can eliminate African meningitis once and for all.

01:01:28:17

Title Caption

MENINGITIS: A SHOT OF HOPE

01:01:33:18

Music: Great Migration

Composers/Performers: Peter Mayne & Ian Tripp, Audio Networks

Caption: Bamako Mali,

2007

17-month-old Samba is one of 600 healthy toddlers taking part in a clinical trial for a new vaccine against African meningitis. Scientists at Mali’s Centre for Vaccine Development need to find out if the innoculation is effective and safe.

01:02:10:01

Prof Samba Sow, Director Center for Vaccine Development Mali

This is a double blind vaccine trial. The doctor does not know which vaccine the participant is getting, and the participant also does not know which vaccine is getting. We are so far all doing very well, we have not had also any particular problem with vaccine.

01:02:31:22

Samba’s mother knows too well about the devastating consequences of meningitis. Her sister died from the disease

01:02:40:18

Assetou Coulibaly,

Samba’s mother,

Translation

01:02:57:05

Music: Apart, Composers/Performers: Paul Mottram, Audio Networks

It started very quickly. She had a high fever and pain. The whole family cried when she died. She was a nice sister, we were all very very sad.

01:03:04:17

The new vaccine is desperately needed. Across the border in neighbouring Burkina Faso an epidemic of deadly meningitis has broken out.

Six year old Jesongo is fighting for his life.

01:03:23:19

Interview with nurse,

French translation

01:03:35:22

Music: Sadness, Composers/Performers: David O’Brien, Audio Networks

He came here last night in a very bad general state. He had a stiff neck and a high fever. I was very worried, he was so drained, and in such a state that I had little hope.

01:03:46:23

He’s being treated with life saving antibiotics, but drugs are in short supply, and even if he recovers, he may have brain damage and deafness.

This tiny health centre covers 2000 villagers and has just three nurses.

01:04:08:00

Interview with nurse, translation from French

01:04:38:04

Music: Freefall, Composers/Performers: Helen Jane Long, Audio Networks

The situation is worrying; actually we’ve calculated we have 200 cases since it started, and eight deaths. Normally we’d just have 2 or 3 patients to deal with. but suddenly we have 50 or 60 patients a day. It’s really stretching our capacity.

01:04:42:00

The health centre can’t cope with this huge influx of meningitis cases. Many patients have to stay outside, day and night. Under a tree sits Awa Bidima. She too is suffering.

01:04:56:19

Interview with nurse: translation from French

This is Awa Bidima. She came yesterday with a high fever. She’s been sleeping here, and this morning there has been an improvement in her condition.

01:05:11:18

Awa is now on antibiotics but medicine can’t treat her greater loss. Seven days ago she came here with her daughter, Rabiatou.

01:05:25:04

Interview with Awa Bidima (mother) French translation

She was vomiting, with fever, so we came here.

01:05:31:14

Despite treatment her condition didn’t improve.

Then one night, whilst relatives took care of Rabiatou, Awa grabbed some much needed sleep outside.

01:05:44:02

Interview with Awa Bidima (mother) French translation

01:05:59:22

Music: Freefall, Composers/Performers: Helen Jane Long, Audio Networks

I was outside with the baby, so my husband and mother in law were with my daughter inside the hospital. It’s strange but I had a nightmare telling me something was very wrong. Suddenly I woke up, and people told me that she had died.

01:06:09:19

Interview with Dr Marc LaForce,

Director, Meningitis Vaccine Project, 2001-2012

Meningitis epidemics are dreadful. You only have to go through one, one of them is enough. People became frightened very quickly. Commerce stops. People stay in their homes and if they leave their homes, it’s usually to bring somebody who has meningitis to a health centre or to visit somebody or to try to assist someone else who has meningitis. It really is dreadful.

01:06:43:07

Mercy Ahun

GAVI, The Vaccine Alliance

01:07:16:14

Music: Freefall, Composers/Performers: Helen Jane Long, Audio Networks

For about 6 to 7 months of the epidemic, nothing else happens, apart from that epidemic, so it’s a major cost to the nation.

Each case of meningitis costs about 90USD to the family, and you are talking about a family where that’s about 3 to 4 months of their disposable family income. So all of a sudden they lose this money, and then of course the deaths, the loss of young lives, lost. It has a major impact on the economy.

