A quiet miracle…..Is this the end of CSM?

Very rarely have vaccines given us the opportunity to create a small miracle. Unlike the miracle of surgery and antibiotics that brings the ill back to health, vaccinations prevent you from getting ill; so the miracle of vaccinations is often not obvious and not celebrated. We do not experience the emotional roller coaster of coming back to life – so we tend to underestimate the impact vaccines have. Every family in Northern Nigeria is aware of “CSM”……cereberospinal meningitis. Particularly affecting children and young adults, they would have fever, signs of collapse, neck stiffness and may even slip into a coma as the bacteria invades their blood and the space around the brain.

Picture courtesy of MSF

The most common cause of this is a bacteria –  meningococcal A. This presents in waves of epidemics every 2 – 3 years in an area across West Africa called the “Meningitis Belt”. With it comes pain and death to many families.Until recently,the options for a medical response was a very painful injection of chloramphenicol or a polysaccharide vaccine of limited use because its effect only lasts for short periods,and it had to be given after the outbreak was already underway – often too late (you can imagine what it would take to mobilise outbreak responses with mass vaccination in our Nigeria). So the term “CSM” is widely associated in the North with pain, suffering and death. 

But in the past few years – we have a new vaccine – the meningococcal A conjugate vaccine developed through the Meningitis Vaccine Project. This vaccine will not need to be given every year and has a long lasting impact and therefore the ability to reduce and potentially eliminate transmission. In a project that is really unique in its conceptualisation and execution, the vaccine was produced with almost no commercial value in the West, entirely for use in the developing world, produced entirely in India. The partnership between the Bill and Melinda Gates Foundation, PATH, the World Health Organization (WHO), the Serum Institute of India, the Centers for Disease Control (CDC), SyncoBio, and academia has made this happen. But as with everything of this nature – it required the relentless energy and passion of one man to push the agenda over a 10 year period – Dr. F. Marc LaForce for which he has just been awarded the Sabin Prize.

In 2011, the meningococcal A conjugate vaccine reached 3 new countries and more than 35 million people including Nigeria. Pending adequate funding, the Meningitis Vaccine Project and its partners hope to vaccinate an additional 265 million people throughout the African “meningitis belt” by 2016, thereby ridding the region of a disease that has caused havoc for more than a century. With all the pain in our country …maybe this is one thing we should celebrate.

But in Nigeria, this programme, like many other public health programmes is at risk. The insecurity in many areas of the North will eventually compromise vaccination programmes. So we need a miracle of peace for the miracle of vaccination to be possible.


Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (www.epiafric.com), which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

Leave A Reply