01:07:21:19

Awa Bidima (mother) French translation

When the epidemic started in the village people closed the markets and stopped going out. And even if you recovered, people don’t want to visit you because they’re afraid of catching it.

I’m sad that my daughter died so suddenly, and I’m praying God will protect this one.

01:07:43:05

Dr Samba Sow on number of outbreaks

I remember clearly from meningitis, we used to be sent to a cemetery, to stay there the whole day long so that they can bring bodies. We spend the whole day putting bodies underground. This was during epidemics like meningitis. It was attacking all ages, mainly children and adolescents so that was a really serious souvenir for me.

01:08:09:09

WHO’s infectious disease specialist is charting the latest outbreak. It has worrying implications.

01:08:16:23

Dr Kader Konde interview

01:08:32:20

Music: Renewal, Composers/Performers: David Kelly , Audio Networks

The current situation of Meningitis in Burkina Faso is critical this year because, as you can see on this map, all the districts in red have crossed over the epidemic threshold.

01:08:35:13

The government’s crisis committee meets to discuss how to tackle the growing epidemic. Over a million vaccines are needed.

01:08:41:23

Dr Kader Konde interview

01:08:59:05

Music: Dangerous Games, Composers/Performers: Terry Devine-King, Audio Networks

They decided to explore the way to fill the gap of 1.5 million doses of vaccine. They have not enough money to buy the vaccine and the government is exploring another donor in order to fill the gap for these necessary vaccines in the field as soon as possible.

01:09:07:19

Here, in Tenkondo district much needed injections have arrived. Health workers can at last begin a mass immunisation campaign.

But while staff work all hours to distribute the vaccines, other health provision suffers.

01:09:23:21

Dr Kader Konde interview

All the activity, care at the hospital and health facilities have stopped because there is not enough staff to take care of all of these things. That is a big challenge for all of the districts in Burkina.

01:09:52:10

As the epidemic tightens its grip, panic breaks out as villagers fight for vaccinations.

01:10:00:24

Female,

Translation

It’s a dangerous disease. It can kill me and my baby. That’s why I came to get the vaccine.

01:10:11:20

Some have waited here since 6am and the local staff must vaccinate 800 villagers a day.

01:10:19:06

Dr Kader Konde

People are very worried, they are afraid that the vaccine will finish before they get the vaccination. There is not enough personnel, there are only 4 people for this team of vaccination.

01:10:34:12

But the “polysaccharide” Meningococcal Meningitis vaccine in use here, is only partially effective.

01:10:41:14

Dr Kader Konde

This vaccine is not long-lasting. We need to vaccinate every two or three years and that is a very big problem for the community and for the population.

01:10:55:19

Mark La Force

The problem with the current polysaccharide vaccines is that the protection is rather short lived, no more than three years and the vaccine is not effective in youngsters under two years of age. A third and very important point is that use of the polysaccharide vaccine does not confer what we call community protection. This is an organism that circulates in the community and the polysaccharide vaccine while providing individual protection for a vaccinee does not diminish the general bacterial load within the population.

01:11:36:14

By the end of 2007, meningitis would have killed 4000 people in Burkina Faso. Two years later in Nigeria, 56,000 people would be infected. The race was on to stop the deadly disease in its tracks.

01:11:55:03

Music: Renewal, Composers/Performers: David Kelly, Audio Networks

Radiodiffusion-Télévision du Burkina

During Africa’s worst meningitis epidemic in 1996 twenty five thousand people died. African leaders called on the World Health Organisation to urgently introduce a more effective vaccine. With a seventy million dollar grant from the Bill and Melinda Gates Foundation, the Meningitis Vaccine Project was set up.

01:12:26:04

Mark La Force talking about MVP and its goal

The project was established with a single goal: to eliminate epidemic meningitis as a public health problem in Sub-Saharan Africa. African public health officials emphasised that vaccine cost was the main constraint to the introduction of new vaccines in Sub-Saharan Africa.

01:12:45:07

Dr Jean-Marie Okwo-Bele, Director Vaccine Dept., World Health Organization

Affordability was one of the key issues. Actually one of my colleagues recalled that the ministers told him no vaccine is better than a vaccine that we in Africa cannot afford.

01:12:59:07

Mark La Force

If the Meningitis Vaccine Project were to succeed, that is, widespread use of this vaccine across this area, the vaccine would have to be priced at less than 50 cents a dose.

01:13:11:02

Music: Diama, Composers/Performers: Guimba Kouyate, Jon Grandcamp, Pablo Love & Campbell E Browning , Audio Networks

In the UK, the development of a powerful new vaccine against meningitis C in the 1990’s had seen startling results.

01:13:23:20

Interview with Prof Ray Borrow

01:14:05:18

Music: Diama, Composers/Performers: Guimba Kouyate, Jon Grandcamp, Pablo Love & Campbell E Browning , Audio Networks

We started to evaluate the meningococcal C conjugate vaccines, there were a number of studies in young babies, young children, adolescents, looking before and after vaccination, then in 1999, the UK was the first country to actually introduce these meningococcal C vaccines. In the first decade after introduction, it was deemed the biggest public health intervention of the decade, I t’s severely reduced group C infections and deaths, and basically, not eliminated, but drastically reduced the number of cases.

01:14:10:14

The hope was that the same type of vaccine, known as a conjugate, could be used against African Meningitis.

But even though some work had been carried out on just such a vaccine, western pharmaceutical companies were not interested in producing it because it wasn’t profitable.

01:14:31:22

Mark La Force talking about conjugate

01:14:54:14

Music: Expectation, Composers/Performers: Duncan Pittock, Audio Networks

Conjugate meningococcal vaccines had been tested in Africa by pharmaceutical firms in the mid to early 1990’s, but these projects were discontinued because it was felt that the economic potential of continuing this development was not something that they wished to continue.

01:14:59:08

Mark La Force’s quest to find a new vaccine intensified after meeting a young man struck down by the disease.

01:15:07:22

Mark La Force

Jean-Francois was an 18 year old from Burkina Faso who was captain of his football team, president of his class, he was awarded the mathematics medal, he was clearly a young person of great promise. I met him and his mother in a hospital where he was recovering from his bout of meningitis. And it was clear in speaking with Jean-Francois that he wasn’t going to win any more mathematics medals and on top of it, he was stone deaf.

01:15:50:24

Music: Lone Voice, Composers/Performers: David Kelly, Audio Networks

01:16:00:07

Deafness is a common result of meningitis. Three quarters of the children at this special school in Ouagadougou have survived the disease. Jean Francois left hospital, and was learning to cope with his disabilities.

01:16:15:06

Mark La Force

After he was discharged from the hospital, the family had adjusted, they developed their own form of sign language, and he was gradually getting better, so much so that he started to play some soccer. A little bit of soccer with his brothers and sisters, and he was playing in the front yard, and the ball rolled into the street, and he was run over by a truck that he never heard because he was deaf.

I remember hearing that on the phone and I started crying because I was so touched and bothered by the fact that this was intensely unfair.

01:17:09:20

New VO

01:17:20:01

Music: Wonders Of The Nile, Composers/Performers: Peter Mayne & Ian Tripp , Audio Networks

With no western pharmaceutical companies willing to develop a vaccine for African meningitis, Mark La Force turned to a vaccine manufacturer in India.

01:17:23:12

Mark La Force

Serum Institute of India quickly came to our attention, when we spoke with individuals at Unicef, and personnel at WHO. Serum Institute of India was a well known supplier of high quality products, and products in quantity.

01:17:42:07

But the question remained - would the Serum Institute take on the project that other companies had deemed uneconomic.

01:17:49:22

Interview with Dr Suresh Jadhav,

Serum Institute of India

Some of the European companies had already done some clinical trials on this particular product but they were not interested to launch the product because the user was the African population who were not going to pay them the money that they were expecting out of this research.

01:18:07:24

Mark La Force

From Serum Institute of India’s standpoint, sure there’s risks. Here’s somebody who shows up and says, ‘Gee, we’d like to work with you, but we’re going to stipulate how much you can sell the product for’. That’s sort of a hard discussion right from the very beginning.

01:18:27:12

Those discussions were not as tough as Mark LaForce had anticipated as the Serum Institute had a different approach to business.

01:18:36:17

Dr Suresh Jadhav,

Serum Institute of India

We thought that this would fit well into the philanthropy philosophy of the Serum Institute, to make the vaccines available to the population, where they do not have the vaccine manufacturing capabilities and they cannot make it on their own. I was pretty confident that if we as a developing country manufacturer look into this product, we will be able to do it in a much economic way, as compared to the big pharma. If we could help them out, by making the vaccine here, we were interested.

01:19:07:16

Music: Walk To The Well, Composers/Performers: Peter Mayne & Ian Tripp , Audio Networks

01:19:14:10

With the Serum Institute on board, everything was now in place to begin work.

01:19:18:22

Dr Jean-Marie Okwo-Bele

This partnership is unprecedented. For the first time we had a UN organsiation working with a US based NGO (WHO and PATH) facilitating the transfer of technology to a company in India, Serum Institute of India, using resources from the Bill and Melinda Gates Foundation, the philanthropist, bringing all of this together we got to developing a vaccine at a cost that could be affordable for the poorest countries that needed the vaccine most.

01:19:52:04

The groundbreaking collaboration would result in the weapon needed to fight African meningitis.

01:20:00:16

Mark La Force

Polysaccharide vaccine calls forth the very simple response with the generation of antibody. This antibody is usually short-lived. However, if one takes the sugar and conjugates it, that is, combines it with a carrier protein, it fundamentally changes the immune response that occurs. The vaccine now becomes a different vaccine, and engenders a much more powerful immune response.

01:20:32:20

Dr Suresh Jadhav,

They form a very stable complex of stable antigen, and this antigen once it is injected, then it gets released very slowly in the body, and the response is much stronger.

01:20:45:14

Mark La Force

It is an immune response that is characterised with higher antibody levels, and also the capacity from memory, so that when the immune system sees this particular polysaccharide with this particular sugar again, it mounts a much more vigorous immune response.

01:21:05:12

A year after clinical trials on the new vaccine began, scientists had the evidence that they had been hoping for.

01:21:15:01

Mark La Force

01:21:47:11

Music: Tama Nion, Composers/Performers: Guimba Kouyate, Jon Grandcamp, Pablo Love & Campbell E Browning, Audio Networks

4 weeks after immunisation with the conjugate vaccine has led to antibody levels that are twenty times higher than those that one would get from the Polysaccharide vaccine.

Introduction of this vaccine at large scale will result in a community immunity, so-called herd immunity. This is a huge benefit, because not only do vaccinated individuals benefit from this, but even the unvaccinated, because there are fewer organisms in the population so there are fewer exposures that can occur.

01:21:52:15

The signs were that the new vaccine could eliminate epidemic meningitis in Africa for good. But first there were obstacles to overcome including winning over the community.

01 :22 :05 :19

Dr Marie-Pierre Preziosi

Anything new that happens, there are always worries and rumours and so it’s part of life that you are worried when something new comes.

01 :22 :14 :24

Woman, translation

Some said we sell blood; others that we were sterilizing our children. By that time I worried they were right.

01:22:25:05

Getting the vaccine to the people who need it most.

01:22:29:12

Man driving, translation

The roads are really difficult- there’s so much sand.

01:22:33:21

Man, French translation

It’s always our nightmare, preserving the vaccines in an environment that is very hot

01:22:41:19

Scene change & VO

And most importantly getting governments to back the new vaccine.

01:22:47:10

Dr Samba Sow

In addition to all the technical and medical aspects, we need political will. Our job as physicians is to convince decision-makers to make this a real success.

PART 2

01:23:07:06

Music: Great Migration

Composers/Performers: Peter Mayne & Ian Tripp, Audio Networks

01:23:10:23

A dry dusty wind that every year has brought deadly Meningitis to Sub-Saharan Africa. But since a new vaccine has been introduced cases of meningitis have fallen dramatically. MenAfrivac is the first vaccine custom made for Africa. Over 200 million people have been immunised in 15 countries.

In Bamako Mali, Samba Coulibaly was one of the first children in Africa to receive the jab as part of a clinical trial. Today, Samba is nearly10 years old and in good health.

The new head of the meningitis vaccine project, which helped develop the vaccine, has come to see him.

01:24:03:23

Sync (In French)

Dr Marie-Pierre Preziosi with Samba’s father

Are you OK Mr Sibiry?

Very well thank you!

You know Samba, your son, is a hero for Meningitis!

He’s one of the first children in the world to have received the MenAfriVac vaccine.

Everyone has taken part in the vaccination campaign.

Doussou, Heta, Malado…

also took part in the big campaign of 2011?

Yes 2011.

They queued for the vaccination and also received the MenAfriVac vaccine.

01:24:36:08

For Dr Preziosi, meeting Samba has brought home how far the project has come.

01 :24 :42 :10

Dr Marie-Pierre Preziosi

Director Meningitis Vaccine Project

In those days way back 7 years ago we had absolutely no idea what would be the results and now only 7 years down the line we have more than 200 million people have received the vaccine across the entire meningitis belt and also it was quite important to see the ripples in his own community because his sisters, his brothers, his friends, have all received the vaccine during the campaigns and they have seen no epidemic ever since then.

01:25:17:11

But there’s one vulnerable section of the population who have not been able to take part in the mass campaigns. That troubles the scientist leading the research.

01:25:27:07

Dr Samba Sow

Centre for Vaccine Development, Mali

01:25:57:03

Music: Renewal, Composers/Performers: David Kelly, Audio Networks

There is still a huge, considerable milestone missing: children under one years old. It is very difficult for a father or a mother to see that you have a vaccine that can protect your family members aged between 1 and 29, and that that same vaccine cannot be given to children under 1, while if meningitis A came in the society, the community, it can hit everyone, everyone can have meningitis.

01:26:01:07

So scientists at the Centre for Vaccine development in Mali tested fifteen hundred babies aged between 9 and 12 months with the new vaccine.

01:26:11:05

Dr Samba Sow

01:26:36:15

Music: Ethno Groove, Composers/Performers: Terry Devine-King & Paul Clarvis, Audio Networks

The latest vaccine trial was given to children for three main reasons. Number 1: to see how well those children will be responding to this new Menafriva vaccine. Number 2: to see how safe giving this vaccine to them will be and number 3: how well it will work given concomitantly with the current routine EPI vaccines.

01:26:41:00

Marie Pierre Preziosi has come to Mali to see the results for herself. There has been a major breakthrough.

01 :26 :48 :20

Dr Marie-Pierre Preziosi

The results look excellent. The vaccine is extremely safe and very immunogenic, provides very good immune response in babies at the age of 9 months.

The initial step was really to introduce Menafrevac in mass campaigns, among a large age group, from age one to age 29 years, and now we need to have a sustainable strategy for the years to come to maintain the population community’s protection, and the introduction to the routine programmes will ensure the elimination of the disease in the long term.

01 :27 :27 :02

But the scientific team need to wait for formal approval from the World Health Organisation before MenAfrivac can be introduced into routine childhood vaccinations.

01 :27 :38 :16

Dr Marie-Pierre Preziosi

Mali has been suffering epidemics of meningitis for over a century and their health and political leaders really want this new vaccine for their population. They want to protect their population and to sustain elimination of these epidemics.

01:27:57:04

Scene change, shots of people singing in Mali

Even with the backing of the government, introducing a new vaccine is not straightforward. At a community meeting in Mali’s capital Bamako, little Samba’s mother told of the hostility she faced when she had her son immunized.

01:28:19:11

Woman, translation

sync

My child was vaccinated by Samba Sow’s team. When we left there, many people blamed us. They said we were selling our kids’ blood. Some said we sell blood; others that we were sterilizing our children.

My kid was among the first ones to be vaccinated. He is ten years old now with no problems.

01 :28 :46 :04

Dr Marie-Pierre Preziosi

When anything new happens there are always worries and rumours – it is part of life that you are worried when something new comes. However whenever a rumour occurred we were able to strongly show the evidence that this was unfounded.

01:29:02:23

Music: Thumb Piano, Composers/Performers: Evelyn Glennie , Audio Networks

01:29:08:10

Overcoming the suspicion of a community was vital to ensure the widespread acceptance of vaccination.

Dr Samba Sow realised the importance of working with women to allay their concerns.

01:29:21:24

Dr Samba Sow

Every time you talk about introducing a new vaccine, you are talking about training vaccinators, training the field workers, and training families, parents, on what is the vaccine and what is the importance of the vaccination.

The first children who will be vaccinated will be my own children. So if it is something not safe I don’t know why I would take my own babies to receive this. So these vaccines are absolutely, very safe.

01:29:51:06

Footage of mosque from kill or Cure

Clip of Immam from Killer or Cure

Keeping religious leaders informed was also essential. They commanded the respect of the community.

01:30:02:18

Dr Mark LaForce

CVD Mali staff involved imams, they involved village elders, explaining to them the purpose of the Meningitis Vaccine Project’s clinical trials, and it is as a result of the success of these interchanges that allowed the community participation to be as good as it is here.

01:30:26:01

Issa Touaoré

Chief Imam

Translation

Every week after my big Friday prayer, I say something on vaccines and health. People were saying vaccines sterilize children, that it would kill people and that it was a bad thing that the Americans had sent over to stop us having children.

But I’ve worked on this very hard for ten years and now all of those people are getting vaccinated and sending their children to get vaccinated too.

01:30:48:00

Music: Walk To The Well, Composers/Performers: Peter Mayne & Ian Tripp , Audio Networks

01:30:51:19

Far from harming or killing people the vaccines were saving lives. The scientific proof was being gathered at this laboratory in the North of England, the leading lab on meningococcal serology. Here all 25, thousand serum samples from the meningitis vaccine trials have been analysed to see just how effective the vaccine has been.

01:31:13:17

Interview with Prof Ray Borrow, Public Health England

The tests basically showed that before vaccination, the individual serum was not killing the bacteria, but after vaccination, there was very high levels of killing in the serum and this is really quite crucial: to license the vaccine, you need to show high levels of killing in the individual serum.

01:31:40:19

Shots of street theatre

At a launch for the vaccine in Mauritania, street theatre instead of science was used to convince people of the safety and efficacy of modern medicine.

01:31:56:19

The play shows a traditional healer using herbal remedies on a meningitis patient.

UP SYNC

At last an ambulance is called and the patient is rushed into hospital in an attempt to save his life.

01:32:11:19

Among those at the launch was the Minister of Health who travelled all the way from the capital city to attend. His very public support for the vaccination campaign would be instrumental in the programme’s success.

01:32:23:13

Music: Rainsong, Composers/Performers: Orlando Jopling , Audio Networks

Elders were also brought into the campaign to share their positive experience that any community can be convinced if properly informed.

01:32:39:02

Abderahmane ould Cheikh/Village Elder

Translation

I joined a project here in Trarza funded by the USA.

We got training for two years, on and off.

When it finished we were given diplomas for very basic healthcare.

They warned me that the nomads didn’t care about health care. They do not listen to health care measures and are difficult to organise. But those who didn’t believe in the beginning ended up accepting it all.

01:33:19:19

01:33:27:04

Music: Ivory Trail, Composers/Performers: Dan Skinner & Adam Skinner, Audio Networks

With wide acceptance of the new vaccine, over 200 million people have received MenAfrivac in mass vaccination campaigns. Dr Preziozi has come to Mauritania on the western edge of the meningitis belt to see how health workers will manage to immunise 1.5 million people in just 10 days. Hot, desert conditions and remote health centres makes the job of distributing vaccines here very tough.

01:34:06:03

Dr Naceredine Ouldzeidoune,

WHO Mauritania

You have more than thirty percent of the population who are beyond the 5km range, which means they do not have access to a routine immunisation.

01:34:17:09

At this temporary vaccination site health workers prepare for a busy day. People have walked miles to get here.

01:34:25:21

Dr Naceredine Ouldzeidoune

As of now we have vaccinated today more than 70 people – people have to walk kilometres in order for them to be vaccinated.

01:34:34:23

With the last major meningitis epidemic in West Africa still fresh in people’s memories, people are keen to be protected.

01:34:44:15

Dr Naceredine Ouldzeidoune and Dr Marie-Pierre Preziosi

‘She got the messages on her cell phone, SMS messages.’

‘SMS to come here today.’

‘To come here today and yesterday’.

01:35:06:09

01:35:07:10

Music: Dangerous Games, Composers/Performers: Terry Devine-King, Audio Networks

But transporting vaccines to these remote outposts is not straightforward.

Traditionally vaccines need to be kept below 8 degrees centigrade from the point of distribution all the way to the point of delivery – the so-called “cold chain”.

It’s a huge challenge in a country like Mauritania where teams are faced with hundreds of kilometres of rough desert terrain.

01:35:40:13

Team member driving,

Translation

There are holes, there’s sand, there are even animals.

The roads are really difficult – there’s so much sand.

01:35:48:00

Scenes of crowding and pushing at clinic

In hot countries like Mauritania, the vaccine only lasts for 3 hours in a cold box.

UP-SYNC

Vaccination teams have to leave the site several times a day to get new ice packs, meaning medical staff are under pressure to get as many people vaccinated as possible.

In the developing world, the logistical hurdles of keeping vaccines cold are one of the main reasons that one in five children worldwide miss out on life saving vaccines.

01:36:18:19

Scene of child being vaccinated

Dr Mohamed Lemine Cheikh,

Ministry of Health Regional Director, Trarza

Translation

It’s always our nightmare, preserving the vaccines in an environment that is very hot and we haven’t yet got enough energy in all the villages and outlying areas in order to vaccinate all children locally.

01:36:41:13

Music: Walk To The Well, Composers/Performers: Peter Mayne & Ian Tripp , Audio Networks

01:36:46:10

This is where MenAfrivac comes into its own. Scientists at Serum Institute were aware that being a conjugate vaccine, it was far more stable than most other vaccines.

01:36:57:05

Dr Suresh Jadhav,

Serum Institute of India

Because this is a lifeless product, when there is no moisture inside, the antigen remains pretty stable.

01:37:04:22

This led to the tantalising possibility that MenAfrivac would not need refrigeration at all times – and could be used in a controlled temperature chain or CTC.

01:37:16:11

Dr Suresh Jadhav

Honestly speaking we did not develop the vaccine taking into account that it will require to be shipped in the controlled temperature chain. When we make a product, we do our stability studies at different temperatures. So it was already tested for 28 degrees but in our own interests we also tested the vaccine at 40 degrees centigrade.

01:37:38:18

Mercy Ahun

GAVI Alliance

01:37:52:14

Music: Peace, Composers/Performers: David Michael & Lee Pomeroy, Audio Networks

The data was reviewed, and this vaccine can actually be used at temperatures of about 40 degrees for up to four days, so now the WHO guidelines allow us to do that, and you can imagine the impact.

01:37:56:22

Dr Jean-Marie Okwo-Bele,

WHO

MenAfrivac is unprecedented on the development model but also on the deployment. We can take advantage of the known stability of the vaccine and use the vaccine at ambient temperature – and that’s again unprecedented.

01:38:17:17

Mercy Ahun

You can take the vaccine out of the fridge, put it in a vaccine carrier and travel long distances, where there are no health facilities to reach people who do not normally have access to health facilities. So this is really a revolution in terms of the controlled temperature chain.

01:38:42:06

It’s a huge advantage for health workers in Mauritania who are using the new method for the first time.

01:38:48:12

Translation

This indicator is white – the white ones are OK, but if it turns black you can’t use it. This shows there’s no problem with the temperature. This one’s fine for using – there you go!

01:39:11:08

At the end of each day, each phial is marked with a line. This one has been out of the cold chain for 3 days – it must be used within 24 hours. Health workers have been specially trained to use the controlled temperature chain.

01:39:27:17

Abderrahmaine Sow,

Field nurse,

Translation

01:39:50:01

Music: Tribe Of Mbira, Composers/Performers: Pete Lockett, Audio Networks

We all underwent training covering vaccine carriers and storage. For the people who have been trained there will be no confusion about it.

I think it’s a very good step. We thank all those who made this possible. Thanks to this approach we’ll have a good foundation for people’s health.

01:39:54:13

By using CTC alongside traditional cold chain delivery, far more of the population can be protected against meningitis.

01:40:04:06

Dr Naceredine Ouldzeidoune

Rosso teams have vaccinated around 40% of their target population, while another city, comparable to Rosso, have vaccinated only 27% using the cold chain method.

So this is very important because you win on ever aspect, financial aspect, logistical aspect and human aspect.

01:40:25:16

Ahmed Mohamed Olindon

Field nurse

Translation

01:40:35:15

Music: Tribe Of Mbira, Composers/Performers: Pete Lockett, Audio Networks

The CTC method is great for us. It can be very good to resolve logistical problems.

It means you can vaccinate more people in less time.

01:40:41:05

By the end of the ten-day campaign 97 percent of the target population will have received the new vaccine.

01:40:48:20

Two nomad women speaking

Translation

We knew about this through the radio.

We like them to come here where we are based. It’s very good. We go to the hospital, sometimes it takes a day to get there. We go when it’s possible. Sometimes there are cars, and sometimes people get sick and it’s difficult to go.

01:41:11:18

Mercy Ahun

Whether you are on a motorbike, you are walking, and some of our health workers go by foot for hours before they get to their destination, it means that more people can have access to this life saving vaccine.

01:41:29:10

When the vaccination team turns up at a clinic, the local community celebrates its arrival.

01:41:37:24

Grandmother comments

Translation

01:41:47:23

Music: Tribe Of Mbira, Composers/Performers: Pete Lockett, Audio Networks

Before this vaccine there were others against many diseases that have virtually disappeared. That’s why when they call us to vaccinate our children, we come.

01:41:52:19

Ahmed Mohamed Olindon

Field nurse

Translation

I hope that one day other vaccines will use CTC. I mean the CTC method for vaccines, like BCG and Polio. This would have a tremendous effect on my work and on the health of all the villagers.

01:42:14:09

Repeat shots

And there is more good news for the team who developed the vaccine.

After 4 years of mass vaccination campaigns, the World Health Organisation has given the go ahead for MenAfrivac to be used in routine immunisation programmes across Africa.

01 :42 :33 :00

Dr Marie-Pierre Preziosi

01:42:51:05

Music: Tama Nion, Composers/Performers: Guimba Kouyate, Jon Grandcamp, Pablo Love & Campbell E Browning, Audio Networks

The introduction strategy was two-pronged. The first part was really to immunise as many people as possible in the shortest time possible to induce community protection and herd immunity, and the introduction into the routine programmes will ensure the elimination of the disease in the long-term.

01 :42 :54 :17

Mali where the early research was carried out will be one of the first countries to introduce it.

01:43:00:18

Dr Mamoudou Harouna Djingarey/Co-ordinator Meningitis Vaccine Project

Translation from French

The routine EPI covers children less than a year old. It would be good to protect birth cohorts to introduce this vaccine into the routine EPI so that every child born can benefit from this vaccine, and be protected for life.

01:43:19:00

Women here, under the age of 29, have already received MenAfrivac during mass vaccination campaigns. When their babies are 9 months old, they will receive the injection along with other routine childhood jabs.

01:43:32:12

1^st Mothers sync

Translation from Bambara language

The benefit we noticed is that it helps mother and child to remain healthy. That’s why we invite people to accept vaccination for them and their children, because health is most important.

01:43:44:08

2^nd mother sync

Translation from Bambara language

I invite other women not to stay at home with their children, but to follow the vaccination schedule. It is important.

01:43:55:04

Dr Samba Sow

Sync

01:44:14:04

Music: Tama Nion, Composers/Performers: Guimba Kouyate, Jon Grandcamp, Pablo Love & Campbell E Browning, Audio Networks

It is very important for all the African countries to go for this vaccine and introduce it into the routine EPI because Meningitis A is just African Mengingitis and this vaccine has been developed in Africa by Africans so we have to use it in Africa by Africans.

01:44:21:07

Mercy Ahun

This is a unique story. The fact that this vaccine has been developed for Africa and it is going to address an issue which has caused major problems, for our continent, is an example for the future.

01:44:37:20

Dr Jean-Marie Okwo-Bele

MenAfrivac could facilitate the development of vaccines tailored for Africa. We have a lot of diseases there that are considered as orphan – no drugs, no vaccines and building from that we’ve seen for instance the acceleration of processes to produce a vaccine against Ebola.

01:45:03:03

MenAfrivac has much promise for the future. Those involved in the project say it’s been the achievement of a lifetime.

01 :45 :11 :05

Dr Marie-Pierre Preziosi

This is something I’ve never, ever seen in my career. I think those of us who have worked on this initiative have been very privileged to be part of this immense success story. Over two hundred million of persons have received it, and we have seen a major public health effect, with complete elimination of the disease in vaccinated areas.

01 :45 :38 :02

Mercy Ahun

I couldn’t describe my sense of joy, satisfaction and achievement, that a disease, which has caused so much devastation in Africa, is finally being addressed.

01:45:56:11

Dr Samba Sow

I’m starting to see the end of the tunnel, I’m starting to see the sun, because I have seen children dying from Meningitis in this country not a long time ago, and I know that this vaccine is a very good vaccine. We made it, we did it. Let’s celebrate this.

01:46:25:15

Fade into credits

End Credits:

With thanks to

Meningitis Vaccine Project

PATH

WHO

Mark LaForce is now Technical Services Director, Serum Institute of India

Narrator

Paul Daniels

Production Manager

Helen Stewart

Researcher

Caroline Spencer

Edit Assistant

Sam Davies

Camera

Geoff Ward

Catherine Farrell

Husain Akbar

Editor

Jason Porthouse

Executive Producer

Richard Wilson

Produced and Directed by

Anya Sitaram

Print

Film: Meningitis: A Shot of Hope

http://www.journeyman.tv/film/6790

Transcript